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This Specialty Course is designed to complement your own experience as a health care provider as well as prior learning from the TEACH Core Course An Interprofessional Comprehensive Course on Treating Tobacco Use Disorder.
We encourage you to explore the course content thoroughly, and we have provided various opportunities for you to interact with fellow participants and the course facilitator.
Please Note: While there is no final exam, you are required to complete the following course components by the specified deadlines. Remember, all activities marked as a “reflection” are optional activities.
Week | Activity |
---|---|
Orientation Module Begins Monday May 29, 2017 | Orientation Module |
Reflection: Setting Your Own Objectives | |
Module 1: Wednesday May 31 to Tuesday, June 6, 2017 Deadline: Tuesday June 6, 2017 (11:59 PM EST) |
Module One: The Relationship between Tobacco Use Disorder and Mental Illness and/or Substance Use Disorders |
Mandatory Reading: Course Manual – Module One | |
Reflection: What is the relationship between tobacco use and mental illness and/or substance use disorders? | |
Reflection: What other benefits of quitting tobacco use do you see for your clients who have MI/SUD? | |
Case Study #1: Madison (Social Determinants of Health) | |
Case Study #2: Jerry or Roger (CLEOS Worksheet and Discussion Board) | |
Attend or review the weekly webinar with Stephanie Kersta – Monday June 5th from 12:30 PM – 1:00 PM EST. | |
Complete the Module Evaluation | |
Wednesday June 7 to Tuesday June 13, 2017 Deadline: Tuesday June 13, 2017 (11:59 PM EST) |
Module Two: Assessment of Tobacco Use among Clients with a Mental Illness and/or Substance Use Disorder |
Mandatory Reading: Course Manual – Module Two | |
Reflection: What is your clinical practice like? Do you currently screen for tobacco use? | |
Reflection: Pros and Cons of Screening Tools | |
Activity: Selecting Screening and Assessment Tools | |
Case Study #3: John (Completing an Assessment and Discussion Board) | |
Attend or review the weekly webinar with Claire Gignac – Monday June 12th from 12:30 PM – 1:00 PM EST. | |
Complete the Module Evaluation | |
Wednesday June 14 to Tuesday June 20, 2017 Deadline: Tuesday June 20, 2017 (11:59 PM EST) |
Module Three (Part 1): Client-centred, Biopsychosocial and Evidence-informed Interventions – Psychosocial |
Mandatory Reading: Course Manual – Module Three | |
Reflection: What is your clinical practice like? Do you currently offer psychosocial approaches for clients with MI/SUD? What are some adaptations you use? | |
Reflection: What is different about developing a treatment plan with clients who have MI/SUD? | |
Case Study #4: Diane (Developing a Treatment Plan and Discussion Board) | |
Reflection: If you were working with a client who was unstable, are there any components of MI that you might still consider relevant in this scenario? | |
Attend or review the weekly webinar with faculty Alexandra Andric – Monday June 19th from 12:30 PM – 1:00 PM EST. | |
Complete the Module Evaluation | |
Wednesday June 21 – Tuesday June 27, 2017 Deadline: Tuesday June 27, 2017 (11:59 PM EST) |
Module Three (Part 2): Client-centred, Biopsychosocial and Evidence-informed Interventions - Pharmacological |
Mandatory Reading: Course Manual – Module Three | |
Reflection: What is your clinical practice like? Do you currently offer pharmacotherapy for tobacco cessation for clients with MI/SUD? What are some adaptations you use? | |
Activity: Prescribing Pharmacotherapy (Janice, Mark, and Tom and Discussion Board) | |
Attend or review the weekly webinar with Dr. Milan Khara – Monday June 26th from 12:30 PM – 1:00 PM EST. | |
Complete the Module Evaluation | |
Wednesday June 28 – Tuesday July 4, 2017 Deadline: Tuesday July 4, 2017 (11:59 PM EST) |
Module Four: Program and Systems Level Implementation |
Mandatory Reading: Course Manual – Module Four | |
Reflection: Share an experience(s) in which you had to advocate for your client (and/or clients). | |
Reflection: Identifying barriers to cessation in Jimmy’s case | |
Activity: Develop an Implementation Plan to Address Barriers within your Scope | |
Reflection: What are some steps you could take to advocate for your clients? How would you advocate for tobacco-free living, tobacco-free hospitalizations, and coverage of medication for tobacco cessation? | |
Complete the Module Evaluation | |
Course Wrap up and Reflection Activity | |
Complete the post-learning assessment and summative evaluations. Note: the post-learning assessment is due on Friday July 21, 2017 by 4 PM EST. |
Around the world, nearly 200 million adult women smoke cigarettes. In 2010, half of the world’s female tobacco users lived in high-income countries, and the remaining half in low- and middle-income countries. Smoking rates were higher among males than females in all years from 1999 to 2011. However, between 2010 and 2011 prevalence remained constant among males, but appeared to increase (though not significantly) among females (Reid, Hammond, Burkhalter, Rynard, & Ahmed, 2013). These figures seem to indicate that although tobacco use among men is slowly declining, among women it has not yet reached its peak. Some studies predict that prevalence among females will reach 20% by 2025 (Greaves, Jategaonkar, & Sanchez, 2007).
