1. In Partnership with and Funded by the Arizona Department of Health Services. Office of Tobacco Education and Prevention Program (AzTEPP) The University of Arizona Health Sciences Center State of Arizona © 2003 Replication to Reduce Cost and Assure Outcomes The Arizona Certification Model Presented by: Louise J. Strayer, B.S., R.N., M.S. HealthCare Partnership Continuing Education & Training Unit Lila Johnson, R.N., M.P.H., C.H.E.S. Hawai’i State Department of Health Tobacco Prevention and Education Program

2. Arizona Department of Health – Tobacco Education and Prevention Program Session Objectives 1.To review the guiding principles and core components of the Arizona Tobacco Cessation Certification model. 2.To describe content, evaluation design, and implementation results of the Basic Tobacco Intervention Skills Certification in Arizona and Hawai’i. 3.To compare the cost of developing/implementing the Arizona Tobacco Cessation Certification model with a replication/implementation experience in Hawai’i.

3. Arizona Department of Health – Tobacco Education and Prevention Program Mission Statement Arizona Department of Health Services Tobacco Education and Prevention Program Based on a belief in excellence, inclusiveness and integrity that honors individual culture and religious practices, the AzTEPP mission is to protect and improve the health and quality of life of all Arizonans by reducing tobacco use through prevention and treatment by denormalizing tobacco use and by reducing exposure to environmental tobacco smoke.

4. Arizona Department of Health – Tobacco Education and Prevention Program Arizona Department of Health Services Tobacco Education and Prevention Program www.TEPP.org HealthCare Partnership Continuing Education & Training Unit Media/PR Campaign Community-based Local Projects AzTEPP Evaluation Unit Arizona Smokers’ Helpline, Information and Internet Services Arizona HealthLinks

5. Arizona Department of Health – Tobacco Education and Prevention Program Background Arizona has a proven comprehensive tobacco control program:  Adult prevalence of tobacco use significantly decreased in three years: from 23.1% (1996) to 18.3% (1999). Caveats:  The tobacco cessation certification model is one component of Arizona’s comprehensive tobacco education and prevention program.  Certification is contractually mandated for funded agencies/individuals providing cessation services.

6. Arizona Department of Health – Tobacco Education and Prevention Program Arizona Certification Program Guiding Principles Population-based and Inclusive  All community-based Local Projects and their cessation providers  Clinicians, systems, service organizations, individuals Capacity building and Sustainable  Training-of-trainer model  American Heart Association (AHA) “CPR” and Advanced Cardiac Life Support (ACLS) model

7. Arizona Department of Health – Tobacco Education and Prevention Program Guiding Principles Continued… Evidence-Based Approach  Agency for Health Care Policy and Research (AHCPR) guideline  revised to reflect Public Health Service Guideline  Adapted for Special Populations Theoretical Foundation  Social Cognitive Learning Theory  Adult Education Methods and Techniques Inspire Community Participation

8. Arizona Department of Health – Tobacco Education and Prevention Program The goal was to increase capacity in local communities to provide effective tobacco cessation services through; Teaching evidence-based practices; Conducting sound evaluation.

9. Arizona Department of Health – Tobacco Education and Prevention Program Continuing Education, Certification, and Training Program CERTIFICATION  Two tiers: Basic Tobacco Intervention Skills and Tobacco Treatment Specialists  Face-to-Face instruction  Skills demonstration  Distance learning  Written examination  Offered to all AzTEPP funded community-based Local Projects  Available to all interested Arizonans

10. Arizona Department of Health – Tobacco Education and Prevention Program Continuing Education, Certification and Training Program CONTINUING EDUCATION  Tobacco Dependence Treatment Continuing Education Program for Healthcare Professionals SYSTEMS TRAINING  Healthcare  Workplace  School

11. Arizona Department of Health – Tobacco Education and Prevention Program Continuing Education, Certification, and Training Program Certification Instructor Certification Systems Training Healthcare Professional Program Basic Tobacco Intervention Skills Basic Tobacco Intervention Skills Instructor Tobacco Cessation in Healthcare Systems Tobacco Dependence Treatment Continuing Education Program Tobacco Treatment Specialist Tobacco Treatment Specialist Instructor Tobacco Cessation in the Workplace Tobacco Cessation in Schools

12. Arizona Department of Health – Tobacco Education and Prevention Program Basic Tobacco Intervention Skills Certification Purpose: prepare participants to deliver brief tobacco cessation interventions Adapted Basic Tobacco Intervention Skills Certification Native American Spanish Language and Culture Maternal & Child Health [Women, Infants and Children (WIC)] Medical School and Allied Health Professionals

13. Arizona Department of Health – Tobacco Education and Prevention Program Content: 4 hour course (instructor : student =1:8) CME/CEU approved Requirement of all AzTEPP funded community-based projects Topics covered:  Tobacco use dependence  Stages of Change  Public Health Service Guideline: 5 A’s Objectives:  Assess level of readiness to quit  Deliver a stage appropriate brief intervention  Knowledge of resources and ability to refer Basic Tobacco Intervention Skills Certification

14. Arizona Department of Health – Tobacco Education and Prevention Program Evaluation Design: Knowledge (pretest, posttest: 3mos., 6mos.) Skills demonstrations (three stages) Self-efficacy (pretest, posttest: 3mos., 6mos.) Post-certification activities (survey: 6mos.) Basic Tobacco Intervention Skills Certification

