Integrating tobacco intervention into a health maintenance organization: The TRACC program

Interventions to reduce use of tobacco have not been effectively integrated into health care delivery systems. Tobacco Reduction and Cancer Control (TRACC) is a five-project, National Cancer Institute funded program of research which involves the design, implementation and evaluation of a variety of tobacco intervention approaches embedded into the daily operations of a large health maintenance organization (HMO). The interventions are designed to reach large numbers of tobacco users in the routine course of their encounters with the health care system, to encourage and support decisions to quit using tobacco, and to do so at a relatively low cost and without requiring substantial provider time or effort. The projects separately evaluate approaches to tobacco use in medical offices, dental offices, the hospital and worksite, and also mail/interview contacts with adolescent smokers. Ultimately the goal of TRACC is to develop practical approaches to tobacco use for large health care organizations. The materials and approaches developed by TRACC are widely disseminable. Those approaches found to be effective will be delivered to the entire membership of the HMO in order to reduce smoking rates to 15% of adults. This paper describes the background, structure and interventions of TRACC.