Tobacco Cessation via Doctors of Chiropractic

描述（由申请人提供）：医生，护士，牙医和牙科医生已被证明是有效的帮助他们的病人戒烟。然而，脊椎指压治疗医生（DCs）并没有被用于这一角色！发展中国家可以为烟草干预提供一个独特的渠道，但它们目前几乎没有接受过这些技术方面的培训。脊椎指压治疗的医生越来越关注病人使用香烟和无烟烟草。脊椎治疗团队为患者提供教育和预防服务，办公室访问可以提供更多的机会与患者谈论他们的烟草使用。考虑到与慢性烟草使用相关的健康影响，脊椎按摩治疗提供了一个“可教的时刻”，在此期间，DC可以将当前的健康问题与烟草使用联系起来，并为吸烟患者提供简短的咨询。在拟议的发展研究中，8个脊椎按摩诊所将参与设计，实施和评估办公室戒烟干预。从以前的办公室为基础的干预协议改编，干预将基于认知学习理论和临床实践指南，也将纳入动机访谈技术。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。这项试点研究将用于开发和完善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。本R21应用程序的具体目标是：1。设计和完善一个既定的基于办公室的烟草干预在脊椎治疗环境中使用。我们将通过使用焦点小组、访谈和书面调查，对区议会、办公室工作人员和脊椎指压治疗患者调整干预方案、培训形式和材料以及患者材料。干预的评估将由RE-AIM框架指导，2。通过与参与的脊椎指压治疗从业者、工作人员和患者的互动过程，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。将使用定量和定性方法收集数据。3.为将来的随机临床试验准备工作手册。本研究将在整个俄勒冈州的8家私人脊椎按摩诊所进行。这些实践将代表各种规模和环境，包括城市和农村地区，实践范围和患者人口统计学。这项试点研究是基于以前研究的补充线，并将由一个高素质的研究人员，包括脊椎指压治疗医生，行为心理学家和流行病学家的跨学科团队进行。本研究的目的是为具有全国代表性的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.