Urban and Reservation Implementation of All Nations Breath of Life to Improve Smoking Cessation Rates among American Indians

项目总结 肺癌是癌症死亡的主要原因，心血管疾病是导致癌症死亡的总原因。 美国印第安人死亡(AI)。导致过早死亡的一个主要风险因素是 人工智能的吸烟率是美国所有主要种族中最高的，为31.8%，几乎是两者的两倍 美国黑人和白人。尽管吸烟和烟草相关疾病的比率很高，但很少有人 研究人员已经解决了这个问题，部分原因是烟草对许多人工智能来说是神圣的植物，不能 完全消极对待，就像大多数戒烟计划一样。密歇根大学的研究人员 堪萨斯医学中心(KUMC)和约翰逊县社区学院(JCCC)一直在与人工智能合作 社区使用基于社区的参与性研究(CBPR)来解决娱乐烟草问题，因为 2003年。我们共同制定了一个成功的文化定制的戒烟计划，所有国家的呼吸 生命(ANBL)，尊重烟草作为一种神圣的植物，并促进尊重它而不是滥用它 娱乐方面。我们的面对面、基于小组的计划的意图戒烟率为27.9%，而 在一项基于保留的疗效试验中，在治疗结束时(12周)进行当前最佳实践比较 (n=463)。6个月时停药率分别为20%和12%(p=0.02)。在大城市实施的可行性 试点(五个州的N=312)，我们在6个月内的戒烟率为22%(P&lt；0.002，而最高的是 之前报告的城市人工智能人口的戒烟率)；我们的保留率为71%。因为ANBL有 在保留地人口中被证明是有效的，在城市人口中显示出希望，因为 烟草滥用问题在保护区和城市人工智能社区的重要性，我们相信 谨慎地采取行动，迅速实施和传播《反洗钱法》。因此，我们建议 通过有效性-实施类型2混合设计进行持续的有效性测试。这种设计允许 用于有效性测试和同步实现测试，以将计划推向大规模 在研究结束时进行传播。我们将解决以下具体目标：(1)评估7天 每个社区站点在6个月(24周)时的点流行率过期CO验证戒烟率 在两个城市和两个保留地随机化和实施ANBL后的参与个体 社区(N=576)，使用等待列表控制设计。我们假设在ANBL的离职率将为21% ARM和9%在每个站点的个人等待名单控制臂中；(2)确定方案和 加强ANBL实施并决定计划成败的组织因素 以RE-AIM(REACH、有效性、采用、实施、维护)和综合为指导 实施研究框架(CFIR)方法；和(3)比较不同的资源和 在每个受让人场地用于交付ANBL的成本。

PROJECT SUMMARY Lung cancer is the leading cause of cancer death and cardiovascular disease is the overall leading cause of death among American Indians (AI). A major risk factor contributing to this premature mortality is the fact that AI have the highest smoking rates of all major ethnic groups in the US, at 31.8%, nearly double that of both African Americans and Whites. Despite these high rates of smoking and tobacco-related illness, few researchers have addressed this issue, in part because tobacco is a sacred plant to many AI and cannot be treated completely negatively, as most smoking cessation programs do. Researchers at the University of Kansas Medical Center (KUMC) and Johnson County Community College (JCCC) have been working with AI communities using community-based participatory research (CBPR) to address recreational tobacco since 2003. Together we have developed a successful culturally tailored cessation program, All Nations Breath of Life (ANBL), that respects tobacco as a sacred plant and promotes honoring it rather than abusing it recreationally. Our in-person, group-based program had an intent-to-treat quit rate of 27.9% versus 17.4% in a current best practices comparison arm at end of treatment (12 weeks) in a reservation-based efficacy trial (N=463). Cessation rate was 20% vs. 12% at 6 months (p=0.02). In a large urban implementation feasibility pilot (N=312 across sites in five states), our quit rate was 22% at 6-months (p<0.002 compared to the highest previously reported quit rates for an urban AI population); our retention rate was 71%. Because ANBL has been proven efficacious in reservation populations and shows promise in urban populations and because of the significance of the tobacco abuse problem in both reservation and urban AI communities, we believe it prudent to move towards expeditious implementation and dissemination of ANBL. Therefore, we propose continued efficacy testing through an effectiveness-implementation type 2 hybrid design. This design allows for efficacy testing with simultaneous implementation testing to move the program towards large-scale dissemination at the conclusion of the study. We will address the following specific aims: (1) To assess 7-day point prevalence expired CO validated quit rates at 6 months (24 weeks) at each community site among participating individuals following randomization and implementation of ANBL in two urban and two reservation communities (N=576), using a waitlist control design. We hypothesize that quit rates will be 21% in the ANBL arm and 9% in the waitlist control arm of individuals at each site; (2) To identify programmatic and organizational factors that enhance implementation of ANBL and contribute to program success or failure guided by RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and Consolidated Framework for Implementation Research (CFIR) approaches; and (3) To compare different resources and costs used in each grantee site for delivery of ANBL.