New Approaches to Tobacco Control

The tobacco products of today are not just your grandfather’s unfiltered Lucky Strikes or Camels, but rather natural and organic cigarettes, confectionary-flavored e-cigarettes and vapes, and emerging heated tobacco products. Jodi Prochaska, PhD, MPH, associate professor of medicine with the Stanford Prevention Research Center, is making seminal contributions to the rapidly changing field of tobacco control.

Prochaska has over a dozen active grants, all directed at addressing tobacco and nicotine use, from evaluations of novel treatments to study of policy dissemination to advances in medical education.

Prochaska’s most scenic project is centered in the Norton Sound region, an inlet in the Bering Sea off the west coast of Alaska. Funded by the National Heart, Lung, and Blood Institute, the Healing and Empowering Alaskan Lives Toward Healthy Hearts (HEALTHH) project uses telemedicine to address significant inequities in tobacco use and tobacco-related disease in the region. About half of Alaska Native men and a third of Alaska Native women smoke—a level of prevalence that hasn’t been seen in the continental United States since the 1960s. “It’s a very high smoking prevalence in a remote location, without easy access to treatment. Developing partnerships and trust is critical,” Prochaska states.

The HEALTHH project works closely with the local tribal health council, in collaboration with a team in Anchorage, including two doctoral students of Alaska Native heritage who received their own fellowship awards on the project.

Launched in 2012, the HEALTHH team has made over 125 trips to the Norton Sound region. “Half the 299 participants are randomized to telemedicine-based counseling for quitting smoking and exercising, and half are randomized to telemedicine-based counseling for a heart-healthy Native diet and compliance with medications for hypertension and/or high cholesterol,” Prochaska explains. Though too early for outcome results, Prochaska says, “The telemedicine treatment approach has been rated highly, and participants are sharing their successes.”

As for e-cigarettes, Prochaska notes, “The science is trying to catch up with the unregulated free-market growth of e-cigarettes, and there’s a huge gap in training for clinicians in terms of best practice for when a patient asks about vaping.” She and her colleagues created a free online CME course to help clinicians work through scenarios with patients asking about e-cigarettes. From an earlier project, Prochaska and her colleagues, in collaboration with HealthTap, studied hundreds of patient-doctor interactions on e-cigarettes, then designed and evaluated a highly interactive course to address the most prevalent concerns. Prochaska describes the course as “a non-linear, Go-Pro, first-person, choose-your-own-adventure, clinician-led experience.” She explains, “The course features a day in the life of a clinician—exposed to media reports on e-cigarettes; in the exam room, encountering patient questions about vaping; and venturing out to visit a virtual vape shop.” So far, over 1,000 health care providers from 70 nations have taken the course. Knowledge scores have significantly improved, and course ratings have been high.

Prochaska is also the faculty director for the Department of Medicine’s Master of Science (MS) Program in Community Health and Prevention Research. She teaches a highly rated course on theories of behavior change and community-based interventions.

Prochaska is a product of social scientists who emphasized “higher education, service to the community, and well-being.” Her father, James Prochaska, developed one of the field’s leading theories of behavior change. Her early start, with an emphasis on “encouragement to ask questions and seek out answers,” has served her well through two decades in the tobacco control field and will continue to help her pursue solutions on the increasingly complicated tobacco frontier.