Educating Physical Therapist Students in Tobacco Cessation Counseling: Feasibility and Preliminary Outcomes.

INTRODUCTIONSmoking is the leading cause of preventable morbidity and mortality, both within the United States and globally.1,2 It has been estimated that smoking leads to 4.83 million preRose mature deaths worldwide, making tobacco cessation a leading health priority.2 Within the United States, approximately 21.7% of the adult population currently smokes.3 In people with physical disabilities, smoking prevalence can be up to 10% higher.3 The magnitude and impact of smoking constitute the need for greater attention towards tobacco cessation counseling (TCC) by health care professionals within the academic and clinical environment.4 Smoking-related health disparities among people with physical disabilities present an even greater incentive for health counseling by physical therapists (PTs).5'7 In general, approximately 40% of people who are counseled by a medical provider will attempt to quit.8 However, surveys have shown that nearly 80% of patients who smoked did not receive any TCC during their last medical visit.9'10 Among PTs, rates of TCC are estimated at 17%.6 This is unfortunate, given that 70% of current smokers want to quit and are amenable to receiving advice and recommendations from their health care provider.4 Chances of successful cessation are doubled when patients who smoke receive advice from more than 1 type of health care provider,11 further demonstrating the importance of TCC by PTs as part of an interprofessional approach.Within physical therapy treatment environments, there are several factors that are conducive to TCC. The Joint Commission on Accreditation of Hospital Organizations (JCAHO) requires tobacco screening and counseling for all patients admitted with pneumonia, myocardial infarction, and congestive heart failure,12 diagnoses commonly encountered by PTs. In addition, patients confronted by an episode of serious illness may be more motivated to quit,13 and may have recently experienced a period of forced abstinence due to smoking restrictions within hospitals and medical rehabilitation facilities. For this reason, an acute episode of illness or injury may provide an additional opportunity for PTs to encourage successful long-range cessation.14 Smoking leads to suboptimal physical therapy treatment outcomes in all 4 physical therapy practice areas: musculoskeletal, neuromuscular, cardiovascular/ pulmonary, and integumentary health/ Each of these factors reinforces the need for the implementation and effective application of evidence-based smoking interventions within physical therapy practice and education.Evidence-based clinical guidelines for TCC, developed and endorsed by the United States Public Health Service (USPHS), and commonly known as the "5 As and 5 R's,"15 are widely recognized as the "gold standard" for smoking cessation treatment.16'17 Studies have shown that targeted education in TCC increases implementation of these guidelines18'21 and enhances the likelihood that patients who smoke will receive effective treatment.9 Therefore, the USPHS endorses TCC education for all health care professionals, including PTs.22Review of the LiteratureWithin other health-related disciplines, deficiencies in the provision of TCC have been linked to a lack of education in appropriate evidence-based counseling methods.23'24 For many health care professionals, insufficient TCC education can lead to limited confidence in their ability to provide successful interventions.25 Other barriers in the application of TCC clinical guidelines include a lack of available resources, uncertainties in professional roles and scope of practice, doubts regarding the efficacy of TCC, and anticipated patient resistance towards receiving cessation advice.26,27 Attitudes and opinions towards people who smoke can also serve as possible impediments. Oftentimes, these opinions are a result of misconceptions regarding reasons for continued smoking, particularly among people who are already experiencing negative repercussions from tobacco use. …