Original Publication
Open Access

Tobacco Ties

Published: December 6, 2009 | 10.15766/mep_2374-8265.3138

Included in this publication:

  • Facilitator_Guide.pdf
  • Tabacco Ties Film Cover.PNG
  • Tabacco Ties.VOB

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. This publication includes large downloadable files. If you experience difficulty downloading these files, please contact mededportal@aamc.org to receive a free DVD version via mail.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Introduction: The Tobacco Ties video and Facilitator Guide are designed to be used formatively to instruct clinicians and health professions learners how to use culturally sensitive, patient-centered communication skills to effectively counsel patients to stop using tobacco. The 9-minute video was independently scored by a standardized patient instructor (SPI) who has been working in tobacco cessation counseling for over 20 years. Using the Tobacco Intervention Risk Factor Interview Scale (TIRFIS), the SPI scored all items as 5s (on a 1-5 scale) with the exception of two. Using the Tobacco Beliefs Management Scale/ Tobacco Cultural Concerns Scale, they also scored all items as 5s (1-5) with the exception of 3 items. Certain skills were intentionally weak or omitted in the film in order to provide learners with the opportunity to discriminate between highly effective skill performance and less effective performance on individual skills. Methods: Tobacco Ties can be used with a wide variety of health professions learners. Currently it is used to prepare first-year PA students for a tobacco cessation counseling standardized patient encounter and to introduce third-year medical students to effective counseling skills in the family medicine clerkship. Results: Students rated the tobacco cessation standardized-patient encounter with first-year students and the didactic sessions, which included viewing and evaluating Tobacco Ties, as an overall score of 3.4 on a scale of 0-4. Discussion: Health care providers play a critical role in addressing tobacco use. This film is a successful teaching tool for facilitating understanding and communication between clinicians and their patients.

Educational Objectives

By the end of this session, learners will be able to:

  1. Appreciate social determinants of health and other underlying factors related to growing up in a tobacco producing and manufacturing region.
  2. Appreciate that even though tobacco use is not a healthy habit, this patient's family is proud of how their tobacco growing heritage enabled their economic stability.
  3. Recognize effective tobacco cessation counseling skills.
  4. Identify patient's readiness to change stage.
  5. Utilize effective patient-centered tobacco cessation counseling skills that attend to the patient's culture in a respectful manner.
  6. Address the impact of smoking in a patient with uncontrolled asthma.

Author Information

  • Gail Marion, PA-C, PhD: Wake Forest School of Medicine of Wake Forest Baptist Medical Center
  • Sonia Crandall, PhD: Wake Forest University School of Medicine
  • Carol Hildebrandt, BA: Wake Forest University School of Medicine
  • Kathy Walker, BA: Wake Forest University School of Medicine
  • Barbara Gamberini, BS: Wake Forest University School of Medicine
  • John Spangler, MD: Wake Forest University School of Medicine

None to report.

None to report.


Marion G, Crandall S, Hildebrandt C, Walker K, Gamberini B, Spangler J. Tobacco ties. MedEdPORTAL. 2009;5:3138. https://doi.org/10.15766/mep_2374-8265.3138