Tobacco Cessation via Public Health Dental Clinics

描述(由申请人提供)：在美国社会经济地位(SES)较低的人群中，烟草使用的流行率尤其高。社区卫生中心为大量流动收入吸烟者和无烟吸烟者提供全面的初级保健服务，通常还包括牙科服务。典型的患者有多次牙科就诊，这可以用于牙科办公室团队的戒烟建议和咨询。这项拟议的研究是基于在两家公共卫生牙科诊所进行的一项成功的试点研究。试点取得了积极成果，并为拟议的研究提供了宝贵经验。这项研究将检验公共卫生牙医提供以办公室为基础的简短干预措施的有效性，旨在帮助患者戒烟或使用无烟烟草，与通常的护理相比。我们建议进行一项随机临床试验，俄勒冈州、密西西比州和纽约市的14家公共卫生牙科诊所将按州分层，在州内按种族/民族组成匹配，然后随机分配到干预或常规护理控制条件。在这两种情况下，前台工作人员将要求吸烟患者(=18)完成一份烟草使用情况调查。在干预条件下，牙科团队将按照《临床实践指南》所倡导的5A进行简短的干预。所有同意的患者将在基线、登记后6周和7.5个月通过邮寄调查和对无反应者的后续电话进行评估。我们预计在六个月内招募3240名吸烟患者，2221名患者将完成所有后续评估。主要结果将是6个月后报告的长期禁欲。牙科医生将在基线、培训后6周和12个月进行评估，以评估协议执行、协议维护以及对向患者提供烟草干预的态度的变化。组织措施将在基线和12个月内进行，以评估诊所和全系统[与在这一背景下采用、实施和维持干预措施有关的行为者]。拟议的项目在几个方面都是创新的。1)它针对的是去公共卫生中心寻求牙科护理的高危、服务不足的人群。2)将在三个不同种族和族裔人口的人权事务高级专员办事处区域进行，使我们能够评估干预对三个不同种族/族裔群体(西班牙裔/拉丁裔；非裔美国人和作家)的影响。3)扩散策略将指导诊所和患者的招募和留住。4)RE-AIM框架将被用来在“真实世界”的环境中翻译和评估干预措施。5)它是一个可传播的模式，如果有效，可以被全美的公共牙科诊所使用。

DESCRIPTION (provided by applicant): The prevalence of tobacco use is especially high in lower socioeconomic status (SES) populations in the U.S. Community Health Centers provide comprehensive primary care services, and usually/ dental services, to large numbers o flow-income smokers and smokeless tobacco users. The typical patient has multiple dental visits, which can be used for tobacco cessation advice and counseling by the dental office team. The proposed study builds on a successful pilot study conducted in two public health dental clinics. The pilot yielded positive results and provided valuable experience to inform the proposed study. This study will examine the effectiveness of public health dental practitioners of providing a brief office-based intervention designed to help patients quit smoking or smokeless tobacco use, as compared to usual care. We propose to conduct a randomized clinical trial in which 14 public health dental clinics in Oregon, Mississippi, and New York City will be stratified by state, matched within state by racial/ethnic composition, and then randomly assigned to either the Intervention or Usual Care Control condition. In both conditions, tobacco-using patients (>=18) will be asked by the front office staff to complete a Tobacco Use Survey. In the Intervention Condition, the dental team will provide a brief intervention that is modeled on the "5 A's" advocated by the Clinical Practice Guideline. All consenting patients will be assessed at baseline, 6 weeks and 7.5 months following enrollment by mailed surveys and follow-up phone calls to non-responders. We anticipate enrolling 3,240 tobacco-using patients over a six-month period and that 2,221 patients will complete all follow-up assessments. The primary outcome will be prolonged abstinence reported at 6 months. Dental practitioners will be assessed at baseline, and at 6 weeks and 12 months post-training to assess protocol implementation, protocol maintenance, and changes in attitudes toward providing tobacco intervention to patients. Organizational measures will be conducted at baseline and 12 months to assess clinic and system-wide [actors related to the adoption, implementation and maintenance of the intervention in this setting. The proposed project is innovative in several ways. 1) It targets a high-risk, under-served population who visit public health centers for dental care. 2) It will be conducted in three HRSA regions with diverse racial and ethnic populations, allowing us to assess the effect of the intervention on three different racial/ethnic groups (Hispanic/Latino; African American and Write). 3) Diffusion strategies will guide recruitment and retention of clinics and patients. 4) The RE-AIM framework will be used to translate and evaluate the intervention in a "real world'' setting. 5) It is a disseminable model that, if effective, can used by public dental clinics throughout the US.