Project 1: Break Free: Effectiveness of a multi-level smoking cessation program adapted for high-risk women in rural communities

在许多服务水平低下的阿巴拉契亚社区，吸烟率（25 - 35%）几乎是2000年的两倍。 宫颈癌的发病率在全国范围内是最高的，是该地区宫颈癌高风险的主要原因。项目1 -“挣脱” (BF)将实施和测试医疗保健提供者和经过培训的患者导航器的有效性， 戒烟干预旨在降低宫颈癌综合风险 预防方案。BF是该团队以前在适应循证吸烟方面的工作的结果 停止计划，农村人口，并将测试，完善和实施，以实现高影响力， 通过可收费的成本回收实现可持续性。BF采用标准格式的临床交付的要求，建议， 连接（AAC），然后进行4次尼古丁替代的主动电话咨询 在10个非重叠健康中心的初级保健实践中向600名成年女性吸烟者提供治疗支持 系统在阿巴拉契亚地区的四个国家（肯塔基州，俄亥俄州，弗吉尼亚州，西弗吉尼亚州）。BF将扩展到所有合资格的吸烟者 在可持续发展阶段。延迟与早期干预卫生系统组将进行比较。项目1 通过提供综合宫颈癌治疗的关键组成部分， 癌症风险降低/预防计划及其总体结果，并将依赖其共享的核心， 协调其执行、衡量、评价和传播进程。项目1的目标是 按照沿着三个不同层次的结果组织：1）服务结果：确定核心服务的有效性。 宫颈癌综合预防计划的一部分，旨在帮助女性吸烟者戒烟， 标准化临床实践支持和协议; 2）客户结果：确定对多层次 3）实施结果：通过以下方式测试多层次干预的可持续性： 对提供者和工作人员进行循证戒烟服务的咨询和计费培训。 BF在参与卫生系统的各种农村阿巴拉契亚诊所中的成功实施 在4个州，通过改善农村患者的健康状况， 获得高质量、文化敏感和当地循证的戒烟治疗。如果成功 在临床水平上是可持续的，BF可以在阿巴拉契亚农村广泛传播，以及 to healthcare医疗systems系统in other underserved欠发达geographic地理settings设置.

The prevalence of smoking (25 – 35%) in many underserved Appalachia communities is nearly double the national rate and is a major contributor to the high-risk for cervical cancer in the region. Project 1 – ‘Break Free’ (BF) will implement and test the effectiveness of a healthcare provider- and trained patient navigator-delivered smoking cessation intervention designed to reduce cervical cancer risk within an integrated cervical cancer prevention program. BF is the result of previous work of the team in adapting an evidence-based smoking cessation program to rural populations and will be tested, refined and implemented to achieve high impact and sustainability through billable cost-recovery. BF utilizes a standard format of clinical delivery of Ask, Advise and Connect (AAC) followed by 4 sessions of proactive telephone-based counseling with Nicotine Replacement Therapy support delivered to 600 adult female smokers in primary care practices of 10 non-overlapping health systems in the Appalachian region of four states (KY, OH, VA, WV). BF will be extended to all eligible smokers in the sustainability phase. Delayed versus early intervention health system groups will be compared. Project 1 is closely coordinated with the overall Program Project by providing a key component of an integrated cervical cancer risk reduction/prevention program and its overall outcome and will rely on its shared Cores for harmonization in its implementation, measurement, evaluation and dissemination processes. Project 1 aims are organized along three distinct levels of outcomes: 1) Service outcomes: Determine the effectiveness of a core component of an integrated cervical cancer prevention program designed to help female smokers quit by standardizing clinical practice supports and protocols; 2) Client outcomes: Determine satisfaction with the multilevel intervention; and 3) Implementation outcomes: Test the sustainability of the multi-level intervention via training of providers and staff on counseling and billing for evidence-based smoking cessation services. Successful implementation of BF in the diverse set of rural Appalachian clinics in participating health systems proposed, across 4 states, has the potential for a substantial and sustained impact by improving rural patients’ access to high quality, culturally sensitive, and local evidence-based smoking cessation treatment. If successfully shown to be sustainable at the clinic level, BF could be disseminated widely within rural Appalachia, as well as to healthcare systems in other underserved geographic settings.