The Time is Now: Improving Substance Abuse Training in Medical Schools.

This commentary highlights the growing demand for substance abuse prevention and treatment, summarizes the literature regarding the current insufficiencies in substance abuse training in medical schools, and suggests strategies to address this gap in physician education. The authors describe how the combination of mandated coverage for substance abuse services and expanding treatment needs means that more physicians, regardless of their patient populations, will be faced with addressing the problem of substance use. The authors review the literature on substance abuse training in medical schools, which indicates insufficient exposure to this topic. The authors describe how current substance abuse training at medical schools is focused on transmitting scientific knowledge with relatively little education or training in attitudes and skills central to effective prevention and treatment. Given the gap between clinical need and physician education, the authors suggest several strategies for medical schools to increase training in substance abuse knowledge, attitudes, and skills, which will enhance the practice of evidence-based care. The authors posit that medical curricular reform, combined with initiatives to change clinical culture around substance abuse, will translate into improved rates of screening, shorter overall length of treatment, effective referrals for continued treatment, and increased access to care for individuals who use substances and so reduce the morbidity and mortality associated with substance use.

Cigarette Smoking Reduction in Pregnant Women With Opioid Use Disorder.

OBJECTIVES: Nearly 95% of women with opioid use disorder continue to smoke cigarettes during pregnancy. Despite this prevalence and the well documented adverse effects of smoking on birth outcomes, cigarette smoking is underaddressed in this population. This study examines factors associated with successful smoking reduction among pregnant women with opioid use disorder and the impact of smoking reduction on maternal and birth outcomes. METHODS: This study is a secondary data analysis of maternal smoking reduction and infant birth outcomes among pregnant women with opioid use disorder (N = 118), enrolled in a randomized controlled trial of a contingency management intervention in which escalating monetary vouchers were provided to women who met escalating smoking-reduction targets. RESULTS: Participants' ability to meet higher smoking reduction targets was associated with less cocaine use at baseline (P = 0.022), higher carbon monoxide levels at baseline (P = 0.039), fewer prior quit attempts (P = 0.016), participation in the contingency management intervention, and greater adherence with the parent trial protocol. Some clinically relevant associations were found between smoking reduction and birth outcomes, including birth weight, spontaneous abortions, and neonatal abstinence syndrome treatment, but these differences did not reach statistical significance. CONCLUSIONS: Contingency management promotes smoking reduction, but other factors may be associated with such reduction, including baseline smoking and illicit drug use, prior quit attempts, and willingness to participate in the incentives program. Clinicians caring for pregnant women with opioid use disorder may see greater smoking behavior change if they first encourage smoking reduction before recommending smoking cessation. Future research is needed to determine the level of smoking reduction needed to positively impact birth outcomes.

Developing role models for health in the fire service: a pilot case study.

OBJECTIVES: The objectives of this case study were to develop role models for health in the fire service through knowledge and behaviour change, to improve the role models' own health, and to facilitate behaviour change in other firefighters through their example. DESIGN: Volunteers interested in improving their own health and serving as role models to others in the fire service were identified at a statewide Maryland fire service leadership meeting. SETTING: Participants worked with the Johns Hopkins Weight Management Center to learn how to improve their own health and shared that knowledge with others in their fire departments. PARTICIPANTS: Three Maryland fire service leaders were recruited at a leadership meeting with the goal of improving their own health and becoming role models. One participant dropped out shortly after beginning, while two male participants, aged 57 and 61, completed the study. MAIN OUTCOME MEASURES: Quantitative measures were collected at baseline and 12 months, and included weight, blood pressure and fasting glucose and cholesterol. Semi-structured interviews were conducted approximately 14 months postintervention to determine the participants' perceptions of their own health and impact on others in the fire service. RESULTS: Each participant had biweekly to monthly visits over a one-year period to learn the knowledge and skills that would assist him with improving dietary behaviours, increasing fitness and achieving a healthy weight. Case study participants experienced reductions in body weight (-13% and -11% of total body weight), glucose and blood pressure. Qualitative one-on-one interviews conducted postintervention with the participants revealed that they embraced their status as role models and felt their success inspired other firefighters. Their experiences suggest that role models can play an important role in helping firefighters increase self-efficacy, self-regulation and social support in the workplace environment. CONCLUSIONS: These findings provide promising evidence for the use of role models to improve health, especially in the workplace.