Optimizing Treatment for Brazilian Smokers through Community-Based Primary Care

项目总结/摘要 到2030年，每年将有800多万人死于烟草，其中80%将发生在发展中国家。 国家许多国家正试图通过成为世界卫生组织的签署国来对抗这一趋势。 烟草控制框架公约（FCTC）。帮助 吸烟者戒烟是FCTC的核心条款。 虽然巴西提供了基于证据的烟草治疗的普遍覆盖，但它仍然没有 烟草流行率和获得治疗的机会方面的差距。这个项目的双重目的是1）进行 一个研究项目，以了解和提高巴西吸烟者获得烟草治疗的机会，以及2）建立 美国和巴西之间的研究合作。该研究项目涉及与 在巴西Juiz de Fora建立社区初级保健诊所，以实现以下具体目标： 有代表性的吸烟者登记，以确定烟草流行率和对治疗的态度; 2） 描述卫生保健提供者对如何最好地接触低收入吸烟者的看法; 3）开发和试点测试 社区代理干预，以增加获得烟草治疗服务的机会。 该项目的父R 01测试了远程医疗的有效性，以增加基于证据的 通过农村初级保健设施在美国农村盎格鲁和拉丁美洲吸烟者中进行烟草治疗。的 该项目还依赖于K奖，该奖项测试了美国-基于非专业卫生工作者的干预设计 增加未被禁止的拉丁美洲人获得烟草治疗的机会。该项目利用多个P.I. 我们需要建立一个机制，以利用这些项目的主要研究人员的互补优势。 该项目将与巴西P.I. Oscarina da Silva Ezequiel博士及其工作人员在 联邦论坛大学。研究能力建设活动包括正式课程 课程、指导研究项目和社区讲座，旨在为 进行临床应用研究。 该项目涉及一个重大的全球健康问题，对巴西来说是一个高度相关的项目， 大量贫穷的吸烟者。它还利用了巴西独特的医疗保健结构， 该系统将识别人口中的每一个吸烟者并将其与现有服务联系起来。因此，它代表了 从被动治疗到主动治疗的模式转变。研究项目的结果将用于支持 申请进行大规模、确定性的试点干预试验。如果有效，该方法可以实现 巴西与烟草有关的发病率和死亡率大幅下降，并为人口- 在国际上进行干预。

PROJECT SUMMARY/ABSTRACT By 2030, over 8 million people will die annually from tobacco, and 80% of these deaths will occur in developing countries. Many countries are attempting to contravene this trend by becoming signatories to the World Health Organization's international tobacco treaty-the Framework Convention on Tobacco Control (FCTC). Helping smokers quit is a core article of the FCTC. Although Brazil provides universal coverage for evidence-based tobacco treatments, it continues to have disparities in tobacco prevalence and access to treatment. The twofold purpose of this project is to 1) conduct a research project to understand and enhance access to tobacco treatment for Brazilian smokers, and 2) build a research collaboration between the U.S. and Brazil. The research project involves collaborating with community-based primary care clinics in Juiz de Fora, Brazil to achieve the following specific aims: 1) create a representative registry of smokers to determine tobacco prevalence and attitudes toward treatment; 2) describe health care provider perspectives on how best to reach low-income smokers; 3) develop and pilot test a community agent intervention to enhance access to tobacco treatment services. The Parent R01 for this project tests the effectiveness of telemedicine to increase access to evidence-based tobacco treatment among rural Anglo and Latino smokers in the U.S. through rural primary care facilities. The project also relies on a K-Award that tests the effects of a U.S.-based lay health worker intervention designed to increase access to tobacco treatment among unban Latinos. The project utilizes the multiple-P.I. mechanism to take advantage of the complementary strengths of the Principal Investigators of these projects. The project will be conducted in collaboration with Brazilian P.I. Dr. Oscarina da Silva Ezequiel and her staff at the Universidade Federal de Juiz de Fora (UFJF). Research capacity building activities include formal course offerings, mentored research projects, and community lectures designed to build knowledge and skills for conducting applied clinical research. The project addresses a significant global health problem and it is a highly relevant project for Brazil, which has a large population of very poor smokers. It also capitalizes on the unique structure of the Brazilian health care system to identify and link every smoker in the population to existing services. As such, it represents a paradigm shift from reactive to proactive treatment. Research project findings will be used to support an application for a large scale, definitive trial of the pilot intervention. If effective, the approach could achieve significant reductions in tobacco-related morbidity and mortality in Brazil and provide a model for population- based intervention internationally.