Hypnotherapy For Smoking Cessation

Click Here & Upgrade PDF Complete Documents Research & Science: Original Contribution Smoking Cessation Education for Chiropractic Interns: A Theory-Driven Intervention By Marion W. Evans, Jr., DC, PhD, CHES* ; Cheryl Hawk, DC, PhD, CHES#; Jennell Boyd, BS, DC^ * Associate Professor of Research, Parker Research Institute #Vice President of Research and Scholarship, Cleveland Chiropractic College ^Assistant Professor of Research, Parker Research Institute Corresponding author: Marion Willard Evans, Jr., DC, PhD, CHES Parker Research Institute 2500 Walnut Hill Lane Dallas, Texas 75229 wevans@ parkercc.edu ABSTRACT Objective: To describe a smoking cessation intervention using current health theories and aimed at chiropractic interns. Methods: Health theory and planning models were used to design the campaign, as well as health behavior models and communications theory. Results: This education campaign used 7 components: a lecture aimed at clinic interns, a card describing the Surgeon General’s 5-As, a lapel button, treatment room posters, a cessation information brochure rack, a list of area cessation programs, and a paperwork stamp to track interns’ participation levels. Within 1 month of the delivery of the campaign, there was a 25% increase in the number of patients reporting receipt of smoking cessation information from interns. Discussion: Chiropractic interns can deliver smoking cessation messages to patients. Integration of theorydriven campaigns can increase engagement rates of chiropractic interns in health promotion counseling. Keywords: tobacco use, smoking cessation, chiropractic, health promotion, health theory INTRODUCTION Tobacco use, particularly smoking, which leads to more than 400,000 premature deaths a year, is the most preventable cause of death in America1. Approximately 20% of the U.S. population, however, continues to smoke2. National guidelines recommend that all health care providers should advise smoking patients about cessation3, 4. In medical practice, a minority of tobacco users report having been advised to quit or having been given speJOURNAL OF THE AMERICAN CHIROPRACTIC ASSOCIATION Expanded Features Unlimited Pages cific cessation information5-7. Similarly, even though doctors of chiropractic report a high level of involvement in health promotion activities in their practices8, one study indicated that tobacco use counseling was not a priority9. This probably results from the lack of tobacco cessation training for health professionals. Previous investigation indicates that U.S. medical and chiropractic school curricula are deficient in training their interns for advising roles in smoking cessation57,10 . DCs and other complementary and alternative medicine (CAM) providers are philosophically well suited to deliver health promotion and prevention messages, and some contend that patients already see them as holistic11. Currently, however, tobacco counseling is not a standardized or even a required part of chiropractic training. A 2005 survey of 9 U.S. chiropractic teaching clinics showed that 40% (52/131) of smoking patients had been advised on quitting but only 18% had been given informational materials on cessation10, despite the fact that doctors of chiropractic see approximately 30% of back pain patients12, and among those with chronic spine disease, smoking is often the primary reported co-morbidity13,14. When this paper was in preparation, the Council on Chiropractic Education was about to implement health promotion and wellness standards for all accredited chiropractic colleges. Therefore, intern advising of patients on adverse health behaviors such as smoking will likely become more important in college curricula. This article details the development of an educational campaign using current health behavior theory and 13 Click Here & Upgrade PDF Complete Documents Expanded Features Unlimited Pages Resear ch & Sci en ce aimed at chiropractic interns to increase the level of smoking cessation advising with clinic patients. METHODS Method Overview We used methods driven by evidence-based health behavior theories. Materials and delivery methods were developed according to health behavior principles. Health Behavior Theory The campaign factored in constructs from applicable health behavior and planning theories that served to guide development of materials and curricula utilizing proven, successful models from previous interventions/campaigns15. The goal was to move interns from possible lack of awareness to awareness and agreement that they should be advising patients, adopting this as practice, and adhering to smoking cessation counseling as a new behavior. This follows a theoretical frame or model known as Pathman-PRECEDE16. The Pathman-PRECEDE model uses some constructs from Green and Krueter’s PRECEDE-PROCEED17, in which predisposing, enabling, and reinforcing factors are identified for a campaign or educational session. The principal investigator identified those factors in the college and clinic to facilitate the educational campaign during a needs assessment phase, which included meeting with key college stakeholders. The college wanted to become more wellness-oriented, faculty and clinic staff expressed willingness to have the project incorporated into class time, and some funding was available for design and creation of materials. The college president, the clinic chief-of-staff, and the director of research were all program champions, which helped with program integration. Identifying factors that would aid facilitation and focusing on moving interns toward adoption within the Pathman model was a central project aim. Two main health behavior models were used to aid delivery of the education and awareness campaign to interns. First, Bandura’s Social Learning Theory18 takes into account the self-efficacy of the individual–in this case, the intern. Interns needed to be comfortable with delivery of a health message to patients and feel capable of delivering the message. They also needed to be able to perform a new task, which included the knowledge and skills to educate patients. An additional construct in Badura’s model is “cue to action.” This term refers to one’s ability to get another person to act. Typically, health care providers are considered credible “cues” by patients. A second theoretical essential to smoking cessation education is the Trans-Theoretical Model, developed by Prochaska and DiClemente19. This model states that there are 5 stages of susceptibility to health behavior change: * Pre-contemplation – The patient has no idea or intention of changing a behavior. * Contemplation – The patient is actively considering making a change in behavior–perhaps thinking about where to begin. * Preparation – The patient is taking steps to prepare for change, such as gathering information on types of nicotine replacements or drugs. * Action – The patient has taken some action, such as removing ash trays from the home or setting a quit date and telling others of the intention, and could actually be in a state of cessation. * Maintenance – the patient has maintained a new (cessation) behavior for at least 6 months. Obviously, a person in one stage may be better counseled than in another, and each stage may require a different approach. People also tend to migrate among the stages during behavior change attempts. Selection of Materials Constructs from selected health behavior theories chosen based on the identified needs guided materials selection. This campaign centered on the Surgeon General’s 5-As3. * Ask all patients about smoking status. * Advise all patients to quit smoking. * Assess their willingness to make a quit attempt. * Assist in any patient cessation effort. * Arrange for follow-up and set a date to check on the patient. All components were either …