Tobacco Cessation via Public Health Dental Clinics

通过公共卫生牙科诊所戒烟

• 批准号: 7234421
• 负责人: JUDITH SARAH GORDON
• 金额: $ 44.53万
• 依托单位: OREGON RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-06-15 至 2009-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7234421
• 关键词: Abstinence; Adoption; Advocate; African American; Age; Attitude; Baseline Surveys; Behavior; Caring; Centers for Disease Control and Prevention (U.S.); Chronic; Cigarette; Clinic; Clinical Practice Guideline; Clinical Trials; Community Health Centers; Condition; Consent; Counseling; Dental; Dental Assistants; Dental Care; Dental Clinics; Dental Hygienists; Dental Offices; Dentists; Diffusion; Drops; Effectiveness; Effectiveness of Interventions; Employee; Enrollment; Ethnic group; Evaluation; Hand; Health Professional; Health Services; Health Services Accessibility; Hispanics; Income; Intervention; Interview; Latino; Mails; Maintenance; Measures; Mississippi; Modeling; New York; New York City; Numbers; Occupations; Oral health; Oregon; Outcome; Patient Self-Report; Patients; Pilot Projects; Population; Prevalence; Preventive; Primary Health Care; Procedures; Protocols documentation; Provider; Public Health; Randomized; Randomized Clinical Trials; Range; Readiness; Reporting; Risk; Sampling; Services; Smokeless Tobacco; Smoker; Socioeconomic Status; Specific qualifier value; Surveys; System; Telephone; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; Training; Translating; Underserved Population; United States Health Resources and Services Administration; Visit; Week; Writing; base; cost; early /brief intervention /therapy; experience; follow-up; innovation; low socioeconomic status; prevention service; racial and ethnic; size; smoking cessation; therapy design

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.

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。社区健康中心为大量流动收入吸烟者和无烟烟草使用者提供全面的初级保健服务以及通常/牙科服务。典型的患者会多次去看牙医，牙科诊所团队可以利用这些信息提供戒烟建议和咨询。拟议的研究建立在两个公共卫生牙科诊所成功进行的试点研究的基础上。该试点取得了积极成果，并为拟议研究提供了宝贵的经验。这项研究将检验公共卫生牙科医生提供简短的办公室干预措施的有效性，该干预措施旨在帮助患者戒烟或无烟烟草使用，与常规护理相比。我们建议进行一项随机临床试验，其中俄勒冈州、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/族裔构成进行匹配，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，前台工作人员都会要求吸烟患者（> = 18）完成烟草使用调查。在干预条件下，牙科团队将根据临床实践指南倡导的“5A”提供简短的干预。所有同意的患者将在基线、入组后 6 周和 7.5 个月通过邮寄调查和对无反应者进行后续电话进行评估。我们预计在六个月内招募 3,240 名吸烟患者，其中 2,221 名患者将完成所有后续评估。主要结局是 6 个月时报告的长期禁欲。牙科医生将在基线以及培训后 6 周和 12 个月时接受评估，以评估方案实施、方案维护以及对向患者提供烟草干预的态度变化。将在基线和 12 个月内实施组织措施，以评估诊所和全系统[与在此环境中采取、实施和维持干预措施相关的参与者。拟议的项目在几个方面具有创新性。 1) 它针对的是前往公共卫生中心寻求牙科护理的高风险、服务不足的人群。 2) 它将在具有不同种族和族裔人口的三个 HRSA 地区进行，使我们能够评估干预措施对三个不同种族/族裔群体（西班牙裔/拉丁裔、非裔美国人和白人）的影响。 3) 扩散策略将指导诊所和患者的招募和保留。 4) RE-AIM 框架将用于翻译和评估“现实世界”环境中的干预措施。5) 这是一个可传播的模型，如果有效，可以被美国各地的公共牙科诊所使用。