title: Tobacco brief intervention training for chiropractic, acupuncture, and massage practitioners: protocol for the CAM reach study.
abstract: BACKGROUND
  Tobacco 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
  The 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.
  
  
  CONCLUSIONS
  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 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.
authors.affiliation: Department of Family and Community Medicine, University of Arizona College of Medicine, 1450 N, Cherry Avenue, Tucson, AZ 85719, USA. myram@email.arizona.edu.
authors.forename: Myra L
authors.initials: ML
authors.lastname: Muramoto
authors.forename: Amy
authors.initials: A
authors.lastname: Howerter
authors.forename: Eva
authors.initials: E
authors.lastname: Matthews
authors.forename: Lysbeth
authors.initials: L
authors.lastname: Floden
authors.forename: Judith
authors.initials: J
authors.lastname: Gordon
authors.forename: Mark
authors.initials: M
authors.lastname: Nichter
authors.forename: James
authors.initials: J
authors.lastname: Cunningham
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ritenbaugh
mesh_terms: D015670:Acupuncture Therapy; D002684:Chiropractic; D000529:Complementary Therapies; D004493:Education; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008405:Massage; D015397:Program Evaluation; D012107:Research Design; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D014029:Tobacco Use Disorder / Q000628:therapy*; D014481:United States; D062789:Tobacco Products