Tobacco Cessation via Public Health Dental Clinics

描述（由申请人提供）：在美国社会经济地位较低的人群中，烟草使用的患病率尤其高。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，通常为牙科服务。典型的患者有多次牙科就诊，这可以用于戒烟的建议和咨询牙科诊所的团队。拟议的研究建立在两家公共卫生牙科诊所成功进行的试点研究的基础上。试验取得了积极的成果，并为拟议的研究提供了宝贵的经验。本研究将检验公共卫生牙科医生提供简短的办公室干预的有效性，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，将俄勒冈州、密西西比州和纽约市的14家公共卫生牙科诊所按州分层，按州内种族/民族组成进行匹配，然后随机分配到干预组或常规护理对照组。在这两种情况下，前台工作人员将要求吸烟患者（>=18）完成一份烟草使用调查。在干预条件下，牙科团队将提供一个简短的干预，以临床实践指南所倡导的“5a”为模型。所有同意的患者将在入组后的基线、6周和7.5个月通过邮寄调查和对无应答者的随访电话进行评估。我们预计在6个月的时间内招募3240名吸烟患者，其中2221名患者将完成所有随访评估。主要结果将是6个月时报告的延长禁欲。牙科医生将在基线、培训后6周和12个月进行评估，以评估方案的实施、方案的维护以及向患者提供烟草干预的态度变化。组织措施将在基线和12个月进行，以评估诊所和系统范围内与在这种情况下采用、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具有创新性。1)它的目标人群是到公共卫生中心接受牙科护理的高风险、服务不足的人群。2)它将在三个不同种族和民族人口的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；非洲裔美国人和白人）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框架将用于在“现实世界”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.