Adaptation and testing of a novel text-based tobacco cessation and education intervention in Kenyan Emergency Department patients

项目摘要 非传染性疾病（NCD）是全球死亡的主要原因，占全球死亡率的70%。 全球范围内的死亡人数，其中80%发生在低收入和中等收入国家（LMIC）。烟草使用，一个主要的 非传染性疾病的风险因素，每年造成800万人死亡。在世界所有区域中，非洲拥有 到2025年，烟草使用的预计增幅最高（37%），尽管美洲的使用预计将减少 百分之五十四需要采取干预措施，解决非洲和其他中低收入国家烟草使用激增的问题， 全球烟草死亡人数急诊科（艾德）人群是一个高危人群， 针对非传染性疾病和烟草等非传染性疾病风险因素的干预措施。然而，对艾德人群的研究表明， 低收入国家数量有限。我们的团队领导了对非洲艾德人群的研究，包括进行最大规模的 非传染性疾病的流行病学研究，并表明非传染性疾病的负担和非传染性疾病的风险因素，如 烟草，在艾德人群中比一般人群更严重。移动的健康 在高收入国家和发展中国家， 我们的团队和其他人所展示的美国基于ED的mHealth干预措施。移动健康干预措施已经 在非洲用于针对艾滋病毒和结核病等传染病，但没有 评估NCD有效性的试验。这代表着一个巨大的错失机会：移动健康是理想的， 因为它可以规避非洲设置有限的人力资源，向广大的信息传播 以最小的代价做到这一点。我们的团队已经开发了Text2Quit，一个基于文本消息的新颖的 mHealth工具解决美国的戒烟问题。该项目显示，在生物化学上， 在美国人群中证实了戒烟，并已在两个国际环境中进行了调整。在这 研究中，我们假设在肯尼亚艾德人群中适应和实施Text2Quit将增加 知识和停止。我们计划使用混合方法、混合实施有效性方法， 评估这些结果。我们的结果将为一项具有全国代表性的随机对照试验提供信息。 未来的ED样本。这项研究将是第一个针对这一人群的烟草使用，第一个使用 移动的戒烟，并将有助于推动全球戒烟的科学实施。它将 还提供了一种新的方法来实施mHealth干预措施，其研究结果可以 这一趋势被推广到其他非传染性疾病和风险因素，如饮酒、高血压和糖尿病。我们的团队， 包括Text2Quit的创建者，实施科学专家和混合方法研究人员， 在非洲艾德人群、移动医疗和非传染性疾病方面拥有二十多年的经验， 本研究

PROJECT SUMMARY Non-Communicable Diseases (NCDs) are the leading cause of global mortality, constituting 70% of deaths worldwide, 80% of which occur in Low- and Middle-Income Countries (LMICs). Tobacco use, a leading risk factor for NCDs, is responsible for 8 million deaths annually. Among all regions of the world, Africa has the highest predicted increase in tobacco use by 2025 (37%), even as use in the Americas is expected to decrease by 54%. Interventions are needed to address the explosion in tobacco use in Africa and other LMICs and to avert global deaths from tobacco. Emergency Department (ED) populations are a high-risk group that are opportune for interventions targeting NCDs and NCD risk factors, like tobacco. However, research in ED populations in LMICs is limited. Our team has led research in African ED populations, including conducting the largest epidemiological study on NCDs, and demonstrated that the burden of NCDs and NCD risk factors, such as tobacco, are systematically worse in ED populations than the general population. Mobile health (mHealth) interventions have had demonstrated effectiveness for tobacco cessation in High-Income Countries and for ED-based mHealth interventions in the US as shown by our team and others. mHealth interventions have been used in Africa to target communicable diseases such as HIV and tuberculosis, however there have been no trials assessing effectiveness for NCDs. This represents a substantial missed opportunity: mHealth is ideal for African settings because it can circumvent limited human resources, disseminate information to large populations, and do so at minimal cost. Our team has developed Text2Quit, a novel text message-based mHealth tool addressing tobacco cessation in the US. The program has shown a doubling of biochemically confirmed smoking cessation in US populations, and has been adapted in two international settings. In this study, we hypothesize that adapting and implementing Text2Quit in a Kenyan ED population will increase knowledge and cessation. We plan to use a mixed-methods, hybrid implementation-effectiveness approach to assess these outcomes. Our results will inform a randomized, controlled trial in a nationally representative sample of EDs in future. This study will be the first to target tobacco use in this population, the first to use mobile cessation, and will contribute to advancing implementation science on tobacco cessation globally. It will also provide a novel approach to implementation for mHealth interventions, with findings that can be generalized to other NCDs and risk factors, such as alcohol use, hypertension and diabetes. Our team, which includes the creators of Text2Quit, experts in implementation science, and mixed methods researchers with more than two decades of experience in ED populations, mHealth and NCDs in Africa, is well poised to conduct this study.