Course Modules
THE HISTORY OF TOBACCO AND PUBLIC HEALTH ISSUES
This module uses text, statistical/graphic, and picture slides to weave the story of the development of the United States tobacco industry and its relationship to the public’s health. The module is an introduction to the prevalence of tobacco use and the disease that results from cigarette use, the role that advertising and marketing have played in promoting the use of cigarettes, and the need for comprehensive approaches to reduce the mortality and morbidity that result from tobacco dependence.
The goal of this module is to help the student to develop a contextual understanding of the interrelationships between the development and marketing of tobacco and the resulting public health epidemic.

GUIDELINES FOR TREATMENT
This training module will use text, slides, and discussion to introduce and summarize both the Public Health Service Tobacco Dependence Treatment Guidelines and the NJ Guidelines for Tobacco Dependence Treatment. The PHS Guidelines provide an overview of the evidence for the effectiveness of tobacco treatments and makes treatment and system-wide recommendations based upon the evidence. The NJ Guidelines provide a procedural overview for implementing evidence-based guidelines in New Jersey.
The goals for this training are to provide participants with a foundation in treating tobacco dependence by presenting an overview of the evidence that supports tobacco dependence treatment, and by introducing the participant to policies and procedures for implementing evidence based specialist treatment.

BIOLOGY OF THE BRAIN, ADDICTION AND TOBACCO DEPENDENCE
In this module, we will review some basic information about how information is organized and processed in the brain and examine where in the brain drugs of addiction have their effects.
The goal of this module is to provide tobacco cessation specialists with the knowledge of the brain and the neurobiological underpinnings of drug addiction. In addition, general knowledge about tobacco addiction will be addressed.

COUNSELING THEORY AND PRACTICE
There are emerging strategies of counseling that have been found useful in promoting behavior changes such as stopping smoking. These techniques utilize a patient-centered model. In this module we will rely on strategies from both the Motivational Interviewing and The Stages of Readiness for Change models as a guide to intervening with clients who use tobacco.

TREATMENT CONTINUUM AND KEY STRATEGIES
Quitting smoking/tobacco use is a process, often involving multiple quit attempts over time before abstinence is achieved. The Public Health Service Guidelines Treating Tobacco Use and Dependence, published in October 2000 by the US Department of Health and Human Services, describes within it a “Stepped Care Model” for treating tobacco use.
The Stepped Care Model involves the assessment of individual differences among tobacco users to serve as a basis for triage to intervention of varying levels of intensity. The model involves three levels of intensity of care: Minimal - self-change and self-help; Moderate - brief counseling plus follow-up; and Maximal - specialized, intensive clinic treatment. This module will focus on strategies for working with patients/clients utilizing the maximal level of care.
The goal of this module presents the framework for providing multi-component maximal care for patients in the engagement, quitting and maintenance phases of treatment. This module will describe the specific and appropriate strategies for each of these phases, including specific objectives, and a clinical "toolbox", an opportunity to practice intervention strategies, as well as literature and resources appropriate to each phase.

MEDICAL COMPLICATIONS CAUSED BY TOBACCO AND ETS
There are numerous effects that tobacco smoke has on various organ systems. These effects are caused by the over 4000 chemicals and toxins found in tobacco smoke. They range from the well-known effects on the cardiovascular and pulmonary systems and include numerous cancers. Additionally, tobacco smoke causes numerous less common illnesses and adverse effects. Finally, environmental tobacco smoke (ETS) contributes additional problems to the public's health by exposing unwilling bystanders to the harmful effects of tobacco smoke.
The goal of this module will be to provide an overview of the health effects of tobacco use and ETS.

NICOTINE REPLACEMENT THERAPY AND OTHER PHARMACOLOGICAL TREATMENTS
A number of pharmacological therapies have been shown to reduce the severity of nicotine withdrawal symptoms and to help tobacco users quit. Each of these medications has their own advantages and disadvantages, and for many tobacco users the optimal pharmacotherapy involves combining different medications. Because it is relatively straightforward for patients to use these medications, and because they can produce a substantial increase in quit rates, it is important for tobacco dependence treatment specialists to be familiar with these medications and their use, and to be able to describe them accurately to patients.
The goal of this module is to provide an overview of pharmacological treatments for tobacco dependence, including the evidence for their efficacy and safety and their use in clinical practice. Participants will have the opportunity to see the medications, and will discuss a series of hypothetical cases with three experienced clinicians.

MOTIVATIONAL INTERVIEWING
This module is intended as a basic introduction to Motivational Interviewing, with specific application to tobacco dependence. We will cover principles and assumptions of the approach, fundamental interviewing skills, ways to manage and minimize client resistance and defensiveness, and common clinical pitfalls. Didactic instruction will be combined with discussion and role-playing.
The goal of this module is to provide participants with specific motivational interviewing techniques to utilize while treating their clients for tobacco dependence.

GROUP COUNSELING SKILLS
Group treatment for tobacco dependence is a particularly cost-effective method of helping addicted smokers to quit. When run effectively, it can also add an extra "active ingredient" to the treatment process. There are a number of different models of delivering treatment in groups (open versus closed, class/didactic versus group-oriented, etc). This module will present the rationale and procedures for delivering one particular form of group treatment for smokers that has become the dominant model in the UK and that has been used successfully for three years at the UMDNJ Tobacco Dependence Clinic
The goal of this module is to describe the rationale and procedures for one specific form of group treatment for smokers. It will include a role-play of one of the group sessions so that participants can experience the process which occurs.

INTAKE, ASSESSMENT AND TREATMENT PLANNING
This course module will use lecture, discussion, group facilitation, rehearsal, and case study to present and practice the various parts of a comprehensive tobacco dependence assessment. The participants will learn and practice all of the components involved in assessment including measurement of respired carbon monoxide, assessing motivation, evaluating level of dependency, all while building the patient's self efficacy. Participants will be challenged in dealing with cases, which may have some added complications, such as a co-occurring mental illness or addiction, or working with youth or other special populations.
The goal of this module is to equip the participants with the skills to provide a thorough and comprehensive assessment for tobacco dependence.

CULTURAL COMPETENCY
Cultural Competency has been defined as a set of congruent behaviors, attitudes and policies that come together in a system, agency, or among professionals, and enable that system, agency or those professionals to work effectively in cross-cultural situations.
The goal of this module is to improve the quality of care for all individuals seeking treatment for tobacco dependence.