Translational Behavioral Medicine

, Volume 4, Issue 4, pp 391–397 | Cite as

Smoking cessation: a community-based approach to continuing medical education

  • Marianna ShershnevaEmail author
  • Adele Cohen
  • Christopher Larrison
  • Katie Detzler
  • Mary Ales
Case Study


Continuing medical education can help close the gaps between current and desired tobacco cessation practices. This paper reports a case of an innovative community-based continuing education approach implemented by a multi-organizational initiative aimed at increasing smoking cessation rates among adults in the USA. The approach involved collaborative partnerships with healthcare professionals and other stakeholders in 14 communities where smoking cessation was an established priority. The centralized evidence-based educational curriculum was delivered locally to more than 15,600 clinicians. Evaluation provided evidence of positive impact on clinicians, healthcare systems, and communities. A collaborative, community-based approach to continuing medical education has potential to increase tobacco cessation rates by leveraging efforts of multiple stakeholders operating at the community level into more effective and sustainable tobacco cessation projects. Future research is needed to study effectiveness of and appropriate evaluation frameworks for this approach.


Tobacco cessation Continuing medical education Community-based approach 



The CS2day partner organizations include California Academy of Family Physicians, CME Enterprise, Healthcare Performance Consulting, Interstate Postgraduate Medical Association, Physicians’ Institute for Excellence in Medicine, Purdue University School of Pharmacy, Telligen, University of Virginia School of Medicine, and University of Wisconsin School of Medicine and Public Health. We want to thank Dr. Karen Hudmon, Dr. Mary E. Gilles, Mrs. Jing Su, Mrs. Louise J. Strayer, and the University of Arizona HealthCare Partnership for their contributions to this paper.

The CS2day initiative was supported by an educational grant from Pfizer. The funder played no role in the design or implementation of the initiative nor in the interpretation and reporting of the evaluation findings. All authors had full access to all of the planning documents and evaluation data and can take responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interest

The authors have no conflict of interest to disclose.

Adherence to Ethical Principles

No animal or human research studies were carried out by the authors for this article; therefore, the project plan was not submitted for an Institutional Review Board review. The evaluation procedures were consistent with the research subjects protection practices in that data from participants were kept confidential, and neither participants nor their clinical settings were identified in the manuscript.


