Support through the K23 Award will provide the Candidate the necessary time, resources, and mentorship to integrate his clinical interests in substance use disorders with his experience in patient-oriented emergency medicine research. His long-term career plan involves using the knowledge gained from the tobacco smoking and nicotine dependence studies outlined in this proposal as a model for future studies of other substances that are commonly abused by emergency department patients, such as alcohol, cocaine, opiates, and """"""""club"""""""" drugs. The emergency department (ED) represents a significant portion of all healthcare delivered in the United States, with 100 million ED visits annually. Approximately 50% of the patients seen in the ED have no source of regular outpatient care, and the ED acts as a healthcare """"""""safety net"""""""" for people with inadequate healthcare insurance. Healthy People 2010 and other government publications have encouraged screening and interventions for tobacco smoking to be conducted during all healthcare encounters, regardless of the setting. However, the extant literature, as well as the Candidate's own pilot studies, indicate that such practices are rare in ED settings. This is true despite the fact that many of the populations shown to be most recalcitrant in their smoking, such as the economically disadvantaged and minorities, are more likely to use the ED for their acute and primary healthcare. If smoking is not addressed with these patients in the ED, it may not get addressed at all. Numerous studies have shown that brief, ED-based interventions for problem behaviors, like alcohol and substance abuse, are both feasible and effective. The noted lack of ED-based screening and intervention for tobacco smoking and nicotine dependence appears due mainly to a lack of relevant research and advocacy rather than a lack of need or barriers prohibiting such practices. The Candidate's career development plan will incorporate needed course work, field experience, and mentorship in data management, study design, statistics, and tobacco research methodology. The research plan concentrates on ED-based tobacco research, beginning with a surveillance study and culminating in a Stage 1A/B behavioral therapy development study of a Behavioral Change Counseling intervention based on principles of Motivational Interviewing. The research plan includes preparing and submitting an R01 in Year 2.
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