• To design and refine our brief office-based tobacco intervention to use within chiropractic settings. [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  
• To develop and refine study implementation protocols, DC and patient recruitment procedures, data collection strategies, and follow-up procedures. [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  
• Prepare a working Manual of Procedures for a future randomized clinical trial. [ Time Frame: 24 months ] [ Designated as safety issue: No ]
  

• Evaluate the reach of the intervention through an evaluation of the proportion of tobacco users of consenting age who give consent, the proportion who complete the baseline survey, and the reasons for not participating of those who decline. [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  
• Evaluate the adoption of the intervention by interviewing clinic staff to identify the organizational-level factors that are related to participation. [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  
• Assess the implementation of the intervention through an examination of patient report of receipt of the intervention components and change in providers' behavior and attitudes as a function of training. [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  
• Explore the short-term maintenance of the intervention through an examination of change in provider behavior from baseline to 12 months after training and through an examination of change in clinic-level procedures. [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  

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.