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特别高。社区卫生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，通常是牙科服务。典型的患者有多次牙科就诊，这可以用于牙科诊所团队的戒烟建议和咨询。拟议的研究建立在两个公共卫生牙科诊所进行的成功试点研究的基础上。试点取得了积极成果，为拟议的研究提供了宝贵经验。本研究将探讨公共卫生牙科医生提供一个简短的办公室为基础的干预，旨在帮助患者戒烟或无烟烟草使用的有效性，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、密西西比和纽约市的14家公共卫生牙科诊所将按州进行分层，按种族/民族组成进行州内匹配，然后随机分配到干预或牙科护理对照条件。在这两种情况下，前台工作人员将要求吸烟患者（≥ 18岁）完成烟草使用调查。在干预条件下，牙科团队将提供一个简短的干预，这是仿照“5A的”倡导的临床实践指南。将在基线、入组后6周和7.5个月通过邮寄调查和电话随访无应答者对所有知情同意的患者进行评估。我们预计在6个月内招募3，240名烟草使用患者，2，221名患者将完成所有随访评估。主要结局将是6个月时报告的长期禁欲。将在基线、培训后6周和12个月对牙科医生进行评估，以评估方案实施情况、方案维持情况以及对向患者提供烟草干预的态度变化。将在基线和12个月时进行组织措施，以评估诊所和全系统与在这种情况下采取、实施和维持干预措施有关的行动者。拟议的项目在几个方面具有创新性。1)它的目标是高风险，服务不足的人口谁访问公共卫生中心的牙齿护理。2)它将在三个不同种族和民族的HRSA地区进行，使我们能够评估干预对三个不同种族/民族群体（西班牙裔/拉丁裔;非裔美国人和书面）的影响。3)传播战略将指导诊所和患者的招募和保留。4)RE-AIM框架将用于在“真实的世界”环境中翻译和评估干预措施。5)这是一个可推广的模式，如果有效，可以在美国各地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.