Cessation programs are a key component of comprehensive tobacco control, producing public health benefits more quickly, and with greater magnitude, than any other component. Currently states have spent or are preparing to spend significant dollars on training models to develop and/or expand tobacco cessation programs as part of their investment in statewide tobacco control, and discussion has already begun at the national level regarding the need for training and certification programs. The PHS guidelines for treatment of tobacco dependence reaffirmed earlier meta-analyses demonstrating the effectiveness of brief interventions for tobacco cessation, and the effectiveness of a range of provider types as interventionists. While extended counseling and pharmacotherapy can generate higher long term quit rates, the gain in efficacy is insufficient to offset the higher cost, leading to costs p e r quitter that are several times higher than those found under low-intensity, brief intervention. To maximize the reduction in smoking attained under a given tobacco control budget, the cost-effectiveness advantages of low-intensity treatments suggest that brief interventions should be extended to as many smokers as possible. The emphasis on healthcare providers and systems for broad dissemination of brief interventions at the community level has been insufficient, missing opportunities to activate the broad range of human service providers (e.g. social services, education, human resources, law and corrections, clergy, and community outreach workers) as interventionists. There is an urgent need to examine training models a p p licable to large-scale community-based implementation in terms of effectiveness, cost, accessibility and acceptability. This project will compare two models of brief intervention training to each other and to a usual practice control group within the target population of human services providers. The primary outcome is the rate of brief interventions for tobacco cessation performed in the community. As a secondary measure, this project will test the effect of each model of training on rates of referral to more intensive tobacco cessation programs, and the attitudes and behaviors of training participants with regard to: reduction of environmental tobacco smoke (ETS) in personal spaces and support of tobacco control policies in the workplace and community. The project will be accomplished in four-phases: Phase I will focus on revision of traditional in-person (IP) training curriculum for use with a population of human services providers, followed by design and production of analogous interactive, multimedia Internet (Web) curriculum. Phase II: Beta testing of Web curriculum through the World Wide Web (WWW) in preparation for randomized controlled effectiveness trial. Phase III: Randomized controlled study testing the relative effectiveness (and cost effectiveness) of the IP and Web models to each other and to a usual practice control group. Phase IV: Dissemination study of the training model shown to be most effective though participating community partners.
