Tobacco Cessation via Doctors of Chiropractic

描述(由申请人提供)：医生、护士、牙医和牙科保健员已被证明能有效地帮助他们的病人戒烟。然而，脊骨疗法(DC)的医生并没有被用来担任这一角色！DC可以为进行烟草干预提供一个独特的渠道，但他们目前很少或根本没有接受过这些技术方面的培训。脊骨疗法的医生越来越关注患者使用香烟和无烟烟草的问题。脊椎按摩团队为患者提供教育和预防服务，而办公室访问可以提供更多机会与患者谈论他们的烟草使用情况。鉴于长期吸烟对健康的影响，脊椎疗法访问提供了一个“可教的时刻”，在此期间，DC可以将当前的健康问题与烟草使用联系起来，并为吸烟的患者提供简短的咨询。在拟议的发展研究中，8家脊椎按摩诊所将参与办公室戒烟干预措施的设计、实施和评估。根据以前的办公室干预方案，干预将以认知学习理论和临床实践指南为基础，并将纳入动机访谈技术。最后，使用RE-AIM框架，我们将评估个人、诊所和组织层面的变量，这些变量可能影响烟草依赖治疗的提供、干预措施的实施和维持。这项先导性研究将用于开发和改进DC培训、研究实施、患者招募、数据收集和后续程序的设计，作为未来随机临床试验的基础。此R21应用程序的具体目标是：1.设计和改进已建立的基于办公室的烟草干预措施，用于脊椎按摩环境中。我们会透过焦点小组、访谈，以及与区议会、办公室职员和脊骨疗法患者的书面调查，调整干预方案、培训形式和教材，以及病人资料。干预措施的评估将以RE-AIM框架为指导，2.通过与参与的脊椎疗法从业者、工作人员和患者互动的迭代过程，制定和完善研究实施方案、DC和患者招募程序、数据收集战略和后续程序。将使用定量和定性两种方法收集数据。3.为将来的随机临床试验准备一份程序工作手册。这项研究将在俄勒冈州的8家私人脊椎按摩诊所进行。这些实践将代表各种规模和环境，包括城市和农村地点、实践范围和患者人口统计数据。这项试点研究是基于先前研究的补充路线，并将由一个由高素质研究人员组成的跨学科团队进行，其中包括脊骨按摩医生、行为心理学家和流行病学家。这项研究的目标是为一项具有全国代表性的DC样本的随机临床试验提供基础。

DESCRIPTION (provided by applicant): Medical doctors, nurses, dentists, and dental hygienists have been shown to be effective in helping their patients quit tobacco. However, Doctors of Chiropractic (DCs) have not been utilized in this role! DCs can provide a unique channel for the conduct of tobacco interventions, but they currently receive little to no training in these techniques. Doctors of Chiropractic are increasingly concerned with patients' use of cigarettes and smokeless tobacco. The chiropractic team provides educational and preventive services to patients, and the office visit can provide an extended opportunity to talk to patients about their tobacco use. Given the health effects associated with chronic tobacco use, the chiropractic visit provides a "teachable moment" during which the DC can relate current health problems to tobacco use and provide brief counseling to patients who use tobacco. In the proposed developmental study, 8 chiropractic clinics will participate in the design, implementation, and evaluation of an office-based tobacco cessation intervention. Adapted from previous office-based intervention protocols, the intervention will be based on Cognitive Learning Theory and the Clinical Practice Guidelines and will also incorporate Motivational Interviewing techniques. Finally, using the RE-AIM framework, we will assess individual-, clinic-, and organization-level variables that may affect the delivery of treatment for tobacco dependence, the implementation and maintenance of the intervention. This pilot research will be used to develop and refine the design of DC training, study implementation, patient recruitment, data collection, and follow-up procedures to serve as a basis for a future randomized clinical trial. The specific aims of this R21 application are: 1. To design and refine an established office-based tobacco intervention for use within chiropractic settings. We will adapt the intervention protocol, training format and materials, and patient materials through the use of focus groups, interviews, and written surveys with DCs, office staff, and chiropractic patients. The evaluation of the intervention will be guided by the RE-AIM framework, 2. To develop and refine study implementation protocols, DC and patient recruitment procedures, data collection strategies, and follow-up procedures through an iterative process of engagement with participating chiropractic practitioners, staff and patients. Data will be collected using both quantitative and qualitative methods. 3. Prepare a working Manual of Procedures for a future randomized clinical trial. This study will be conducted in 8 private chiropractic clinics throughout Oregon. The practices will represent a variety of sizes and settings, including both urban and rural locations, scope of practice, and patient demographics. This pilot research is based on complementary lines of previous research, and will be conducted by an interdisciplinary team of highly qualified researchers, including Doctors of Chiropractic, behavioral psychologists, and epidemiologists. The goal of this study is to provide the foundation for a randomized clinical trial with a nationally-representative sample of DCs.