AUG/SEP 2006
Volume 12 - No. 3

SRNT Newsletter

August/September 2006, Volume 12, Number 3

The Mayo Clinic Nicotine Research Program

by Ivana Croghan, Richard Hurt, J. Taylor Hays, Lowell Dale, Michael Burke & Jon Ebbert

Mayo Clinic Campus, located in Rochester, MN

The mission of the Mayo Clinic Nicotine Dependence Center (NDC) is to promote tobacco-free living through an integrated program of intervention services, education, and research. The NDC is comprised of three programs (Treatment, Education, and Research), each led by an Associate Director and Program Coordinator. The full integration of these three programs is consistent with the Mayo Clinic's primary value: "The needs of the patient come first"; NDC's programs allow for the prompt translation of research findings into patient care. Once a new intervention is proven effective, a model is developed for the incorporation of the intervention into the treatment of patients through the Treatment Program. Treatment models are then disseminated through the Education Program by the education of health care professionals through a variety of venues.

The NDC Research Program had its origins with the opening of the Nicotine Dependence Center in April 1988. The first nicotine patch clinical trial began in August of 1988, and since then, the NDC Research Program has made and continues to make contributions to the treatment of tobacco dependence. Initially centered on pharmacologic therapy trials, the NDC Research Program has expanded to include investigation of behavioral interventions for tobacco users, population-based epidemiological studies, and cost-effectiveness and outcomes research. We have conducted over 75 randomized clinical trials involving more than 10,000 research subjects testing about 15 different pharmacologic agents. The NDC Research Program portfolio continues to grow through investigator-initiated peer reviewed grants from the NIH and foundations and industry-sponsored research. Investigators from the NDC Research Program have published over 100 peer-review articles in the last ten years, and scholarly output continues to grow.

We are currently conducting several tobacco research studies for unique populations of tobacco users who chew tobacco or smoke. Current studies include smokers with high blood pressure, chronic lung disease or those with ADHD. Other studies work with young adults (college age) who are currently smoking and would like to quit. In addition, there are newer studies which use complementary and alternative medicine as novel therapeutic approaches for cigarette smokers.

The studies at the NDC Research Program are usually highly visible within our community as a standard recruitment technique using press releases, flyers, print ads, radio ads, TV ads, and letters, which altogether have proven to be very effective means of subject recruitment. A central telephone triage system is used to enable the Nicotine Research staff to place subjects in the study that best suits them.

The NDC treatment program has treated more than 34,000 patients for tobacco dependence since 1988. Treatment is provided using a range of evidence-based modalities and consultative services including:

brief motivational treatment for those not yet ready to quit
face-to-face counseling for outpatients and at the bedside for hospital in-patients
thorough assessment and individualized treatment planning that includes behavioral counseling, pharmacotherapy, and a follow-up plan for relapse prevention
ongoing individual or group counseling to sustain efforts to stop
workplace tobacco dependence treatment programs
an 8 day residential treatment program
an outpatient group program of intermediate intensity.

We also provide education and support to help others manage tobacco dependence within any of the clinical practice areas of Mayo Clinic. This includes a nurse-initiated protocol for hospitalized smokers that has been implemented throughout both of our hospitals.

The NDC treatment program maintains about a 25% six-month tobacco abstinence rate for all patients who come in for an initial assessment. In the most recent outcome assessment, 45% of the patients who entered the NDC 8 day residential treatment program were smoke free at 1 year follow-up. Both statistics are based on an intent-to-treat analysis.

The NDC Education Program conducts educational activities oriented toward healthcare professionals who are interested in incorporating nicotine dependence treatment into their practice and/or developing a service to meet the needs of tobacco dependent patients. Physicians, nurse practitioners, physician assistants, dentists, psychologists, chemical dependency counselors, respiratory therapists, nurses, social workers, and other allied health professionals have found these education offerings of assistance.

Now in its 11^th year, the biannual Mayo Clinic Nicotine Dependence Conference draws approximately 200 national and international attendees to each session. In addition to the conference, the Education Program staff provides four- to eight-hour workshops to external groups. Mayo Clinic residents receive eight hours of instruction in providing effective tobacco intervention to their patients. Most recently we have begun providing training and certification for Tobacco Treatment Specialists (TTS). We provide four TTS courses per year.

To provide continuing support to our learners, the Education Program developed a web site that offers up-to-date resources, materials, and links to support their intervention efforts after completion of the conference, workshop, or certification training.

At the Nicotine Dependence Center, we continue to place the needs of the patient first as the foundation for the integration of practice, education, and research. This model has and will continue to best serve the needs of our patients while providing a stimulating academic environment for our staff.

You can find out more about the Mayo Clinic Nicotine Dependence Center at http://ndc.mayo.edu.

About the Authors:

Ivana T. Croghan, Ph.D., is the Research Program Coordinator of The Nicotine Dependence Center at Mayo Clinic.

Richard D. Hurt, M.D., is the Director of The Nicotine Dependence Center at Mayo Clinic.

J Taylor Hays, M.D., is the Associate Director for the Treatment Program of The Nicotine Dependence Center at Mayo Clinic.

Lowell C. Dale, M.D., is the Associate Director for the Education Program of The Nicotine Dependence Center at Mayo Clinic.

Michael V. Burke, Ed.D., is the Treatment Program Coordinator of The Nicotine Dependence Center at Mayo Clinic.

Jon O. Ebbert, M.D., is an Investigator in the Research Program of The Nicotine Dependence Center at Mayo Clinic.