Tobacco Cessation via Doctors of Chiropractic

描述（由申请人提供）：医生、护士、牙医和牙科保健员已经被证明在帮助他们的病人戒烟方面是有效的。然而，捏脊医生（DCs）并没有被用于这个角色！发展中国家可以为实施烟草干预提供一个独特的渠道，但他们目前在这些技术方面接受的培训很少或根本没有。脊椎按摩医生越来越关注患者使用香烟和无烟烟草的情况。整脊团队为患者提供教育和预防服务，办公室访问可以提供一个延长的机会，与患者谈论他们的烟草使用情况。考虑到长期吸烟对健康的影响，脊椎治疗的访问提供了一个“教育时刻”，在此期间，DC可以将当前的健康问题与吸烟联系起来，并为吸烟的患者提供简短的咨询。在拟议的发展研究中，8家脊椎指压诊所将参与以办公室为基础的戒烟干预的设计、实施和评估。根据以前的基于办公室的干预协议，干预将基于认知学习理论和临床实践指南，并将纳入动机性访谈技术。最后，使用RE-AIM框架，我们将评估个人、诊所和组织层面的变量，这些变量可能会影响烟草依赖治疗的提供、干预措施的实施和维持。该试点研究将用于发展和完善DC培训、研究实施、患者招募、数据收集和随访程序的设计，作为未来随机临床试验的基础。这个R21应用程序的具体目标是：1。设计和完善一种在脊椎指压治疗环境中使用的基于办公室的烟草干预措施。我们将通过使用焦点小组、访谈和对临床医生、办公室工作人员和脊椎指压治疗患者的书面调查来调整干预方案、培训形式和材料以及患者材料。干预措施的评估将以RE-AIM框架为指导。制定和完善研究实施方案、DC和患者招募程序、数据收集策略和随访程序，通过参与脊医从业人员、工作人员和患者的反复参与过程。将采用定量和定性两种方法收集数据。3. 为将来的随机临床试验准备工作手册。这项研究将在俄勒冈州的8家私人脊椎按摩诊所进行。实践将代表各种规模和设置，包括城市和农村地区，实践范围和患者人口统计。这项试点研究是基于先前研究的补充，将由一个高素质的跨学科研究团队进行，包括脊椎指压医生、行为心理学家和流行病学家。本研究的目的是为一项具有全国代表性的dc样本的随机临床试验提供基础。

DESCRIPTION (provided by applicant): Medical doctors, nurses, dentists, and dental hygienists have been shown to be effective in helping their patients quit tobacco. However, Doctors of Chiropractic (DCs) have not been utilized in this role! DCs can provide a unique channel for the conduct of tobacco interventions, but they currently receive little to no training in these techniques. Doctors of Chiropractic are increasingly concerned with patients' use of cigarettes and smokeless tobacco. The chiropractic team provides educational and preventive services to patients, and the office visit can provide an extended opportunity to talk to patients about their tobacco use. Given the health effects associated with chronic tobacco use, the chiropractic visit provides a "teachable moment" during which the DC can relate current health problems to tobacco use and provide brief counseling to patients who use tobacco. In the proposed developmental study, 8 chiropractic clinics will participate in the design, implementation, and evaluation of an office-based tobacco cessation intervention. Adapted from previous office-based intervention protocols, the intervention will be based on Cognitive Learning Theory and the Clinical Practice Guidelines and will also incorporate Motivational Interviewing techniques. Finally, using the RE-AIM framework, we will assess individual-, clinic-, and organization-level variables that may affect the delivery of treatment for tobacco dependence, the implementation and maintenance of the intervention. This pilot research will be used to develop and refine the design of DC training, study implementation, patient recruitment, data collection, and follow-up procedures to serve as a basis for a future randomized clinical trial. The specific aims of this R21 application are: 1. To design and refine an established office-based tobacco intervention for use within chiropractic settings. We will adapt the intervention protocol, training format and materials, and patient materials through the use of focus groups, interviews, and written surveys with DCs, office staff, and chiropractic patients. The evaluation of the intervention will be guided by the RE-AIM framework, 2. To develop and refine study implementation protocols, DC and patient recruitment procedures, data collection strategies, and follow-up procedures through an iterative process of engagement with participating chiropractic practitioners, staff and patients. Data will be collected using both quantitative and qualitative methods. 3. Prepare a working Manual of Procedures for a future randomized clinical trial. This study will be conducted in 8 private chiropractic clinics throughout Oregon. The practices will represent a variety of sizes and settings, including both urban and rural locations, scope of practice, and patient demographics. This pilot research is based on complementary lines of previous research, and will be conducted by an interdisciplinary team of highly qualified researchers, including Doctors of Chiropractic, behavioral psychologists, and epidemiologists. The goal of this study is to provide the foundation for a randomized clinical trial with a nationally-representative sample of DCs.