Abstract
BackgroundTobacco use remains the leading cause of morbidity and mortality in the US. Effective tobacco cessation aids are widely available, yet underutilized. Tobacco cessation brief interventions (BIs) increase quit rates. However, BI training has focused on conventional medical providers, overlooking other health practitioners with regular contact with tobacco users. The 2007 National Health Interview Survey found that approximately 20% of those who use provider-based complementary and alternative medicine (CAM) are tobacco users. Thus, CAM practitioners potentially represent a large, untapped community resource for promoting tobacco cessation and use of effective cessation aids. Existing BI training is not well suited for CAM practitioners’ background and practice patterns, because it assumes a conventional biomedical foundation of knowledge and philosophical approaches to health, healing and the patient-practitioner relationship. There is a pressing need to develop and test the effectiveness of BI training that is both grounded in Public Health Service (PHS) Guidelines for tobacco dependence treatment and that is relevant and appropriate for CAM practitioners.Methods/DesignThe CAM Reach (CAMR) intervention is a tobacco cessation BI training and office system intervention tailored specifically for chiropractors, acupuncturists and massage therapists. The CAMR study utilizes a single group one-way crossover design to examine the CAMR intervention’s impact on CAM practitioners’ tobacco-related practice behaviors. Primary outcomes included CAM practitioners’ self-reported conduct of tobacco use screening and BIs. Secondary outcomes include tobacco using patients’ readiness to quit, quit attempts, use of guideline-based treatments, and quit rates and also non-tobacco-using patients’ actions to help someone else quit.DiscussionCAM practitioners provide care to significant numbers of tobacco users. Their practice patterns and philosophical approaches to health and healing are well suited for providing BIs. The CAMR study is examining the impact of the CAMR intervention on practitioners’ tobacco-related practice behaviors, CAM patient behaviors, and documenting factors important to the conduct of practice-based research in real-world CAM practices.
Highlights
Tobacco use remains the leading cause of morbidity and mortality in the US
complementary and alternative medicine (CAM) practitioners provide care to significant numbers of tobacco users. Their practice patterns and philosophical approaches to health and healing are well suited for providing Brief intervention (BI)
The 2002 National Health Interview Survey (NHIS) reported 36% of adults used some form of CAM therapy in the previous 12 months [10], a figure that had increased to nearly 40% by 2007 [11]
Summary
The CAM Reach system intervention targets both individual CAM practitioner clinical practice behavior and the office systems that shape practice behavior. In spite of co-location in a space, CAM practitioners tend to function independently of one another, and many practitioners operate out of one or more locations. This makes a focus on practitioners, rather than sites or practices, essential. There is a pressing need to examine the role of CAM practitioners in promoting and sustaining healthy behaviors such as tobacco cessation as members of a public health community of practice [24]. Results from the CAMR study will contribute to a better understanding of the role CAM practitioners can play in public health and the possibility of forming collaborative communities of practices around health behavior change such as tobacco cessation.
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