A Pragmatic Trial of Chronic Disease Approaches To Ameliorate Tobacco Related Cardiovascular Disease Health Disparities

项目摘要/摘要--项目2 吸烟是心血管疾病和相关慢性病的主要原因(例如，高血压； CVD和RCC)。根据2014年卫生局局长关于吸烟与健康的报告，吸烟 导致大约四分之一的人死于心血管疾病。BIPOC社区心血管疾病和肾癌患病率较高 与白人社区相比，部分原因是烟草暴露的差异。吸烟可以有效地 接受指南建议的戒烟咨询和药物治疗，但这种治疗很少使用 尤其不太可能提供给BIPOC患者或由BIPOC患者使用。C2DREAM项目2测试效果 增加一项干预措施以促进BIPOC患者的健康公平：纵向主动外联 (LPO；由受过激励性面试培训的咨询师在一年内进行4个文化定制的外展电话周期 为了帮助患者获得戒烟咨询和药物治疗)与当前的护理标准，询问-建议- Connect(AAC；初级保健提供者询问所有患者是否吸烟，建议吸烟者戒烟，以及 通过电子转介将吸烟者连接到州戒烟专线)。拟议的项目有3个目标：A1： 进行随机对照试验以检验AAC+LPO(一个多层次卫生系统)的直接效果 18个月人群水平戒烟和治疗利用的干预)与AAC的比较 2000名BIPOC成人。A2：审查结构性种族主义和日常人际关系的调节效果 对干预效果的辨析。答案3：使用混合方法评估实施情况 AAC和LPO对BIPOC患者的适宜性、可接受性和可行性的结果。为了测试这些 目标，我们将在2000名BIPOC患者中进行混合类型1实施-有效性试验 明尼苏达州两个城市和农村医疗系统的烟雾将随机分配给BIPOC 量身定做LPO+AAC或单独使用AAC。参与者将在注册后6个月、12个月和18个月接受调查 评估结果。主要结果是生物化学证实18个月后戒烟。 潜在的治疗机制包括增加治疗利用率、感知行为控制和 打算退出。潜在的主持人包括社区中的结构性种族主义和个人的 种族主义。LPO通过解决结构性种族主义造成的障碍促进健康公平，包括获得 护理、护理碎片化和提供者种族主义，通过系统地接触到所有BIPOC患者 烟。LPO通过确保为心血管疾病和肾细胞癌的最高风险人群提供预防性服务来改善卫生公平 关心。LPO将个人层面的治疗与公共卫生方法相结合，以增加治疗 订婚。此外，LPO将与明尼苏达州的BIPOC社区合作进行文化定制，以 有效地接触到目标人群并使其参与进来。

PROJECT SUMMARY/ABSTRACT – Project 2 Tobacco use is a leading cause of cardiovascular disease and related chronic conditions (e.g., hypertension; CVD & RCC). According to the 2014 Surgeon General’s Report on smoking and health, cigarette smoking causes about 1 in 4 deaths from CVD. BIPOC communities experience higher prevalence of CVD & RCC compared to White communities due, in part, to disparities in tobacco exposure. Smoking can be effectively treated with guideline-recommended cessation counseling and medication, but such treatments are rarely used and are particularly unlikely to be offered to or used by BIPOC patients. Project 2 of C2DREAM tests the effect of adding an intervention to promote health equity among BIPOC patients: Longitudinal Proactive Outreach (LPO; 4 culturally tailored outreach call cycles over one year by a counselor trained in motivational interviewing to help connect patients to cessation counseling and medication) to the current standard of care, Ask-Advise- Connect (AAC; primary care providers asking all patients if they smoke, advising smokers to quit, and connecting smokers to the state quit line through an electronic referral). The proposed Project has 3 aims: A1: Conduct a randomized controlled trial to examine the direct effect of AAC+LPO (a multilevel health system intervention) vs. AAC on population-level smoking abstinence at 18 months and treatment utilization among 2000 BIPOC adults. A2: Examine the moderating effects of structural racism and daily interpersonal discrimination on intervention effectiveness. A3: Use a mixed methods approach to evaluate implementation outcomes of appropriateness, acceptability, and feasibility of AAC and LPO for BIPOC patients. To test these aims, we will conduct a hybrid type 1 implementation-effectiveness trial where 2000 BIPOC patients who smoke across two urban and rural healthcare systems in Minnesota will be randomly assigned to BIPOC tailored LPO + AAC or AAC alone. Participants will be surveyed at 6, 12, and 18 months post-enrollment to assess outcomes. The primary outcome is biochemically confirmed tobacco abstinence at 18 months. Potential treatment mechanisms include increased treatment utilization, perceived behavioral control and intention to quit. Potential moderators include structural racism in communities and personal experiences of racism. LPO promotes health equity by addressing barriers caused by structural racism, including access to care, care fragmentation, and provider racism, by systematically reaching out to all BIPOC patients who smoke. LPO improves health equity by ensuring that those most at risk for CVD & RCC are offered preventive care. LPO integrates individual-level treatment with public health approaches to increase treatment engagement. Further, LPO will be culturally tailored in collaboration with BIPOC communities in Minnesota to effectively reach and engage the target population.