Tobacco Cessation Training for accupuncture, massage, and chiropractic practition

针灸、按摩和脊椎按摩疗法的戒烟培训

• 批准号: 7728651
• 负责人: MYRA L. MURAMOTO
• 金额: $ 62.65万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7728651
• 关键词: Acupuncture procedure; Address; Adult; Advisory Committees; Attitude; Behavior; Chinese Traditional Medicine; Chiropractor; Client; Clinical; Clinical Practice Guideline; Communities; Complementary and alternative medicine; Data; Dental; Educational Intervention; Effectiveness; Environment; Guidelines; Health Personnel; Healthcare; Individual; Intervention; Knowledge; Maintenance; Massage; Measures; Medical; Medicine; Methods; Modality; Morbidity - disease rate; National Health Interview Survey; Nurses; Patient Education; Patient Self-Report; Patients; Pattern; Phase; Phase II Clinical Trials; Phase III Clinical Trials; Physicians; Play; Population; Preparation; Preventive; Primary Health Care; Provider; Randomized; Randomized Controlled Trials; Readiness; Reporting; Research; Research Training; Resources; Role; Sampling; Screening procedure; Self Efficacy; Services; Smoke; Social Network; Source; System; Testing; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; Training; United States; United States Public Health Service; Visit; Withholding Treatment; base; behavior change; brief intervention; chiropracty; conventional therapy; cost; design; evidence base; experience; mortality; multi-site trial; patient population; primary outcome; public health relevance; screening and brief intervention; secondary outcome; success; training project

DESCRIPTION (provided by applicant): Tobacco use remains the leading cause of morbidity and mortality in the United States. Effective tobacco cessation treatments are more widely available than ever before, yet remain underutilized. Tobacco cessation brief interventions (BIs) are low-cost and effective for increasing quit attempts and quit rates. However, BI training has focused primarily on conventional medical providers, largely overlooking other community-based health care and wellness practitioners who see tobacco users in their client and patient populations. Data from the 2004 National Health Interview Survey indicate that 36% of U.S. adults use some form of complementary and alternative medicine (CAM), and among those individuals, approximately 20% are tobacco users. Thus, CAM practitioners represent a large, untapped community resource for promoting tobacco cessation. Existing cessation intervention training is not suitable for the background and practice patterns of CAM practitioners, as it assumes a background in conventional biomedicine. Thus there is a pressing need to develop and test the effectiveness of cessation training that is grounded in guideline-based treatment and that is relevant and appropriate for CAM practitioners. The current proposal addresses this gap and builds on our prior research in community-based tobacco BI training and research with CAM practitioners. Primary aims are to: 1) conduct a multi-method study with three types of CAM practitioners (chiropractors, massage therapists, and acupuncture/Traditional Chinese Medicine practitioners) to document their knowledge, attitudes and experiences regarding tobacco dependence and cessation, and to elicit a range of practice patterns and scenarios in which to provide tobacco cessation interventions; 2) tailor a tobacco cessation BI training for CAM practitioners that is part of an office system intervention (called CAM Reach); 3) conduct a cluster-randomized lagged intervention Phase 2 study of CAM Reach in 60 CAM practices that will: a) test the feasibility and acceptability of implementing the CAM Reach intervention; and b) evaluate its effect on the primary outcomes of CAM practitioners' conduct of tobacco use screening and brief interventions and secondary outcomes of patients' readiness to quit, quit attempts, use of guideline-based tobacco cessation treatments and quit rates. A secondary aim is to explore CAM Reach's effect on patients who are do not use tobacco but want to help someone else quit, with respect to knowledge cessation aids and actions to help the user quit. Results of the Phase 2 trial will provide the necessary parameters, e.g. effect size and intraclass correlation, to design a Phase 3 multi-site trial. To this end, we also propose a qualitative study of a sample of trained CAM providers and their patients to examine factors associated with CAM providers' implementation and maintenance of cessation intervention behaviors, and changes in patients' tobacco use. We hypothesize that: 1) Trained CAM practitioners will have significantly higher rates of screening and delivery of tobacco cessation BIs compared to untrained CAM practitioners; and 2) Patients of trained CAM practitioners will have significantly higher rates of quit attempts and use of evidence-based tobacco cessation aids, than patients of untrained CAM practitioners. PUBLIC HEALTH RELEVANCE: Practitioners of Complementary and Alternative Medicine (CAM) are an important source of health care for the US population, including tobacco users. The proposed research will tailor and evaluate a tobacco cessation brief intervention training and office system intervention for 3 types of CAM practitioners: acupuncture/Traditional Chinese Medicine, massage, and chiropractic.

描述（由申请人提供）：烟草使用仍然是美国发病和死亡的主要原因。有效的戒烟治疗比以往任何时候都更加广泛，但仍未得到充分利用。戒烟短期干预措施 (BI) 成本低廉，可有效增加戒烟尝试和戒烟率。然而，BI 培训主要集中于传统医疗提供者，很大程度上忽视了其他社区医疗保健和健康从业者，他们在客户和患者群体中看到烟草使用者。 2004 年全国健康访谈调查的数据表明，36% 的美国成年人使用某种形式的补充和替代医学 (CAM)，其中大约 20% 是烟草使用者。因此，CAM 从业者代表了促进戒烟的大量未开发的社区资源。现有的戒烟干预培训不适合CAM从业者的背景和实践模式，因为它假定其具有传统生物医学背景。因此，迫切需要开发和测试戒烟培训的有效性，该培训以基于指南的治疗为基础，并且与 CAM 从业者相关且合适。当前的提案解决了这一差距，并建立在我们之前对基于社区的烟草 BI 培训和 CAM 从业者研究的研究之上。主要目的是：1) 对三类 CAM 从业者（脊椎按摩师、按摩治疗师和针灸/中医从业者）进行多方法研究，记录他们关于烟草依赖和戒烟的知识、态度和经验，并得出结论提供戒烟干预措施的一系列实践模式和情景； 2) 为 CAM 从业者量身定制戒烟 BI 培训，这是办公系统干预措施的一部分（称为 CAM Reach）； 3) 在 60 个 CAM 实践中进行 CAM Reach 整群随机滞后干预第二阶段研究，该研究将： a) 测试实施 CAM Reach 干预的可行性和可接受性； b) 评估其对 CAM 从业人员进行烟草使用筛查和简短干预的主要结果的影响，以及患者戒烟准备、戒烟尝试、基于指南的戒烟治疗的使用和戒烟率的次要结果的影响。第二个目标是探讨 CA​​M Reach 对不吸烟但想要帮助其他人戒烟的患者的影响，包括戒烟知识和帮助用户戒烟的行动。第二阶段试验的结果将提供必要的参数，例如效应大小和组内相关性，设计 3 期多中心试验。为此，我们还建议对经过培训的 CAM 提供者及其患者样本进行定性研究，以检查与 CAM 提供者实施和维持戒烟干预行为以及患者烟草使用变化相关的因素。我们假设： 1) 与未经培训的 CAM 从业者相比，经过培训的 CAM 从业者的筛查和提供戒烟 BI 的比率显着更高； 2) 与未经培训的 CAM 从业人员的患者相比，经过培训的 CAM 从业人员的患者尝试戒烟和使用循证戒烟辅助工具的比率显着更高。公共卫生相关性：补充和替代医学 (CAM) 的从业者是美国人口（包括烟草使用者）医疗保健的重要来源。拟议的研究将为针灸/中医、按摩和脊椎按摩这 3 种 CAM 从业者定制和评估戒烟简短干预培训和办公系统干预。