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Because tobacco use remains one of the leading causes of disease, disability, and mortality, tobacco treatment programs should be integrated into medical systems such as hospitals and outpatient centers. Medical providers have a unique, high-impact opportunity to initiate smoking cessation treatment with patients. However, there are several barriers that may hinder the development and implementation of these programs. The purpose of this review was to address such barriers by illustrating several examples of successful tobacco treatment programs in US health-care systems that were contributed by the authors. This includes describing treatment models, billing procedures, and implementation considerations. Using an illustrative review of vignettes from existing programs, various models are outlined, emphasizing commonalities and unique features, strengths and limitations, resources necessary, and other relevant considerations. In addition, clinical research and dissemination trials from each program are described to provide evidence of feasibility and efficacy from these programs. This overview of example treatment models designed for hospitals and outpatient centers provides guidelines for any emerging tobacco cessation services within these contexts. For existing treatment programs, this review provides additional insight and ideas about improving these programs within their respective medical systems.
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Instituições de Assistência Ambulatorial , Hospitais , Tabagismo/terapia , Humanos , Modelos Teóricos , Estados UnidosRESUMO
Tobacco use is causally associated with the risk of developing multiple health conditions, including over a dozen types of cancer, and is responsible for 30% of cancer deaths in the U [...].
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Quitting smoking leads to improved outcomes for patients with cancer, yet too few patients receive cessation services during their oncology healthcare visits. The National Cancer Institute (NCI) dedicated Cancer Moonshot funding for NCI-Designated Cancer Centers to develop a population-based approach to reach all patients who smoke with tobacco treatment services. As a result, the Cancer Center Cessation Initiative (C3I) offers an unparalleled opportunity to identify effective implementation strategies and barriers to delivering tobacco treatment services across multiple clinical oncology settings. Over one year after receiving funding, the first cohort of C3I funded Centers demonstrated progress in hiring tobacco treatment specialists, adding new tobacco treatment programs, and integrating EHR-based tobacco treatment referrals. However, tobacco treatment program reach remains low in some settings, even using a broad definition of patient engagement. Centers identified implementation challenges related to staff training needs, devising new clinical workflows, and engagement of IT leadership. Understanding implementation challenges may help other clinical oncology settings effectively implement tobacco treatment programs, leading to improved cancer outcomes by helping patients quit smoking.
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Institutos de Câncer/estatística & dados numéricos , Implementação de Plano de Saúde , Neoplasias/reabilitação , Abandono do Hábito de Fumar/métodos , Fumar Tabaco/prevenção & controle , Humanos , National Cancer Institute (U.S.) , Abandono do Hábito de Fumar/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Estados UnidosRESUMO
INTRODUCTION: Concomitant use of two forms of tobacco is an increasing public health concern, yet there is little consensus regarding a consistent definition of so-called "dual use." We defined dual use as cigarette and smokeless tobacco (ST) consumption with either product used daily or nondaily. METHODS: We analyzed a cohort of 36,013 Air Force recruits. We categorized dual tobacco use across 2 dimensions, type of tobacco products (cigarettes, ST, or others), and the frequency of use (daily vs. nondaily). We determined how varying the definition impacted the prevalence estimates and evaluated the prevalence estimate based on our recommended definition of dual use. Multivariate logistic regression analysis was used to evaluate the risk profile of dual users of ST and cigarettes versus mono users of ST and mono users of cigarettes. RESULTS: Varying definitions of dual use vary prevalence estimates 50-fold (0.5%-25.3%). Including only ST and cigarettes narrows the prevalence estimate to less than 4-fold (2.0%-9.7%). Dual users are more likely to be young Caucasian males, with lower education, and from families with relatively higher incomes. Compared with mono users, dual users of cigarettes and ST have a distinct pattern of risk profiles. CONCLUSIONS: Depending on the definition of dual use, markedly different prevalence and risk profiles are observed. Dual users of ST and cigarettes are a unique group of tobacco users. We propose a common definition of dual use to advance our understanding of this unique group.
