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

项目概要/摘要-项目2 烟草使用是心血管疾病和相关慢性疾病的主要原因（例如，高血压; CVD和RCC）。根据2014年卫生部长关于吸烟与健康的报告，吸烟 每四个死于CVD的人中就有一个。BIPOC社区的CVD和RCC患病率较高 与白色社区相比，部分原因是烟草暴露的差异。吸烟可以有效地 接受指南推荐的戒烟咨询和药物治疗，但这种治疗很少使用 并且特别不可能提供给BIPOC患者或由BIPOC患者使用。C2 DREAM项目2测试效果 增加干预措施以促进BIPOC患者的健康公平：纵向主动外展 (LPO;一名接受过动机性面谈培训的顾问在一年内进行4次针对不同文化的外联电话访问 帮助连接患者戒烟咨询和药物治疗），以目前的护理标准，问-建议- 连接（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， 通过电子转介将吸烟者与国家戒烟热线联系起来）。本项目有三个目标：A1： 进行一项随机对照试验，以检查AAC+LPO（多层次健康系统）的直接影响 干预）与AAC对18个月时人群水平戒烟率和治疗利用率的影响 2000名BIPOC成人。A2：研究结构性种族主义和日常人际关系的调节作用 对干预效果的歧视。A3：使用混合方法评估执行情况 AAC和LPO用于BIPOC患者的适当性、可接受性和可行性的结局。测试这些 目的，我们将进行一项混合1型实施有效性试验，其中2000名BIPOC患者， 明尼苏达州两个城市和农村卫生保健系统吸烟者将被随机分配到BIPOC 定制LPO + AAC或单独AAC。参与者将在入组后6个月、12个月和18个月接受调查， 评估结果。主要结局是18个月时经生化证实的戒烟。 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经历， 种族主义LPO通过消除结构性种族主义造成的障碍，包括获得 护理，护理碎片化和提供者种族主义，通过系统地接触所有BIPOC患者， 抽烟LPO通过确保为CVD和RCC风险最高的人提供预防措施来改善健康公平性 在乎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， 有效地接触和吸引目标人群。

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.