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Though tobacco use accounts for half of all deaths of individuals with mental illness or substance use disorder, “educational opportunities for psychiatrists and residents remain limited,” wrote Jill Williams, M.D., of Rutgers-Robert Wood Johnson Medical School in New Jersey and colleagues. The data suggest “that an online training opportunity, especially early in residency, may increase knowledge about tobacco use disorder and, more importantly, increase the frequency of behaviors likely to result in reduced tobacco use in the vulnerable populations these residents will treat,” they noted.
U.S. psychiatry residency program directors provided the researchers with the email addresses of current psychiatry residents; participation was not required. A total of 199 residents completed surveys that evaluated their attitudes toward tobacco treatment practices (such as monitoring patients' progress in attempting to quit and prescribing tobacco treatment medications) and estimated how frequently they applied such practices.
The residents then viewed three one-hour webinars on tobacco treatment, which covered topics such as the prevalence and consequences of tobacco use disorder among individuals with behavioral health conditions, as well as counseling strategies and pharmacological treatments. Of the 152 participants who completed the online course, 89 completed a follow-up assessment three months later.
There was “considerable variability” in residents’ ratings of tobacco treatment practices at baseline, the authors reported. Asking patients about their smoking status was the most highly reported treatment practice, with 47% of residents always asking, and 44% usually asking. Others, such as prescribing tobacco treatment medications or arranging follow-up visits to address smoking, were reported less frequently.
In the three-month follow-up, however, “[r]esidents reported a significant increase in their use of nine of the 12 tobacco treatment practices,” Williams and colleagues wrote. The findings include the following:
- Residents who said they always assess patients’ willingness to quit smoking increased from 15% at baseline to 23% at follow-up.
- Residents who said they usually refer patients who smoke to others for appropriate cessation treatment increased from 18% to 36%.
- Residents who said they usually refer smokers to a telephone cessation service like Quitline increased from 8% to 19%.
The authors found that residents who were earlier in their training (first- and second-year residents) were more likely to change their tobacco treatment practices than third- through fifth-year residents. “This finding may imply that educational efforts are more effective before residents have solidified their practice patterns, even though junior residents have less control over their own practice.”
For related information, see the Psychiatric News article “Psychiatrists Hold Key for Helping Patients Quit Tobacco.”
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