Jamie Pomeranz

Project Title
AHEC Tobacco Training and Cessation-Initial Training Program (ATTAC-IT)

Role
Co-Investigator

Funding Agency
AHEC

Funding Period
August 2007 – July 2012

Abstract
The overall goal of the ATTAC Program is to strengthen the capacity of Florida’s healthcare system to deliver effective evidence-based tobacco use treatment, cessation, and prevention services throughout the state. This is done in keeping with the Centers for Disease Control and Prevention (CDC) Best Practices for Comprehensive Tobacco Control Programs.
ATTAC-IT’s goal is to ensure that all health professions students receive tobacco education during the course of their program providing them with the skills necessary to work with patients and clients in tobacco cessation.
Health professions students (HPS) are targeted because most health care providers traditionally receive insufficient education in tobacco to be able to effect patient behavior change in the treatment of tobacco dependence. Middle school students are the other target group. With 90% of tobacco initiation beginning prior to the age of 18, it is important to reach children early in life, preferably before they have been faced with the decision of whether or not to use tobacco. The appeal of HPS as role models for youth is a crucial component of the Program. Conversely, HPS placed as educators in middle school classrooms will be motivated to learn the material more thoroughly and in ways that may also affect their personal and professional behavior. This double-pronged approach focuses on provision of accurate didactic information to interdisciplinary groups of HPS from universities, colleges, and vocational technology schools, as well as provision of engaging, age-appropriate tobacco prevention education for middle school students.
An Annual Learning Event: The Afternoon of Learning for HPS is the first component, which typically occurs within the first few weeks of the students beginning their health professions’ programs. This training session focuses on the science, epidemiology, and treatment of tobacco addiction. After completing individual preparatory materials, the students come together in a large-group lecture to reinforce and expand on this information. Included in this is an introduction to motivational interviewing techniques. Small-group cooperative learning activities are also included in the training. Combining a mix of Medical, Dental, Nursing, Pharmacy, Physician Assistant, Public Health, and other HPS where possible lends strength both to the academic program and future bridging of gaps between healthcare disciplines. The skills learned in the session can also be applied to other areas of health risk behaviors.
An Applied Learning Day or Service Day: The second component of this project reinforces the tobacco Afternoon of Learning by sending the trained HPS into the community in teaching teams of two to four students to engage middle school youth in tobacco prevention education and activities. Groups take a kit of classroom teaching aids featuring a trigger videotape consisting of five to six vignettes to area middle school classrooms. For many HPS this is their first experience providing health education, a role that is an important part of their future practice as health professionals.
Since 2007, the UF AHEC Program has trained over 5,000 health professions students and provided an anti-tobacco message to over 73,000 middle school youth in its 37 county region.

Keywords
Tobacco Cessation, Middle School, Health Professions, public health,


Project Title
Creating a Tobacco Cessation Program for People with Disabilities: A CBPR Approach

Role
Principal Investigator; Tracey Barnett PhD, Barbara Curbow PhD, Michael Moorhouse PhD, & Mary Ellen Young PhD – Co-Investigators

Funding Agency
National Institute of Health; National Cancer Institute

Funding Period
September 2009 – January 2012

Abstract
The overall goal of this study is to develop a tobacco cessation program for people with disabilities. Smoking is the single most preventable cause of morbidity and mortality, accountable for 438,000, or one out of every five, fatalities in the United States annually. Unfortunately, individuals from low income populations have higher rates of tobacco use and lower rates of tobacco cessation. In fact, approximately 30.6 percent of U.S. adults living below the federal poverty level are current smokers compared to 20.4 percent of adults living above this level. People with disabilities (PWD) very often fall into this low income category. Data from the U.S. Census Bureau show that PWD receive less education, rely more on state/federal assistance, have government issued health insurance, and are more likely to live below the national poverty level. Moreover, 76.6% of PWD compared to 39.3% of people without disabilities reported earning less than $20,000 per year. Approximately 50 million Americans (22%) suffer from some form of disability, with evidence suggesting that people with disabilities are 50% more likely to smoke than the general population. Additionally, PWD are more likely to have ever smoked and be current smokers, had fewer quit attempts, smoked more cigarettes per day, and smoked earlier upon waking. The higher incidence of tobacco use among PWD has been shown to be directly related to barriers to tobacco cessation treatment which include: attitudinal barriers by health professionals leading to less dissemination of tobacco cessation materials, accessibility to preventative health care, and economic disparity. The purpose of this proposal is to develop a tobacco cessation program designed by and for PWD. According to NIH, limited available research data regarding tobacco interventions suggest that both adapting general treatment methods and developing novel approaches may be effective in developing cessation programs for low-income populations. Additionally, interventions for unique populations, including PWD, are most promising for health behavior change when they included feedback from the targeted communities. Therefore, we are proposing to conduct Community-Based Participatory Research (CBPR) to develop and test a tobacco cessation group treatment program for PWD. Consumers with disabilities who use tobacco will be recruited from a large population of PWD utilizing services at multiple centers for independent living (CIL) within North Central Florida. CILs provide immediate and long-term solutions for people with disabilities through assistance with finding housing or a job, equipping a home with assistive technologies, and enhancing independent living skills. Strong preliminary data collected by our research team suggests that tobacco cessation represents a high priority among CILs. Since this R21 is designed for novel, exploratory, and pilot studies, this project will lead to a process-evaluated tobacco cessation program for PWD. Study findings will set the stage for a subsequent controlled clinical trial examining the efficacy of a CBPR-based tobacco treatment program for this low income population.

Keywords
Tobacco; People with Disabilities; Community-Based Participatory Research


Project Title
Life Care Planning for Veterans with Spinal Cord Injury

Role
Principal Investigator

Funding Agency
VA Rehabilitation Outcomes Research Center

Funding Period
October 2009 – October 2011

Abstract
Of the 259,000 individuals living with spinal cord injury (SCI) in the United States, approximately 17% are veterans. Due to the complex medical and psychosocial problems associated with SCI, careful planning and timely intervention is required to avoid significant delays in rehabilitation and further complications. According to recent literature, research is warranted that focuses on the best way to manage complex injuries and to address the psychosocial and medical concerns for veterans with spinal cord injury. One technique to assess the current and future disability-related needs of an individual who sustains a spinal cord injury is life care planning. The life care plan (LCP) is a dynamic document based upon published standards of practice, comprehensive assessments, data analysis, and research. This valid and reliable method provides a mechanism to ensure community re-integration and improved rehabilitation outcomes for individuals with spinal cord injury. The purpose of this pilot study is to determine the feasibility of the life care plan to improve rehabilitation outcomes for veterans with spinal cord injury. To evaluate the effectiveness of life care planning, sixteen veterans with spinal cord injuries will be recruited from rural areas in North Central Florida and randomized to either an intervention group (8 veterans who receive life care plans) or a control group (8 veterans who do not receive a life care plan. A series of pre and post quantitative and qualitative measures will be administered to evaluate the effects of life care planning on quality of life, depression, anxiety, and perceived social support. Findings from this study will serve as prelimary work for controlled trial to determine the appropriateness and utility of applying the life care plan to a larger veteran population.

Keywords
Life care planning, veterans, spinal cord injury