15. Arizona Department of Health – Tobacco Education and Prevention Program Basic Tobacco Intervention Skills Certification CategoryArizonaHawai’i Time Period 12/98 – 12/99 12/02 – 11/03 Total Participants947283 Total Certifications Issued947260 Average Score on 25 Item Post-Certification Knowledge Test90.1%91.0% Average Number of Partici- pants who passed the 53 Item Skills Demonstration99.4%91.5%

16. Arizona Department of Health – Tobacco Education and Prevention Program Basic Skills Certification Self Efficacy Measurements 1.I can accurately assess my client’s motivation to quit. 2.I can explore issues related to smoking and quitting, even with someone NOT INTERESTED in quitting. 3.I can accurately assess the dependence level of my clients. 4.I can provide clients with accurate information regarding the health benefits of quitting.

17. Arizona Department of Health – Tobacco Education and Prevention Program Self Efficacy Measurements Continued… 5. I can personalize the benefits of quitting with each individual client. 6. I can provide clients with simple advice and instructions about nicotine replacement therapy. 7. I can help clients develop a personalized plan for quitting. 8. I can arrange for appropriate follow-up for my clients. All pretest, posttest changes in self efficacy scores were statistically significant (p<0.01)

18. Arizona Department of Health – Tobacco Education and Prevention Program I can accurately assess my clients’ motivation to quit. Basic Skills Certification Pretest - Posttest Data Definitely Confident Definitely Not Confident Average Change AZ: 1.31 HI: 1.38

19. Arizona Department of Health – Tobacco Education and Prevention Program I can explore issues related to smoking and quitting, even with someone NOT INTERESTED in quitting. Basic Skills Certification Pretest - Posttest Data Definitely Confident Definitely Not Confident Average Change AZ: 1.26 HI: 1.33

20. Arizona Department of Health – Tobacco Education and Prevention Program I can help clients develop a personalized plan for quitting. Basic Skills Certification Pretest - Posttest Data Definitely Confident Definitely Not Confident Average Change AZ: 1.20 HI: 1.79

21. Arizona Department of Health – Tobacco Education and Prevention Program Basic Skills Certification Pretest - Posttest Data Definitely Confident Definitely Not Confident I can arrange for appropriate follow-up for my clients. Average Change AZ: 1.55 HI: 1.68

22. Arizona Department of Health – Tobacco Education and Prevention Program Basic Skills Certification Participant Satisfaction Selected Questions ArizonaHawai’i How useful were the certification materials?4.74(SD=0.48)4.72(SD=0.55) Was the content of the certification course professionally relevant?4.42(SD=0.75)4.63(SD=0.71) How would you rate the overall quality of the certification course?4.53(SD=0.73)4.70(SD=0.58)

23. Arizona Department of Health – Tobacco Education and Prevention Program Arizona Basic Skills Participants Post-Certification Activities (6-month follow-up) Post-Certification Activities Arizona Performed at least one brief intervention. 80.9% Made at least one referral to a local intensive cessation service or the Arizona Smokers’ Helpline. 74.8% Average Brief Interventions conducted per month (self-report). 11,420 Average Brief Interventions performed per individual (self-report). 12

24. Arizona Department of Health – Tobacco Education and Prevention Program Methods & Techniques to Support Replication Systematic framework  Algorithm  Video Tapes  Skills Demonstrations  Client Materials  Knowledge Examination Standardized Evaluation Process Web-based database

25. Arizona Department of Health – Tobacco Education and Prevention Program Arizona Basic Skills Certification Spanish-Adaptation

26. Arizona Department of Health – Tobacco Education and Prevention Program Basic Tobacco Intervention Skills Certification Cost Comparison ARIZONA Design Development Implementation Revisions Testing FY 1 = $1.0 M FY 2 = $1.7 M $2.7 MHAWAI’I Adaptation Certification of Core Group Implementation Evaluation FY 1 = $60,000

27. Arizona Department of Health – Tobacco Education and Prevention Program Results of Replication Initiative The Arizona Basic Tobacco Intervention Skills Certification Model:  Has potential for National/International adaptation/replication.  Demonstrates cost saving of replicating a tested model of certification.  Shows statistically significant and durable increases in participants’ self-efficacy.  Establishes evidence of participants transfer of learning.  Increases population exposure and therefore public health impact of brief interventions.

28. Arizona Department of Health – Tobacco Education and Prevention Program Number Certified in Arizona by 06/30/03: Basic Skills: 3,771 Spanish Basic Skills: 75 Native American Basic Skills: 93 Maternal & Child Health Basic Skills: 115 Basic Tobacco Intervention Skills Certification

29. In partnership with and Funded by the Arizona Department of Health Services. Office of Tobacco Education and Prevention Program (AzTEPP) The University of Arizona Health Sciences Center State of Arizona © 2003 Louise J. Strayer, B.S., R.N., M.S. HealthCare Partnership Continuing Education & Training Unit Arizona Department of Health Services Office of Tobacco Education & Prevention Program Contact Information: The University of Arizona Mel & Enid Zuckerman Arizona College of Public Health 2030 East Speedway Boulevard, Suite 120 Tucson, AZ 85719 lstrayer@u.arizona.edu 520.318.7253 x162