  1. 1.
    World Health Organization. WHO report on the global tobacco epidemic 2013. Available at Accessibility verified May 6, 2014.
  2. 2.
    King BA, Dube SR, Tynan MA. Current tobacco use among adults in the United States: findings from the National Adult Tobacco Survey. American Journal of Public Health. 2012;102(11):e93-e100.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Cole HM, Fiore MC. The war against tobacco: 50 years and counting. JAMA. 2014;311(2):131-132.PubMedCrossRefGoogle Scholar
  4. 4.
    Giovino GA, Mirza SA, Samet JM, for The GATS Collaborative Group, et al. Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet. 2012;380(9842):668-679.PubMedCrossRefGoogle Scholar
  5. 5.
    Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service; 2008.Google Scholar
  6. 6.
    Jamal A, Dube SR, Malarcher AM, Shaw L, Engstrom MS, Centers for Disease Control and Prevention. Tobacco use screening and counseling during physician office visits among adults: National Ambulatory Medical Care Survey and National Health Interview Survey, United States, 2005–2009. MMWR Morbidity and Mortality Weekly Report. 2012;61(Suppl):38-45.PubMedGoogle Scholar
  7. 7.
    Moody-Thomas S, Celestin MD Jr, Tseng TS, Horswell R. Patient tobacco use, quit attempts, and perceptions of healthcare provider practices in a safety-net healthcare system. Ochsner Journal. 2013;13(3):367-374.PubMedCentralPubMedGoogle Scholar
  8. 8.
    Quinn VP, Hollis LF, Smith KS, et al. Effectiveness of the 5-As tobacco cessation treatments in nine HMOs. Journal of General Internal Medicine. 2009;24(2):149-154.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Davis DA, Barnes BE, Fox RD, eds. The continuing professional development of physicians: from research to practice. The United States of America: American Medical Association Press; 2003.Google Scholar
  10. 10.
    Davis N, Davis D, Bloch R. Continuing medical education: AMEE Education Guide No 35. Medical Teacher. 2008;30(7):652-666.PubMedCrossRefGoogle Scholar
  11. 11.
    Kühne-Eversmann L, Fischer MR. Improving knowledge and changing behavior towards guideline based decisions in diabetes care: a controlled intervention study of a team-based learning approach for continuous professional development of physicians. BMC Res Notes. 2013;6:14.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Pingleton SK, Carlton E, Wilkinson S, et al. Reduction of venous thromboembolism (VTE) in hospitalized patients: aligning continuing education with interprofessional team-based quality improvement in an academic medical center. Academic Medicine. 2013;88(10):1454-1459.PubMedCrossRefGoogle Scholar
  13. 13.
    Cochrane LJ, Olson CA, Murray S, Dupuis M, Tooman T, Hayes S. Gaps between knowing and doing: understanding and assessing the barriers to optimal health care. The Journal of Continuing Education in the Health Professions. 2007;27(2):94-102.PubMedCrossRefGoogle Scholar
  14. 14.
    Thompson B, Hopp HP. Community-based programs for smoking cessation. Clinics in Chest Medicine. 1991;12(4):801-818.PubMedGoogle Scholar
  15. 15.
    Matthews, A.K., Li, C.C., Kuhns, L.M., Tasker, T.B., & Cesario, J.A. (2013). Results from a community-based smoking cessation treatment program for LGBT smokers. Journal of Environmental on Public Health 984508Google Scholar
  16. 16.
    Andrews JO, Newman SD, Heath J, Williams LB, Tingen MS. Community-based participatory research and smoking cessation interventions: a review of the evidence. The Nursing Clinics of North America. 2012;47(1):81-96.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Khan N, Anderson JR, Du J, Tinker D, Bachyrycz AM, Namdar R. Smoking cessation and its predictors: results from a community-based pharmacy tobacco cessation program in New Mexico. The Annals of Pharmacotherapy. 2012;46(9):1198-1204.PubMedCrossRefGoogle Scholar
  18. 18.
    Ales MW, Rodrigues SB, Snyder R, Conklin M. Developing and implementing an effective framework for collaboration: the experience of the CS2day collaborative. The Journal of Continuing Education in the Health Professions. 2011;31(Suppl 1):S13-S20.PubMedCrossRefGoogle Scholar
  19. 19.
    Shershneva MB, Larrison C, Robertson S, Speight M. Evaluation of a collaborative program on smoking cessation: translating outcomes framework into practice. The Journal of Continuing Education in the Health Professions. 2011;31(Suppl 1):S28-S36.PubMedCrossRefGoogle Scholar
  20. 20.
    McKeithen T, Robertson S, Speight M. Developing clinical competencies to assess learning needs and outcomes: the experience of the CS2day initiative. The Journal of Continuing Education in the Health Professions. 2011;31(Suppl 1):S21-S27.PubMedCrossRefGoogle Scholar
