Optimizing Treatment for Brazilian Smokers through Community-Based Primary Care

描述(申请人提供)：到2030年，每年将有超过800万人死于烟草，其中80%将发生在发展中国家。许多国家正试图通过成为世界卫生组织的国际烟草条约--《烟草控制框架公约》(FCTC)的签署国来反对这一趋势。帮助吸烟者戒烟是FCTC的一篇核心文章。虽然巴西为循证烟草治疗提供了普遍覆盖，但在烟草流行率和获得治疗的机会方面仍然存在差距。该项目的双重目的是：1)开展一个研究项目，以了解和加强巴西吸烟者获得烟草治疗的机会；2)在美国和巴西之间建立研究合作。该研究项目涉及与巴西Juiz de Fora的社区初级保健诊所合作，以实现以下具体目标：1)创建一个有代表性的吸烟者登记册，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关于如何最好地接触低收入吸烟者的观点；3)开发和试点社区代理人干预措施，以增加获得烟草治疗服务的机会。该项目的母公司R01测试远程医疗的有效性，通过农村初级保健设施增加美国农村盎格鲁和拉丁裔吸烟者获得循证烟草治疗的机会。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干预的效果，该干预旨在增加未被禁止的拉丁裔获得烟草治疗的机会。该项目利用多重私人调查机制，利用这些项目的首席调查员的互补优势。该项目将与巴西P.I.奥斯卡琳娜·达席尔瓦·埃兹奎尔博士及其在论坛联邦大学的工作人员合作进行。研究能力建设活动包括提供正式课程、指导研究项目和社区讲座，旨在培养开展应用临床研究的知识和技能。该项目解决了一个重大的全球健康问题，而且对巴西来说是一个高度相关的项目，巴西有大量非常贫穷的吸烟者。它还利用巴西卫生保健系统的独特结构，确定人口中的每一位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范式转变。研究项目的结果将被用于支持大规模、明确的试点干预试验的申请。如果有效，这种方法可以显著降低巴西与烟草有关的发病率和死亡率，并为国际上的基于人口的干预提供一个模式。 与公共健康相关：该项目的双重目的是1)加强巴西吸烟者获得烟草治疗的机会，2)在美国和巴西之间建立研究合作。如果有效，该项目将为增加国际上获得烟草治疗的机会提供一个模式，并将加强巴西研究人员开展应用临床研究的能力。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: The twofold purpose of this project is to 1) enhance access to tobacco treatment for Brazilian smokers, and 2) build a research collaboration between the U.S. and Brazil. If effective, the project will provide a model for increasing access to tobacco treatment internationally and will strengthen the capacity of Brazilian researchers to conduct applied clinical research.