Optimizing Treatment for Brazilian Smokers through Community-Based Primary Care

项目摘要/摘要 到2030年，每年将有超过800万人死于烟草，其中80%的死亡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反对这一趋势 本组织的国际烟草条约--《烟草控制框架公约》。助人 烟民戒烟是《烟草控制框架公约》的核心条款。 尽管巴西为循证烟草治疗提供了普遍覆盖，但它仍然有 烟草流行率和获得治疗机会方面的差异。这个项目的双重目的是：1)进行 一个研究项目，以了解和加强巴西吸烟者获得烟草治疗的机会，以及2)建立 这是美国和巴西之间的研究合作。该研究项目涉及与 巴西Juiz de Fora的社区初级保健诊所，以实现以下具体目标：1)创建 吸烟者代表性登记册，以确定烟草流行率和对治疗的态度；2) 描述医疗保健提供者关于如何最好地接触低收入吸烟者的观点；3)开发和试行测试 促进获得烟草治疗服务的社区代理人干预。 该项目的家长R01测试远程医疗的有效性，以增加获取循证医学的机会 通过农村初级保健设施，为美国农村的盎格鲁和拉丁裔吸烟者提供烟草治疗。这个 该项目还依赖于K奖，该奖项测试了美国非专业卫生工作者设计的干预措施的效果 增加未被禁烟的拉美裔人获得烟草治疗的机会。该项目利用了多个P.I. 建立机制，利用这些项目的首席调查员的优势互补。 该项目将与巴西P.I.奥斯卡琳娜·达席尔瓦·埃兹奎尔博士及其工作人员合作进行，地址为 论坛联邦大学(UFJF)。研究能力建设活动包括正规课程 课程、有指导的研究项目和社区讲座，旨在培养以下知识和技能 开展临床应用研究。 该项目解决了一个重大的全球卫生问题，而且对巴西来说是一个高度相关的项目，巴西已经 大量非常贫穷的吸烟者。它还利用了巴西医疗保健的独特结构 识别人口中的每个吸烟者并将其与现有服务联系起来的系统。因此，它代表一种 治疗模式从被动治疗向主动治疗转变。研究项目成果将用于支持 申请大规模、最终试点干预试点。如果有效，这种方法可以实现 显著降低了巴西与烟草有关的发病率和死亡率，并为人口- 以国际干预为基础。

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.