  21. 21.
    Miller, W.R., & Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioural and Cognitive Psychotherapy 37 129-140Google Scholar
  22. 22.
    Shershneva MB, Harper PL, Elsinger LM, Olson CA. Facilitating multiorganizational smoking cessation knowledge translation through on-line toolkit for educators and clinicians. The Journal of Continuing Education in the Health Professions. 2010;30(2):149-150.PubMedCrossRefGoogle Scholar
  23. 23.
    Moore DE, Green JS, Gallis HA. Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities. The Journal of Continuing Education in the Health Professions. 2009;29(1):1-15.PubMedCrossRefGoogle Scholar
  24. 24.
    Lai DT, Cahill K, Qin Y, et al. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews. 2010;1, CD006936. doi: 10.1002/14651858.CD006936.pub2.PubMedGoogle Scholar
  25. 25.
    Werner JJ, Lawson PJ, Panaite V, Step MM, Flocke SA. Comparing primary care physicians' smoking cessation counseling techniques to motivational interviewing. Journal Addict Med. 2013;7(2):139-142.CrossRefGoogle Scholar
  26. 26.
    Venner, K.L., Feldstein, S.W., & Tafoya, N. (2006). Native American motivational interviewing: weaving Native American and Western practices. A manual for counselors in Native American communities. Available at Accessibility verified May 6, 2014
  27. 27.
    Bellg AJ, Borrelli B, Resnick B, Treatment Fidelity Workgroup of the NIH Behavior Change Consortium, et al. Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychology. 2004;23(5):443-451.PubMedCrossRefGoogle Scholar
  28. 28.
    Breitenstein SM, Gross D, Garvey CA, Hill C, Fogg L, Resnick B. Implementation fidelity in community-based interventions. Research in Nursing & Health. 2010;33:164-173.Google Scholar
  29. 29.
    Harn B, Parisi D, Stoolmiller M. Balancing fidelity with flexibility and fit: what do we really know about fidelity of implementation in schools? Exceptional Children. 2013;79(2):181-193.Google Scholar
  30. 30.
    Dusenbury L, Brannigan R, Falco M, Hansen WB. A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Health Education Research. 2003;18(2):237-256.PubMedCrossRefGoogle Scholar
  31. 31.
    Wiltsey Stirman S, Kimberly J, Cook N, Calloway A, Castro F, Charns M. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implementation Science. 2012;7:17.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Marinopoulos SS, Dorman T, Ratanawongsa N, et al. Effectiveness of continuing medical education. Evidence Report/Technology Assessment No. 149 (Prepared by the Johns Hopkins Evidence-based Practice Center, under Contract No. 290-02-0018.) AHRQ Publication No. 07-E006. Rockville, MD: Agency for Healthcare Research and Quality; 2007.Google Scholar
  33. 33.
    Schell SF, Luke DA, Schooley MW, et al. Public health program capacity for sustainability: a new framework. Implementation Science. 2013;8:15.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Scheirer MA. Linking sustainability research to intervention types. American Journal of Public Health. 2013;103(4):e73-e80.PubMedCrossRefGoogle Scholar
  35. 35.
    Edvardsson K, Garvare R, Ivarsson A, Eurenius E, Mogren I, Nyström ME. Sustainable practice change: professionals’ experiences with a multisectoral child health promotion programme in Sweden. BMC Health Services Research. 2011;11:61.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Appleton-Dyer S, Clinton J, Carswell P, McNeill R. Understanding evaluation influence within public sector partnerships: a conceptual model. American Journal of Evaluation. 2012;33:532-546.CrossRefGoogle Scholar
  37. 37.
    Lasker RD, Weiss ES, Miller R. Partnership synergy: a practical framework for studying and strengthening the collaborative advantage. The Milbank Quarterly. 2001;79(2):179-205.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Spencer LM, Schooley MW, Anderson LA, et al. Seeking best practices: a conceptual framework for planning and improving evidence-based practices. Preventing Chronic Disease. 2013;10:130186.CrossRefGoogle Scholar

Copyright information

© Society of Behavioral Medicine 2014

Authors and Affiliations

  • Marianna Shershneva
    • 1
    • 2
  • Adele Cohen
    • 3
  • Christopher Larrison
    • 4
  • Katie Detzler
    • 2
  • Mary Ales
    • 5
  1. 1.University of Wisconsin Office of Continuing Professional Development in Medicine and Public HealthMadisonUSA
  2. 2.CME EnterpriseCarmelUSA
  3. 3.Physicians’ Institute for Excellence in MedicineAtlantaUSA
  4. 4.Healthcare Performance Consulting, Inc.ZionsvilleUSA
  5. 5.Interstate Postgraduate Medical AssociationMadisonUSA

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