WV Medical Journal — July/August 2014
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Smoking Cessation For Pregnancy & Beyond - A Virtual Clinic

Interactive Web-Based Training For Health Care Professionals.

“Smoking Cessation for Pregnancy and Beyond: A Virtual Clinic” (www.smokingcessationandpregnancy.org) is an updated interactive multimedia program based on the “Virtual Practicum” model.

Which Health Care Professionals Should Take This Training?

Physicians, physician assistants, nurse-midwives, registered nurses, licensed practical/vocational nurses, nurse practitioners, certified health educators, other health educators, pharmacists, health professional students, and other health care professionals who will be assisting their female patients in quitting smoking, in particular, patients who are pregnant or in their child-bearing years.

What Will The Health Care Professional Learn?

After completing the training, the health care provider will be able to apply principles of the 5 As intervention, a best practice approach for smoking cessation, which reflects current clinical recommendations from the U.S. Public Health Service Guidelines for Treatment of Tobacco Use and Dependence 2008 update and the American College of Obstetricians and Gynecologists, Committee Opinion No. 471: Smoking Cessation During Pregnancy. Detailed objectives are listed on the following page.

This interactive media program offers various learning tools:

Training includes a host and mentor, Dr. Sharon Phelan. Using interactive simulations, Dr. Phelan will guide participants as they counsel and assist patients in smoking cessation.

Comprehensive discussions of the patient visits

Mini-lectures on relevant topics from leading experts, including former Surgeon General Dr. C. Everett Koop and a new lecture on motivational interviewing by Dr. Michael Goldstein

Interviews with real patients who have quit

A dedicated web site of pertinent links and office resources


After completing this activity, the participants will be able to:

1. Apply a standard method of tobacco cessation counseling, the 5 As, for female smokers prior to, during, and following pregnancy.

2. Describe the effects of inhaled tobacco smoke on the health of the mother and fetus, at a minimum to include the effects of nicotine and carbon monoxide.

3. Describe the benefits of quitting for the mother and fetus.

4. List the effects of nicotine withdrawal and ways of coping with them.

5. State the risks and benefits of pharmacotherapy for smoking cessation during pregnancy or while breastfeeding.

6. Discuss the application of the 5 As for the patient who has relapsed during pregnancy.

7. Describe strategies for addressing weight gain in relationship to smoking.

8. Describe the application of the 5 As to help a patient deal with postpartum relapse.

9. Apply the 5 Rs for a patient who is not ready to quit.

10. Describe the effects of secondhand smoke exposure on the health of children.

11. Apply the 5 As (full and abbreviated versions) for patients who are not pregnant.

12. Describe the use of pharmacotherapy, counseling, and adjuncts to cessation such as quit lines and fax referrals for patients who are not pregnant.

13. Describe the risks associated with smoking on reproductive health, including the effects on the health of the woman and the newborn.

14. Describe the neurophysiological aspects of nicotine addiction.

15. Describe the behavioral aspects of nicotine addiction, with emphasis on triggers and the predominant role of behavioral modification for smoking cessation.

16. Discuss the importance of counseling combined with pharmacotherapy.

17. Apply motivational interviewing for smoking cessation.

18. List the core skills involved in motivational interviewing.

19. Describe the use of scales to elicit patient consideration about conviction and confidence regarding their commitment to behavior change.

20. Describe the steps of implementing an office system for smoking cessation through the “GAPS” approach.

21. Implement disease detection and prevention health care services (e.g., smoking cessation) to prevent health problems and maintain health.

Target Audience: Physicians, nurse-midwives, registered nurses, licensed practical/vocational nurses, nurse practitioners, certified health educators, other health educators, pharmacists, health professional students, and other health care professionals that see women of reproductive age.

Prerequisites: Participants should have a general interest in helping female smokers quit smoking, and, though not required, participants should have a basic understanding of the clinical care of female patients during prenatal and postpartum care.

