AHA launches ‘timely’ tobacco treatment professional certification
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Key takeaways:
- The American Heart Association is offering a professional certification for tobacco treatment.
- Certification is open to tobacco treatment professionals who complete prerequisite education.
Quitting smoking or other tobacco products can be difficult under the best circumstances. Cardiologists can help patients who want to quit, but data show more training is needed on optimal strategies and available therapies.
To help more patients who use tobacco quit successfully, the American Heart Association is collaborating with the Association for the Treatment of Tobacco Use and Dependence (ATTUD) to offer health care professionals a new individual certification for tobacco treatment.
The certification, available through the AHA’s professional education hub, aims to standardize training for health care professionals in tobacco cessation care delivery, with education on the latest evidence-based counseling and pharmacotherapy options, motivational interviewing strategies and best practices for developing individualized tobacco cessation plans.
“Nicotine is a highly addictive substance,” Esa M. Davis, MD, MPH, senior associate dean of population health and community medicine and associate vice president for community health at the University of Maryland School of Medicine, and an AHA volunteer, told Healio. “People can become dependent on nicotine, so this is about much more than just saying to a patient, ‘You need to quit.’ There is a biological or physical part to smoking that is driven by the nicotine that the brain likes. The brain sets up that reward system and makes it challenging to stop. Many patients want to quit, and many studies show people want to quit, but they find it difficult without the appropriate support.”
Addressing clinician knowledge gaps
The certification is open to tobacco treatment professionals who complete prerequisite education and includes an assessment via live remote proctoring, a certification award via AHA platforms and credentials good for 3 years.
“This helps health professionals learn where their knowledge gaps are and what the evidence shows regarding the harms of tobacco and the strategies that work,” said Davis, who is also lead strategist for health equity at the [University of Maryland] Institute for Health Computing. “Professionals who complete this program will understand the risks and benefits of tobacco cessation medications, strategies for supporting those who have trouble quitting or relapse and working with people from underrepresented populations that have more trouble than others.”
Cigarette smoking is a major risk factor for CVD, including stroke, yet data show more than one-fourth of adults with CVD use tobacco products and few of them quit over 5 years.
According to the AHA, about 12.5% of U.S. adults overall report regular cigarette use, with higher numbers reported among people from underrepresented groups. Data also show a sharp rise in the use of tobacco products among adolescents, particularly vaping products.
The certification program will also highlight how to assess patients for tobacco use and initiate a conversation about tobacco use, according to Caroline Cranos, MPH, president of ATTUD and training program and contract manager for the Center for Tobacco Treatment Research and Training at the University of Massachusetts Chan Medical School.
“First is the systems issue — are tobacco users asked about this issue in a way that is patient centered and nonjudging and asked consistently at every visit?” Cranos said during an interview. “Second, this certification program will train people to offer both counseling and pharmacotherapy and understand best practices. Those are changing very often. Providers will also learn the counseling skills to work with patients to create a collaborative environment where people feel they understand their choices, can make those choices and are supported in those choices.”
Quitting a ‘complex’ concept
Such support is critical for patients who want to quit tobacco but struggle to do so, or for those who have relapsed, Thomas Payne, PhD, professor and director of the ACT Center for Tobacco Treatment, Education and Research at the University of Mississippi Medical Center and a member of ATTUD’s interagency committee, told Healio.
“This is a complex biopsychosocial concept,” Payne said during an interview. “Many people who have a harder time quitting are those who are more nicotine-dependent and this drug is much more active for them. There are social factors. Smokers tend to associate with and marry people who are tobacco users. People with diagnosable disorders such as anxiety, depression or psychotic conditions all use tobacco at much higher rates than the general public. Nicotine is by itself a short-acting antidepressant. It can be a brief escape, to a degree, which complicates things further.”
Davis said education will also model how to work with patients on the best use of tobacco cessation aids, such as medications, nicotine patches or nicotine gum.
“Providers may tell patients to use nicotine gum as a way to quit,” Davis said. “A patient may buy the gum and start chewing it, but they do not realize that you are not supposed to chew nicotine gum like regular gum. If you do that, you swallow a large amount of nicotine and it can give you nausea and hiccups. It tastes terrible. The proper instructions are to chew it until it becomes peppery, and then put the gum between the cheek and their teeth. Let it sit there and then ‘reactivate’ it by chewing it more. Do that during the course of about an hour and then discard it. Explaining something that simple to a patient can make a big difference.”
Payne said patients who discuss quitting tobacco with a trained tobacco cessation specialist are much more likely to quit long term, as they receive a much more comprehensive treatment approach.
“We need more people who provide the kinds of treatment that can help these people who have so much going on that it is really hard to quit,” Payne told Healio. “As the AHA expands the number of people certified, people will have greater access to the appropriate therapies and we will see improvements in quit rates.”
“This certification is so timely and exciting,” Davis said. “We must arm clinicians with the resources and knowledge to be able to address this absolutely devastating disease of tobacco use. It is a major cause of CVD and one of the top five causes of preventable death. We can do something about it. Quitting smoking is the single best thing people can do for their health.”
The tobacco cessation certification is the second such individual certification offered by the AHA. As Healio previously reported, the AHA launched its first individual certification for telehealth in July, part of an effort to improve standards of care for a delivery model that grew exponentially during the COVID-19 pandemic.
For more information:
Caroline Cranos, MPH, can be reached at caroline.cranos@umassmed.edu.
Esa M. Davis, MD, MPH, can be reached at esa.davis@som.umaryland.edu.
Thomas Payne, PhD, can be reached at tjpayne1@umc.edu.
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