NCI has developed a Handheld Computer Smoking Intervention Tool (HCSIT), which assists clinicians with smoking-cessation counseling during patient visits. The software was developed in accordance with the current PHS guideline and includes a handheld version of the Fagerstrom Test for Nicotine Dependence. The tool guides clinicians through the appropriate questions and makes intervention recommendations, including prescription information, on the basis of the level of dependence. The HCSIT contains medication information, brief motivational interventions for tobacco users, and evidence-based recommendations from the PHS guideline. The easy-to-use program can be used with Palm®, SmartPhone, and MicrosoftTM Pocket PC handheld computers. For more information, see http://www.smokefree.gov/hphcsit.html.

VA initiated a preceptor training program to improve delivery of tobacco-cessation treatment for veterans with mental disorders. The program uses a train-the-trainer format to educate more than 160 VA mental-health and substance-use disorder providers from every Veteran Integrated Service Network about evidence-based clinical practices and mentors their progress in integrating smoking cessation into routine psychiatric care.

Finding: The training of health-care providers in tobacco-cessation interventions is effective in increasing the likelihood that a patient will be asked about tobacco-use status, be advised to quit, and be assisted with tobacco-cessation services. Computer-aided training and reminder systems help health providers to discuss tobacco cessation with their patients.

TOBACCO CESSATION IN SPECIAL POPULATIONS

The 2007 IOM report Ending the Tobacco Problem: A Blueprint for the Nation acknowledges that some tobacco users will have a more difficult time in quitting than others. Many populations of tobacco users may be reluctant to quit, find it hard to do so, or be at risk for adverse health outcomes; these special populations include “hard-core” smokers who have smoked for many years, people with psychiatric and medical comorbidities, and people who have other complicating conditions, such as homelessness. Those populations have not traditionally been the focus



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