Format: Internet Enduring – Web-based

Origination/Expiration Dates: November 28, 2011 – November 13, 2015

Continuing Education
Location: www.smokingcessationandpregnancy.org
Contact Information: info@iml.dartmouth.edu

Accreditation Statements:

CME: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Centers for Disease Control and Prevention (CDC) and Interactive Media Laboratory, Dartmouth Medical School. CDC is accredited by the ACCME® to provide continuing medical education for physicians.

The Centers for Disease Control and Prevention designates this enduring activity for a maximum of 4.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Non-physicians will receive a certificate of participation.

CNE: The Centers for Disease Control and Prevention is accredited as a provider of Continuing Nursing Education by the American Nurses Credentialing Center’s Commission on Accreditation. This activity provides 4.3 contact hours.

CEU: The CDC has been approved as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 1760 Old Meadow Road, Suite 500, McLean, VA 22102. The CDC is authorized by IACET to offer 0.4 ANSI/IACET CEUs for this program.

CECH: Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designed for Certified Health Education Specialists (CHES) to receive up to 4.5 Category I CECH in health education. CDC provider number GA0082.

CPE: The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is a designated event for pharmacists to receive 4.5 contact hours in pharmacy education. The Universal Activity Number is 0387-9999-11-102-L01H01-P.

Course Category: This activity has been designated as Knowledge-Based.

Method Of Participation

You may participate in the educational activity by visiting: www.smokingcessationandpregnancy.org

To evaluate this educational activity, receive a certificate, and be able to print out an ongoing transcript of all your TCE Online CE activities for credits/contact hours, please go to: www.cdc.gov/TCEOnline.

The course number for this program is WB 1941


No fees are charged for CDC’s CE activities. The training is available for free for a limited time (expires August 2014).

Faculty / Credentials

Neal L. Benowitz, MD, Professor, Chief, Division of Clinical Pharmacology, Departments of Medicine and Biopharmaceutical Sciences, Schools of Medicine and Pharmacy, University of California

James Broadhurst, MD, MHA, Department of Family Medicine and Community Health, University of Massachusetts Medical School

Allen Dietrich, MD, Professor of Community and Family Medicine, Dartmouth Medical School

Michael Goldstein, MD, Associate Chief Consultant for Preventive Medicine, Office of Patient Care Services, VHA National Center for Health Promotion and Disease Prevention

C Everett Koop, MD, ScD, 13th Surgeon General of the U.S. (1982-1989), Director of the Koop Institute, Dartmouth Medical School

Cathy Melvin, PhD, MPH, Research Associate Professor, Maternal and Child Health, University of North Carolina Gillings School of Global Public Health

Sharon Phelan, MD, Professor, University of New Mexico Health Sciences Center School of Medicine; Co-chair, American College of Obstetricians and Gynecologists Committee on Smoking Cessation.

Nancy Rigotti, MD, Professor of Medicine, Harvard Medical School; Director, Tobacco Research and Treatment Center, Massachusetts General Hospital


CDC, our planners, and our content experts wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters with the exception of:

Dr. Neal Benowitz. He wishes to disclose that he was a member of the Pfizer Inc. advisory board and a paid consultant for GlaxoSmithKline.

Dr. Nancy Rigotti. She wishes to disclose that she was a member of the Pfizer Inc. scientific advisory board, receives royalties for chapter on smoking cessation from UpToDate, Inc., and a research grant was awarded to Massachusetts General Hospital (not to Dr. Rigotti) from Nabi Biopharmaceuticals.

Planning committee reviewed content to ensure there is no bias. Presentations will not include any discussion of the unlabeled use of a product or a product under investigational use. CDC does not accept commercial support.


The current, updated version was developed by the Interactive Media Laboratory, Dartmouth Medical School (IML) in collaboration with the American College of Obstetricians and Gynecologists and was supported by the Centers for Disease Control and Prevention (CDC) cooperative agreement 1U48DP001935-01 with the Dartmouth Prevention Research Center. The original version of this program was developed by the IML, with support from the Robert Wood Johnson Foundation. The presence of the CDC logo on this material is not intended as an endorsement of any commercial entity or product/service references herein. The original and updated versions of this program were designed, written, directed, and produced by Joseph Henderson, MD, Professor of Community and Family Medicine, Dartmouth Medical School.