National School of Medical Tobaccology: experiences and programmes| Tabaccologia

Despite the awareness of the magnitude of the damage, prevention culture and knowledge about smoking cessation techniques are very limited among health professionals. In most cases, interventions consist of a generic advice to stop, without providing specific indications and even less support associated with pharmacological therapies.

This means that the percentage of “spontaneous” cessations from smoking remains very low (generally less than 3% per year), due to nicotine addiction and the consequent difficulties in implementing a change.

Among the obstacles, in addition to the lack of treatments knowledge, we remember some clichés, such as the one that identifies smoking as an insignificant voluptuary habit, the judgmental attitude towards those who do not succeed in quitting or the idea that patients must overcome the problem with personal resources alone.

If brief interventions, reimbursement of cessation drugs and quitlines were put together, up to a 4.75% reduction in the prevalence of smokers in Italy could be achieved [1]. Unfortunately, the commitment of health professionals towards smoking cessation remains low [2,3] and the data available in our country have shown that only 22% of smokers refer to have received advice to quit smoking from their GPs [4]. Smoking among students in Health Givers’ schools, however, do not differ much from that of the general population. 20.9% of the interview respondents declare to smoke and only 17% have received specific training [5]. These are the reasons why in 2019 the National School of Medical Tobaccology (NSMT), which pursues the goal of offering training at national level, with a multilevel strategy and methods that may facilitate using correct treatment pathways, was founded. The NSMT is proposed to all Healthcare Professionals potentially involved in prevention strategies, Tobacco Control, and clinical smoking cessation activities.

The activity carried out

In the academic years carried out so far, 740 health workers have been trained through e-learning and for “basic” training, including 234 clinicians, 237 nurses, 106 psychologists, 81 professional educators, 39 midwives, 38 psychiatric rehabilitation technicians, as well as other health figures in smaller numbers. The advanced level training involved 208 professionals: 109 clinicians, 20 psychologists, 64 nurses and health assistants, 7 educators, 1 pharmacist, 1 dentist, 2 obstetricians, and 4 other professional figures. Assessments were carried out on the level of information and theoretical-practical skills acquired through the courses. A first analysis of the results shows how the training activity has produced an increase of 52.4% in knowledge in the epidemiological field, 40.2% on smoking damage, 32.4% on correct communication styles to deal with tobacco addiction and 12.1% compared to the short motivational counseling methodology.

“Basic” training

For the year 2022-2023 it is possible to benefit of three levels of ECM accredited training, a basic level, some residential events, and an advanced level. The basic level, scheduled to be delivered in December 2022, will include two webinars that together offer the essential knowledge and skills on the following topics:

1. Tobacco epidemiology and tobacco control strategies.
2. Smoking-related diseases.
3. Elements on the neurochemistry, and behavioral mechanisms of nicotine dependence.
4. Brief motivational counselling.
5. Pharmacological treatments in smoking cessation.
6. Behavioral support techniques.
7. Information of the network of tobacco treatment services.

Residential training

The residential level, which act as experimental centres for a subsequent and possible revival of the training model in the following years, is scheduled, in December 2023, in three Italian cities. The centres are those of Vimercate (Milan), and Rome, on the dates of 13,14,15 December.

The advanced course

As far as the advanced course is concerned, it will be available in 2023 and will include a series of interactive webinars that will address each of the specific topics, in detail, and that will involve the leading Italian experts in the various subjects as protagonists. One of the characteristics of the training is not to address only a professional figure (e.g., doctors), but to take into account the needs of the different roles involved in smoking cessation, such as psychologists, pharmacists or nursing staff. Another peculiarity, which is also a novelty in the panorama of Italian proposals, is that of meetings dedicated to the supervision of operators, with the establishment of small groups, each led by two smoking cessation professionals (seniors): a physician and a psychologist. In this way it is intended to offer to professional moments of comparison on smoking cessation techniques, the opportunity to discuss particularly complex cases or non-responders, without neglecting an indirect effect that is to increase the aptitude for integrated work between various professional figures and the network of services. Registration for webinars is free of charge (also accessible from the website), registrations for the advanced course are for SITAB members (registration is possible through the forms available on the site).

Figures and tables

References

1. Levy D, Gallus S, Blackman K, Carreras G, La Vecchia C, Gorini G. Italy SimSmoke: the effect of tobacco control policies on smoking prevalence and smoking attributable deaths in Italy. BMC Public Health. 2012; 12:709. DOI
2. Pizzo AM, Chellini E, Grazzini G, Cardone A, Badellino F. Italian general practitioners and smoking cessation strategies. Tumori. 2003; 89:250-4. DOI
3. Gallus S, Lugo A, Garattini S, Pacifici R, Mastrobattista L, Marzo G. General practitioners and dentists: a call for action against tobacco. Nicotine Tob Res. 2016; 18:2202-8. DOI
4. Ferketich AK, Gallus S, Colombo P, Fossati R, Apolone G, Zuccaro P. Physician-delivered advice to quit smoking among Italian smokers.. Am J Prev Med. 2008; 35:60-63.
5. La Torre G, Saulle R, Unim B, Angelillo IF, Baldo V, Bergomi M. Knowledge, attitudes, and smoking behaviours among physicians specializing in public health: a multicentre study. Biomed Res Int. 2014; 2014:516734. DOI