Background
 
The Healthcare Partnership, funded by tobacco tax revenues in 1998 under the program name Arizona Cessation Training and Evaluation (ACTEV), was contracted to support the Arizona Department of Health Services Tobacco Education and Prevention Program (ADHS-TEPP) mission addressing tobacco use and dependence:

• To prevent tobacco use among all Arizonans
   
• To protect all Arizonans from environmental tobacco smoke
   
• To assure that all Arizonans who wish to quit tobacco use will have access to affordable, state of the art cessation services

Focusing on the development of an evidence-based statewide education and training model to support ADHS-TEPP, the HealthCare Partnership (HCP) brings together seasoned professionals in the areas of tobacco dependence treatment, adult education methods and techniques, instructional design and teaching, data management and analysis, and public health. HCP staff contributes in-depth experience in tobacco use and dependence in clinical, community, worksite, and research settings. HCP is part of the Department of Psychology in the College of Social & Behavioral Sciences at The University of Arizona.

Goals
 
The initial goals of the program were to 1) assist ADHS-TEPP in establishing and maintaining a statewide infrastructure for the effective design, development, implementation, and evaluation of tobacco cessation education programs, and to 2) support ADHS-TEPP funded projects to integrate comprehensive, innovative evidence-based tobacco prevention and cessation programs into Arizona’s schools, worksites, community, and healthcare systems.

Audience
 
The original target audiences for certification, education and training programs, as identified by ADHS-TEPP, were community-based local & tribal project personnel and their community partners. As implementation progressed, programs were adopted by health care organizations and community organizations unaffiliated with local projects along with general public adoption. Target audience focus has evolved throughout the funding periodswith emphasis on equipping local community-based projects to promote change in policy and practice at a systems level—schools, worksites, communities, and healthcare entities. As a comprehensive tobacco control program, ADHS-TEPP considered these groups to be key points of service delivery at the community level.

Since 2000, the program has been strengthened to expand healthcare system penetration.
A statewide survey Tobacco Control in Arizona Healthcare Systems Survey was completed in 2000.
A statewide Tobacco Dependence Treatment Continuing Education Program for Healthcare Professionals has been developed and implemented with resources and continuing medical education credits for participants.

Rationale
 
As a tri-university collaborative project, preliminary planning for the development of the state’s education and training model included representatives from the University of Arizona (UA), Arizona State University (ASU) and Northern Arizona University (NAU) as well as local, state, and national key informants and experts in an iterative process of meetings and discussions. It was determined that education and training programs would draw heavily from the Agency for Health Care Policy and Research (Public Health Service) while incorporating scientific strategies recommended by other national experts.
 
As a result of this process, the statewide education and training model was predicated on stakeholder recommendations and scientific literature that demonstrated evidence that:

• Brief smoking cessation interventions lasting less than 3 minutes are proven to increase a tobacco user’s likelihood of quitting by 30%.
   
• Brief smoking cessation interventions lasting 3 - 10 minutes, are statistically proven to increase a tobacco user’s likelihood of quitting by 60%.
   
• Intensive smoking cessation Interventions are statistically proven to increase a tobacco user’s likelihood of quitting by 130%.
   
• Interventions directed toward supporting an individual to move forward in their readiness to quit are effective in increasing population-based cessation rates.
   
• Brief interventions have a larger public health impact than intensive interventions due to their ability to reach larger and more diverse populations. Hence, the potential for a wider application of brief interventions.
   
• Tobacco use and dependence is a broad, population-based, public health problem and warrants a population-based model.
   
• A capacity-building model integrating a train-the-trainer method to encourage local community ownership and continued diffusion and sustainability would address Arizona’s diverse population and geographic landscape.
   
• The American Red Cross’ CPR distribution model demonstrated the components identified by stakeholders as addressing ADHS-TEPP’s mission and intent of its education and training programs.
   
• The Five A construct—ask, advise, assess (agree), assist, and arrange—tested by the National Cancer Institute and later adopted by the U.S. Public Health Service provides an evaluative framework and replicable process to capture tobacco cessation interventions.
   
• For smoking cessation interventions to impact large numbers of tobacco users, it is essential that clinicians and healthcare delivery systems including administrators, insurers, and purchasers institutionalize office systems to identify, treat, and document status of every tobacco user seen in a healthcare setting.
   
  

Current Activities 2006
 
The advancement and diffusion of ADHS-TEPP’s major programs:
Arizona Certification Program and Tobacco Dependence Treatment Continuing Education Program for Healthcare Professionals includes, but is not limited to:

• Researching, writing, revising, adapting and evaluating curriculum, enabling resources and supplementary multimodal educational materials.
   
• Coordinating and managing the HCP continuing education, certification and training Programs.
   
  
• Entering data, analyzing data, distributing reports and assuring databases are functional and the database programs meet current data requirements.
   
• Securing, applying for, and maintaining infrastructure for board-approved continuing education units.
   
• Distributing curricula, instructional materials, reports and certificates.
   
• Maintaining inventory and quality control.
   
• Teaching instructor level courses, as well as special population adapted courses as needed.
   
• Teaching and building capacity within hospitals and other healthcare organizations to deliver Basic Tobacco Cessation Intervention Skills for Medical and Allied Professionals.
   
• Supporting the infrastructure of a community of over 5000 individuals who comprise the State’s population-based model to help people quit smoking by delivering evidence-based tobacco cessation interventions.
   
  

As a result of these efforts, ADHS-TEPP is assured that their statewide affiliates and personnel who deliver brief and intensive smoking cessation interventions have met a standard in quality practice as recommended by the U.S. Public Health Service Clinical Practice Guideline: Treating Tobacco Use And Dependence. Moreover, ADHS-TEPP can assure Arizona tobacco users who want to quit tobacco that his/her effort to overcome dependency/addiction to tobacco will be supported by the best available evidence-based treatment.