Optimizing Treatment for Brazilian Smokers through Community-Based Primary Care

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）的签署国来与这一趋势背道而驰。帮助吸烟者戒烟是FCTC的核心条款。虽然巴西提供了循证烟草治疗的普遍覆盖，但在烟草流行率和获得治疗方面仍然存在差距。该项目有两个目的：1）开展一项研究项目，以了解和提高巴西吸烟者获得烟草治疗的机会; 2）建立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合作，以实现以下具体目标：1）创建一个具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）描述医疗保健提供者对如何最好地接触低收入吸烟者的看法; 3）制定并试行社区代理干预措施，以增加获得烟草治疗服务的机会。该项目的Parent R 01测试了远程医疗的有效性，以通过农村初级保健设施增加美国农村盎格鲁和拉丁美洲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-基于非专业卫生工作者的干预措施，旨在增加非禁令拉丁美洲人获得烟草治疗的机会。该项目利用多个P.I.我们需要建立一个机制，以利用这些项目的主要研究人员的互补优势。该项目将与巴西P.I. Oscarina da Silva Ezequiel博士和她在Universidade联邦de Juiz de Fora（UFJF）的工作人员。研究能力建设活动包括正式的课程设置，指导研究项目，旨在建立知识和技能进行应用临床研究的社区讲座。该项目针对的是一个重大的全球健康问题，对于拥有大量贫穷吸烟者的巴西来说，这是一个高度相关的项目。它还利用巴西卫生保健系统的独特结构，查明人口中的每一个吸烟者，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。研究项目结果将用于支持试点干预的大规模确定性试验的申请。如果有效，这一方法可以大幅降低巴西与烟草有关的发病率和死亡率，并为国际上基于人口的干预提供一个模式。 公共卫生相关性：该项目有两个目的：1）增加巴西吸烟者获得烟草治疗的机会，2）建立美国和巴西之间的研究合作。如果有效，该项目将为在国际上增加烟草治疗提供一个模式，并将加强巴西研究人员进行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.