Smoking cessation delivered by medical students is helpful to homeless population
ABSTRACT The authors pilot a smoking-cessation outreach for the homeless that extends medical students' tobacco cessation education.
In this prospective study, second-year medical students administered cognitive behavior therapy or unstructured support to homeless subjects to help them quit smoking. Self-report and biological measures (carbon monoxide) of smoking taken at baseline and follow-up were analyzed using t tests to determine intervention efficacy.
Out of 11 enrolled subjects, six completed the protocol and all decreased their smoking frequency. The mean rate of smoking dropped significantly from 19 to nine cigarettes per day when pooling all subjects, and carbon monoxide mean level decreased from 28.0 to 20.2.
The homeless subjects who received counseling from medical students significantly reduced their smoking frequency. Subject recruitment and retention were challenges, but a close partnership with local homeless shelters and the addition of pharmacotherapy could improve outcomes and are recommended for future efforts.
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ABSTRACT: ContextStudent-run clinics (SRCs) have existed for many years and may provide the most realistic setting for context-based learning and legitimate early clinical experiences with responsibility for patient care. We reviewed the literature on student outcomes of participation in SRCs.MethodsA systematic literature review was performed using the PubMed, EMBASE, PsycINFO and ERIC databases. Included articles were reviewed for conclusions and outcomes; study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).ResultsA total of 42 articles met the inclusion criteria and were included in the quantitative synthesis. The effects of participation on students’ attitudes were mainly positive: students valued the SRC experience. Data on the effects of SRC participation on students’ skills and knowledge were based mainly on expert opinions and student surveys. Students reported improved skills and indicated that they had acquired knowledge they were unlikely to have gained elsewhere in the curriculum. The quality of specific aspects of care delivered by students was comparable with that of regular care.Conclusions The suggestion that students should be trained as medical professionals with responsibility for patient care early in the curriculum is attractive. In an SRC this responsibility is central. Students valued the early training opportunity in SRCs and liked participating. However, little is known about the effect of SRC participation on students’ skills and knowledge. The quality of care provided by students seemed adequate. Further research is needed to assess the effect of SRC participation on students’ skills, knowledge and behaviour.Medical Education 03/2015; 49(3). DOI:10.1111/medu.12625 · 3.62 Impact Factor
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ABSTRACT: There is almost no information available on cigarette smoking among homeless youth, whether they are currently receiving services for smoking cessation, and how to best help them quit. This paper presents data collected from a series of semi-structured telephone interviews with service providers from 23 shelters and drop-in centers serving homeless youth in Los Angeles County about their current smoking cessation programming, interest in providing smoking cessation services to their clients, potential barriers to providing this service, and ways to overcome these barriers. Results indicated that 84% of facilities did not offer smoking cessation services, although nearly all (99%) were interested in doing so. Barriers to implementing formal smoking cessation programs on site included lack of resources (e.g., money, personnel) to support the programs, staff training, and concern that smoking cessation may not be a high priority for homeless youth themselves. Overall, service providers seemed to prefer a less intensive smoking cessation program that could be delivered at their site by existing staff. Data from this formative needs assessment will be useful for developing and evaluating a smoking cessation treatment that could be integrated into the busy, complex environment that characterizes agencies that serve homeless youth.Journal of Substance Abuse Treatment 10/2014; DOI:10.1016/j.jsat.2014.05.009 · 3.14 Impact Factor
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ABSTRACT: Introduction: Homeless adults are more likely to smoke tobacco and are less likely to successfully quit smoking than smokers in the general population, despite comparable numbers of cessation attempts and desire to quit. To date, studies that have examined smoking cessation in homeless samples have used traditional lab/clinic-based assessment methodologies. Real-time assessment of key variables may provide new insights into the process of quitting among homeless smokers. Methods: The purpose of the current study was to identify predictors of a quit attempt using real-time assessment methodology during the 6 days prior to a scheduled quit attempt among homeless adults seeking care at a shelter-based smoking cessation clinic. Parameters for multiple variables (i.e., motivation for quitting, smoking expectancies, quit self-efficacy, smoking urges, negative affect, positive affect, restlessness, hostility, and stress) were calculated and were used as predictors of biochemically verified quit date abstinence (i.e., >= 13 hr abstinent) using logistic regression analyses. Results: Participants (n = 57) were predominantly male (59.6%), non-White (68.4%), and smoked an average of 18 cigarettes per day. A total of 1,132 ecological momentary assessments (83% completion rate) were collected at random times (i.e., up to 4 assessments/day) during the 6 days prior to a scheduled quit attempt. Results indicated that declining (negative slope) negative affect, restlessness, and stress predicted quit date abstinence. Additionally, increasing positive coping expectancies across the prequit week predicted quit date abstinence. Conclusions: Study findings highlight multiple variables that may be targeted during the precessation period to increase smoking cessation attempts in this difficult to treat population of smokers.Nicotine & Tobacco Research 09/2014; 16:1371-1378. DOI:10.1093/ntr/ntu088 · 2.81 Impact Factor