Tobacco Cessation Via Doctors of Chiropractic

Medical doctors, nurses, dentists, and dental hygienists have been shown to be effective in
helping their patients quit tobacco. However, Doctors of Chiropractic (DCs) have not been
utilized in this role. DCs can provide a unique channel for the conduct of tobacco
interventions, but they currently receive little to no training in these techniques (Hawk &
Evans, 2005). Doctors of Chiropractic are increasingly concerned with patients’ use of
cigarettes and smokeless tobacco. The chiropractic team provides educational and preventive
services to patients, and the office visit can provide an extended opportunity to talk to
patients about their tobacco use (Hawk, Long, Perillo, & Boulanger, 2004; Rupert, 2000).
Given the health effects associated with chronic tobacco use, the chiropractic visit
provides a “teachable moment” during which the DC can relate current health problems to
tobacco use and provide brief counseling to patients who use tobacco (Gordon & Severson,
2001; Vogt, Lichtenstein, Ary, et al., 1989).

In the proposed developmental study, eight chiropractic clinics will participate in the
design, implementation, and evaluation of an office-based tobacco cessation intervention.
Adapted from previous office-based intervention protocols, the intervention will be based on
Cognitive Learning Theory (Bandura, 1997) and the Clinical Practice Guidelines (Fiore,
Bailey, Cohen, et al., 2000) and will also incorporate Motivational Interviewing techniques
(Miller & Rollnick, 1991). Finally, using the RE-AIM framework (Glasgow, Vogt & Boles,
1999), we will assess individual-, clinic-, and organization-level variables that may affect
the delivery of treatment for tobacco dependence, the implementation and maintenance of the
intervention.