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Wake Forest Receives Federal Grant to Develop Model Tobacco Intervention Curriculum

WINSTON-SALEM, N.C. – With funding from a $1.6 million federal grant, a Wake Forest University School of Medicine faculty member will develop a model curriculum to teach medical students how to help their future patients quit smoking.

"Research has shown that medical schools are not doing enough to train their students on how to help patients quit smoking, even though tobacco use remains the leading cause of preventable death in the United States," said John G. Spangler, M.D., M.P.H. “With this grant, we hope to change that.”

Spangler''s five-year grant from the National Cancer Institute will also encompass smokeless tobacco and snuff to create a comprehensive tobacco intervention curriculum.

"It will be integrated into all four years of the Wake Forest curriculum," said Spangler, associate professor of family and community medicine. "Ultimately, we hope it will be a model curriculum that can be used at all medical schools nationally."

The grant application emerged from Spangler''s earlier research.

In the Sept. 4, 2002, issue of the Journal of the American Medical Association (JAMA), Spangler had reported, "Tobacco use and dependence are not integrated throughout the four years of medical school curricula and no national curriculum exists on what should be taught to medical students regarding the harm of tobacco use or how to help patients quit."

Furthermore, smokeless tobacco use and cessation are virtually ignored, he reported.

Spangler and his colleagues reported in the JAMA article that a majority of medical school graduates "still are not adequately trained to treat nicotine dependence." And despite evidence that most current smokers would quit if told to do so by their doctors, "several studies have documented physicians'' failure to counsel their patients to stop smoking…. Physicians often perceive they are ill prepared in treating patients addicted to nicotine." A month later, the Northwest Area Health Education Center at the medical school posted the first on-line course to teach health care professionals how to help their patients quit smoking. The course, "Counseling for Change: Quit Smoking," can be found at

Spangler said that that even with programs like the one on the web, curricula still needed to be integrated into all four years of medical school.

He said that in addition to smoking, the program will include research on methods to teach students on counseling patients on smokeless tobacco use and cessation. "No research has looked at educating medical students in smokeless tobacco cessation counseling," he said.

He said the materials should be culturally sensitive. Spangler notes that use of tobacco is higher among blacks and Native Americans than among the white population. "To be culturally appropriate, tobacco cessation must reflect the targeted racial/ethnic group''s cultural values," he said. "We have to use strategies that are acceptable to that particular ethnic group."

He said explicit national guidelines have already been prepared by the U.S. Public Health Service to train physicians in tobacco cessation. Spangler will incorporate these guidelines as well as use case studies, trained volunteers who act as "standardized" patients and role playing to train medical students.

Spangler said that the materials developed will be available both on the Web and on CD-ROM. ###

Contact: Robert Conn ( or Karen Richardson ( at (336) 716-4587.

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