While smoking rates have declined between 1998 and 2007, persons with lower levels of education and those below the poverty level exhibit higher rates of smoking. Although office visits represent an opportunity for clinicians to engage smokers in the topic of cessation, that topic competes with other acute and chronic medical problems and is often overiooked. Automated voice recognition (AVR) systems represent an emerging technology which has been demonstrated to have utility in optimizing chronic disease management through interactive telephone educational messages to patients. AVR may represent a viable platform for managing other chronic diseases, including nicotine dependence. This research will combine AVR with the use of Practice Enhancement Associates (PEAs) to create systems changes in medical offices to support the development of smokers'registries to address cessation beyond the primary care medical office. A mixed methods approach will be used to optimize culturally relevant messaging to smokers identified from i) African American and ii) underserved rural community based primary care medical offices. Translation will include steps to ensure that the cessation messaging is relevant based on focus group, clinician and community advisor input.
Specific aims of the project include: 1) characterizing tailored cessation messages to be delivered via AVR technologies to smokers recruited from primary care medical offices, 2) determining the impact of practice-based "smoker's registry" toward positively influence smoking cessation efforts in primary care physician (PCP) offices;and 3) examining the comparative influence ofthe Practice Enhancement Associates (PEAs) activities (i.e.,"smoker's registry") and AVR to increase patient cessation behaviors compared to standard practices within urban African American and rural underserved communities.
The proposed effort is innovative and theory-driven, with strong implications for improving tobacco control in community settings. Because tobacco use is a useful proxy measure for other unhealthy behaviors, this smokers'registry represents a potential resource for the delivery of other health behavior change interventions to address behavioral problems which contribute to the growing burden of chronic diseases.
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