Tobacco Cessation Training for accupuncture, massage, and chiropractic practition

描述（由申请人提供）：烟草使用仍然是美国发病率和死亡率的主要原因。有效的戒烟治疗比以往任何时候都更广泛，但仍然没有得到充分利用。戒烟简短干预（BIs）是低成本和有效的增加戒烟尝试和戒烟率。然而，BI培训主要集中在传统的医疗提供者，在很大程度上忽视了其他社区卫生保健和健康从业人员，他们在客户和患者人群中看到烟草使用者。2004年全国健康访谈调查的数据显示，36%的美国成年人使用某种形式的补充和替代医学（CAM），其中约20%是烟草使用者。因此，CAM从业者代表了一个巨大的，未开发的社区资源，以促进戒烟。现有的戒烟干预培训不适合CAM从业者的背景和实践模式，因为它假设了传统生物医学的背景。因此，迫切需要开发和测试基于指南治疗的戒烟培训的有效性，并与CAM从业者相关和适当。目前的建议解决了这一差距，并建立在我们以前的研究，以社区为基础的烟草BI培训和研究与CAM从业人员。主要目标是：1）对三种类型的CAM从业者进行多方法研究（脊医、按摩治疗师和针灸/中医）记录他们对烟草依赖和戒烟的知识、态度和经验，并引出一系列提供戒烟干预的实践模式和情景; 2）为CAM从业者量身定制戒烟BI培训，这是办公室系统干预的一部分（称为CAM Reach）; 3）在60个CAM实践中进行CAM Reach的群集随机滞后干预II期研究，将：a）测试实施CAM Reach干预的可行性和可接受性;以及B）评估其对CAM从业者进行烟草使用筛查和简短干预的主要结果的影响，以及对患者戒烟准备、戒烟尝试、基于指南的戒烟治疗的使用和戒烟率的次要结果的影响。第二个目的是探索CAM Reach对不吸烟但想帮助他人戒烟的患者的影响，包括戒烟知识和帮助用户戒烟的行动。II期试验的结果将提供必要的参数，例如效应量和组内相关性，以设计III期多中心试验。为此，我们还提出了一个样本的培训CAM供应商和他们的病人的定性研究，以检查与CAM供应商的实施和维持戒烟干预行为，并在患者的烟草使用的变化相关的因素。我们假设：1）与未经培训的CAM从业者相比，经过培训的CAM从业者将有更高的筛查率和戒烟BI的交付率; 2）与未经培训的CAM从业者相比，经过培训的CAM从业者的患者将有更高的戒烟尝试率和循证戒烟辅助工具的使用率。公共卫生相关性：补充和替代医学（CAM）从业人员是美国人口（包括烟草使用者）的重要医疗保健来源。拟议的研究将为3种类型的CAM从业者量身定制和评估戒烟简短干预培训和办公室系统干预：针灸/中医，按摩和脊椎按摩。

DESCRIPTION (provided by applicant): Tobacco use remains the leading cause of morbidity and mortality in the United States. Effective tobacco cessation treatments are more widely available than ever before, yet remain underutilized. Tobacco cessation brief interventions (BIs) are low-cost and effective for increasing quit attempts and quit rates. However, BI training has focused primarily on conventional medical providers, largely overlooking other community-based health care and wellness practitioners who see tobacco users in their client and patient populations. Data from the 2004 National Health Interview Survey indicate that 36% of U.S. adults use some form of complementary and alternative medicine (CAM), and among those individuals, approximately 20% are tobacco users. Thus, CAM practitioners represent a large, untapped community resource for promoting tobacco cessation. Existing cessation intervention training is not suitable for the background and practice patterns of CAM practitioners, as it assumes a background in conventional biomedicine. Thus there is a pressing need to develop and test the effectiveness of cessation training that is grounded in guideline-based treatment and that is relevant and appropriate for CAM practitioners. The current proposal addresses this gap and builds on our prior research in community-based tobacco BI training and research with CAM practitioners. Primary aims are to: 1) conduct a multi-method study with three types of CAM practitioners (chiropractors, massage therapists, and acupuncture/Traditional Chinese Medicine practitioners) to document their knowledge, attitudes and experiences regarding tobacco dependence and cessation, and to elicit a range of practice patterns and scenarios in which to provide tobacco cessation interventions; 2) tailor a tobacco cessation BI training for CAM practitioners that is part of an office system intervention (called CAM Reach); 3) conduct a cluster-randomized lagged intervention Phase 2 study of CAM Reach in 60 CAM practices that will: a) test the feasibility and acceptability of implementing the CAM Reach intervention; and b) evaluate its effect on the primary outcomes of CAM practitioners' conduct of tobacco use screening and brief interventions and secondary outcomes of patients' readiness to quit, quit attempts, use of guideline-based tobacco cessation treatments and quit rates. A secondary aim is to explore CAM Reach's effect on patients who are do not use tobacco but want to help someone else quit, with respect to knowledge cessation aids and actions to help the user quit. Results of the Phase 2 trial will provide the necessary parameters, e.g. effect size and intraclass correlation, to design a Phase 3 multi-site trial. To this end, we also propose a qualitative study of a sample of trained CAM providers and their patients to examine factors associated with CAM providers' implementation and maintenance of cessation intervention behaviors, and changes in patients' tobacco use. We hypothesize that: 1) Trained CAM practitioners will have significantly higher rates of screening and delivery of tobacco cessation BIs compared to untrained CAM practitioners; and 2) Patients of trained CAM practitioners will have significantly higher rates of quit attempts and use of evidence-based tobacco cessation aids, than patients of untrained CAM practitioners. PUBLIC HEALTH RELEVANCE: Practitioners of Complementary and Alternative Medicine (CAM) are an important source of health care for the US population, including tobacco users. The proposed research will tailor and evaluate a tobacco cessation brief intervention training and office system intervention for 3 types of CAM practitioners: acupuncture/Traditional Chinese Medicine, massage, and chiropractic.