Below 10%
10 - 19.9%
20 - 29.9%
30 - 39.9%
As discussed in the introduction to this module, we know that those living with HIV are significantly more likely to use tobacco, between 40-70% (Chander et al., 2012; Tesoriero, Gieryic, Carrascal & Lavigne, 2010; Balfour & MacPherson, 2010). Research in both Canada and the US has shown that the harm related to tobacco use is higher in those living with HIV when compared to the general population.
These observed trends are partly attributable to the higher prevalence of tobacco use among those living with HIV but also to an increased susceptibility of the impact of tobacco use in comparison to those who use tobacco but do not have an HIV diagnosis. These trends will be described further in the next section.
Please listen to the audio below. A transcript with references is available following the audio.
Adolescence is a period of exploration where youth are experiencing and discovering change, and the need to assert their autonomy. For many young women, tobacco may become one of the first substances they experiment with due to peer pressure and easy access. For instance, experimenting with their parents’ tobacco. Educating on the impact of tobacco use is an important conversation to have with young girls. This primary prevention activity can be integrated into the school systems to provide an opportunity for all youth, regardless of gender, to learn about the far-reaching effects of tobacco.
Puberty is a time of life when the body changes rapidly, and when any adverse health effects can significantly disrupt hormonal levels and patterns. Because nicotine acts on the “pleasure centers” of the brain, young women may smoke to help them cope with anger, depression, and mood swings brought on by fluctuating hormone levels (Peck et al., 2011).
However, if young women use tobacco (or alcohol) at this time, it can:
Adolescence is a time of exploration, change and discovery, when youth experience the need to assert their autonomy. For many young women, tobacco may become one of the first substances they experiment with: ready access makes it easy to experiment with their parents’ cigarettes, for example. Peer pressure may also push them to try tobacco products. This is why it is so important to educate girls on the far-reaching health effects of tobacco use. Conversations about prevention may be integrated into school systems, to teach girls not to smoke.
A 2012 Health Canada study showed that among youth aged 15–19, some 11% smoked (approximately 233,000 of Canada’s teens). As outlined in Table 1, below, slightly more males than females smoked: 12% compared to 9%. For older youth—young adults aged 20–24—some 20% smoked (about 488,000). Of these, 23% were male and 17% female (Health Canada, 2012).
Among Youth ages 15-19 yrs | Among Youth ages 20-24 yrs |
---|---|
11% are smoking | 20% are smoking |
9% are girls | 17% are female |
12% are boys | 23% are male |
According to a 1994 study by the U.S. Centers for Disease Control & Prevention (CDC), the short-term and long-term consequences of tobacco use for youth and girls can include:
Research has found that young people who start smoking around the ages of 11 and 12 are likely to be daily smokers by age 18 (Voorhees, Schreiber, Schumann, Biro, & Crawford, 2002). For female youth, the most important factors leading to daily smoking in young adulthood include stressors such as:
Other stressors for young women (as well as older women) may include peer pressure, family troubles, unhappy love life, difficulties with relationships, etc.
As discussed in the previous module, it is likely that your client will have thought about quitting at some point however, they may not feel ambivalence towards making a change. The following section will briefly outline the value of motivational interviewing in guiding your work with clients who may be ambivalent about quitting tobacco use.
Motivational interviewing is a form of collaborative conversation for strengthening a person's own motivation and commitment to change.
“Motivational interviewing is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for, and commitment to, a specific goal by eliciting and exploring the persons own reasons for change within an atmosphere of acceptance and compassion”
The underlying philosophy of motivational interviewing is the “spirit”. When engaging in a motivational interviewing approach with your clients, the spirit of motivational interviewing should embody the following guiding principles:
Compassion is the commitment to prioritizing the client’s needs and promoting what is best for the client. It includes a commitment to understand the client’s experiences and values without judgement.
Acceptance of what the client has to offer and what the client brings to therapy also helps to establish the spirit. Acceptance does not mean that you have to approve of the client’s behaviour.
Partnership describes a collaborative relationship between you and your client. Together, you make decisions on goals and how to achieve those goals.
Your role is to evoke from clients the skills and strengths they already have in order to make a change.
To practice motivational interviewing skills, access our free online modules.
OARS are the skills used to implement motivational interviewing. Using OARS can help elicit change talk, or self-motivational statements for a client. Change talk includes statements that indicate the client may be considering the possibility of change. OARS stands for the following:
Open-ended questions elicit more elaborate responses from clients versus closed-ended questions that usually elicit a yes or no response
Affirmations promote optimism and acknowledge the client’s expertise, efforts and experience. This is different that praising, which usually focuses on how the clinician feels.
Offering client a reflection of what they say can help communicate empathy and understanding. Reflections can be simple (paraphrasing) or complex (feeling behind the content).
The best are targeted and succinct, and include elements that keep the client moving forward. The goal is to help the client organize his or her experience.
To practice motivational interviewing skills, access our free online modules.
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