FRESH Delivers: An Innovative Approach to Reducing Tobacco Use Among Rural Black/African American Smokers

摘要--项目2 黑人/非裔美国人的吸烟可归因于癌症的死亡率在美国最高 各州。在阿肯色州的农村县，吸烟人数几乎是全国平均水平(23%-26%)的两倍 超过48%的人口是黑人/非裔美国人。社会结构性应激源，如持续性 贫困，低教育程度，高失业率，新冠肺炎大流行，交通不便， 获得医疗保健的机会很少，加上历史上的压迫，这些都是成功戒烟的巨大障碍。戒烟 吸烟可以大大降低非裔美国人的癌症发病率和死亡率，但很成功 戒烟以及以证据为基础的干预措施对农村非裔美国人的影响低得令人震惊。一些 研究已经经验性地测试了社会结构性干预(基于家庭的食物递送)的有效性 解决癌症危险行为(如吸烟)和长期存在的社会因素之间的动态相互作用 不平等，比如粮食不安全。这项研究的长期目标是填补一项关键的知识空白 阿肯色州低资源农村消除癌症健康差距的社会结构性干预 黑人/非裔美国人比例高、吸烟率高的县。我们的目标是测试 社会变革干预(以家庭为基础的食物递送)对三臂戒烟的有效性 随机对照设计，2)检查吸烟滥用倾向指标的变化，以及3)检查 家庭送餐在多大程度上改善了黑人/非裔美国吸烟者的招募和留存 在治疗条件下。我们的学术和社区伙伴关系--阿肯色大学医学院 科学、阿肯色州无烟草联盟和阿肯色州食品银行-有很强的协作性 在阿肯色州三角洲地区农村地区合作减少烟草使用的基础和经验 黑人/非裔美国人的比例。需要多层次的干预措施来解决持续的社会问题 可能增加吸烟滥用责任并阻碍成功戒烟的条件。吸烟者 食物越不安全，戒烟的可能性就越小。我们的多学科团队将利用社会生态学 检验我们中心假设的模型：接受基于证据的实时视频激励的吸烟者 咨询和社会变革干预(以家庭为基础的食物递送)将有更多的可替宁验证7天 戒酒时点患病率高于单独接受励志咨询或单独接受社会变革的人。 满足黑人/非裔美国吸烟者直接社会需求的社会结构性干预措施 改善黑人/非裔美国人招募和留存到有帮助的癌症的巨大希望 预防社区试验，增加成功戒烟，减少长期存在的社会不平等 烟草引起的癌症差异。

SUMMARY – PROJECT 2 Blacks/African Americans have the highest cigarette smoking-attributable cancer mortality rates in the United States. Cigarette smoking is nearly double the national average (23%-26%) in Arkansas rural counties where more than 48% of the population is Black/African American. Social structural stressors such as persistent poverty, low educational attainment, high rates of unemployment, the COVID-19 pandemic, poor transportation, poor access to health care, and historical oppression pose tremendous barriers to successful quitting. Quitting smoking can substantially reduce cancer morbidity and mortality among African Americans, but successful quitting as well as the reach of evidence-based interventions to rural African Americans is alarmingly low. Few studies have empirically tested the efficacy of social structural interventions (home-based food delivery) that address the dynamic interplay of cancer risk behaviors, like smoking, and social factors that perpetuate disparities like food insecurity. The long-term goal of this study is to fill a critical gap in knowledge on the role of social structural interventions in the elimination of cancer health disparities in low resource rural Arkansas counties with high proportions of Blacks/African Americans and high smoking prevalence. Our aims are to 1) test the efficacy of a social change intervention (home-based food delivery) on smoking abstinence using a 3-armed randomized controlled design, 2) examine changes in measures of cigarette abuse liability, and 3) examine the extent to which home-based food delivery improves recruitment and retention of Black/African American smokers in the treatment conditions. Our academic-community partnership – the University of Arkansas for Medical Sciences, Coalition for a Tobacco Free Arkansas, and the Arkansas Foodbank – has a strong collaborative foundation and experience in working together to reduce tobacco use in rural Arkansas Delta counties with high proportions of Blacks/African Americans. Multilevel interventions are needed to address persistent social conditions that potentially increase the abuse liability of smoking and impede successful quitting. Smokers who are more food insecure are less likely to quit smoking. Our multidisciplinary team will use the Socioecological Model to test our central hypothesis: smokers who receive evidence-based real-time video-based motivational counseling and a social change intervention (home-based food delivery) will have greater cotinine-verified 7-day point prevalence abstinence than those who receive motivational counseling alone or social change alone. Social structural interventions that meet the immediate social needs of Black/African American smokers hold tremendous promise for improving Black/African American recruitment and retention into helpful cancer prevention community trials, increasing successful quitting, and reducing social disparities that perpetuate tobacco-caused cancer disparities.