Tobacco Cessation Training for accupuncture, massage, and chiropractic practition

描述(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，但仍未得到充分利用。戒烟简短干预(BIS)对于增加戒烟尝试和戒烟率是低成本和有效的。然而，BI培训主要集中在传统医疗提供者身上，很大程度上忽视了其他以社区为基础的保健和健康从业者，他们在客户和患者群体中看到了烟草使用者。2004年全国健康访谈调查的数据表明，36%的美国成年人使用某种形式的补充和替代医学(CAM)，在这些人中，大约20%是烟草使用者。因此，CAM从业者代表着一个巨大的、尚未开发的社区资源，用于促进戒烟。现有的戒烟干预培训不适合CAM从业者的背景和实践模式，因为它假设有传统生物医学的背景。因此，迫切需要开发和测试戒烟培训的有效性，这种培训以指南为基础，并与CAM从业者相关和适当。目前的提案解决了这一差距，并建立在我们之前对社区烟草BI培训和与CAM从业者的研究的基础上。主要目标是：1)与三种类型的CAM从业者(脊椎按摩师、按摩治疗师和针灸/中医从业者)进行多方法研究，以记录他们关于烟草依赖和戒烟的知识、态度和经验，并引出提供戒烟干预的一系列实践模式和情景；2)为CAM从业者量身定做戒烟商务培训，这是办公系统干预(称为CAM REACH)的一部分；3)在60个CAM实践中对CAM REACH进行随机分组滞后干预第二阶段研究，这将：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要干预的主要结果以及患者准备戒烟、戒烟尝试、使用以指南为基础的戒烟治疗和戒烟率的次要结果的影响。第二个目标是探索CAM REACH对不吸烟但想要帮助其他人戒烟的患者的影响，涉及帮助戒烟的知识和行动。第二阶段试验的结果将提供必要的参数，例如效应大小和组内相关性，以设计第三阶段多点试验。为此，我们还建议对训练有素的CAM提供者及其患者进行一项定性研究，以检查与CAM提供者实施和维持戒烟干预行为相关的因素，以及患者烟草使用的变化。我们假设：1)与未经培训的CAM从业者相比，受过培训的CAM从业者将具有显著更高的戒烟BIS筛查率；以及2)受过培训的CAM从业者的患者戒烟尝试和使用循证戒烟辅助工具的比率将显著高于未经受训的CAM从业者的患者。公共卫生相关性：补充和替代医学(CAM)从业者是包括烟草使用者在内的美国人口的重要医疗保健来源。这项拟议的研究将为3种类型的CAM从业者量身定做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.