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Fumar/epidemiologia , Terminologia como Assunto , Tabaco sem Fumaça , Adolescente , Alcoólicos , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Militares , Prevalência , Assunção de Riscos , Abandono do Uso de Tabaco , Estados Unidos/epidemiologia , Adulto JovemRESUMO
PURPOSE: As the science of team science evolves, the development of measures that assess important processes related to working in transdisciplinary teams is critical. Therefore, the purpose of this paper is to present the psychometric properties of scales measuring collaborative processes and transdisciplinary integration. METHODS: Two hundred-sixteen researchers and research staff participating in the Transdisciplinary Tobacco Use Research Centers (TTURC) Initiative completed the TTURC researcher survey. Confirmatory-factor analyses were used to verify the hypothesized factor structures. Descriptive data pertinent to these scales and their associations with other constructs were included to further examine the properties of the scales. RESULTS: Overall, the hypothesized-factor structures, with some minor modifications, were validated. A total of four scales were developed, three to assess collaborative processes (satisfaction with the collaboration, impact of collaboration, trust and respect) and one to assess transdisciplinary integration. All scales were found to have adequate internal consistency (i.e., Cronbach alpha's were all >0.70); were correlated with intermediate markers of collaborations (e.g., the collaboration and transdisciplinary-integration scales were positively associated with the perception of a center's making good progress in creating new methods, new science and models, and new interventions); and showed some ability to detect group differences. CONCLUSIONS: This paper provides valid tools that can be utilized to examine the underlying processes of team science--an important step toward advancing the science of team science.
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Comportamento Cooperativo , Processos Grupais , Comunicação Interdisciplinar , Psicometria/estatística & dados numéricos , Pesquisadores/estatística & dados numéricos , Atitude , Humanos , Relações Interprofissionais , Modelos Psicológicos , Satisfação Pessoal , Avaliação de Programas e Projetos de Saúde , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Recent epidemiologic data on the stabilization of adult and youth smoking rates underscore the need for vigorous research across the cancer control spectrum on tobacco use interventions. The steady decline in adult rates of smoking has stalled for the first time in 8 years, and certain race, ethnic, and population groups are disproportionately at risk to tobacco-related cancers because of disparities in tobacco use or access to effective interventions. Although substantial progress has been made across levels of basic through applied research, tobacco-control research across the discovery and delivery continuum must be accelerated to further reduce the cancer burden. Following a brief review of the prevalence and trends affecting tobacco use initiation and cessation, we identify and describe four domains of extraordinary research opportunities: genetics and gene-environment interactions, bioinformatics and health informatics, disparities and disproportionate risk, and prevention and treatment. Evolutionary scientific changes, like rapidly advancing technology and emphasis on the paradigm of team science research approaches, provide both a challenge as well as unparalleled opportunities for scientific advancement and public health progress.
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Pesquisa Biomédica , Promoção da Saúde/métodos , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Fumar/epidemiologia , Humanos , Neoplasias/etiologia , Neoplasias/prevenção & controle , Prevalência , Saúde Pública/métodos , Nicotiana/efeitos adversosRESUMO
Cigarette smoking is the largest preventable cause of death and morbidity in the United States. Heightened recognition of this public health concern has led researchers from multiple and varied disciplines to address this complex and multidimensional behavior. The need for an alternative research paradigm, focusing on a transdisciplinary approach that integrates work across disciplines in order to advance the field most quickly, has been identified. This recognized need led to the development of the Transdisciplinary Tobacco Use Research Centers (TTURC) initiative, funded jointly by the National Cancer Institute, the National Institute on Drug Abuse, and The Robert Wood Johnson Foundation. This paper discusses the formation and early implementation stages of the initiative, including meetings that led to the development of the TTURCs, funders' and research centers' perspectives on implementation, and early observations about the products of the initiative.