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

改善烟草相关心血管疾病健康差异的慢性病方法的务实试验

• 批准号: 10494234
• 负责人: STEVEN FU
• 金额: $ 60.24万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10494234
• 关键词: Address; Adopted; Behavior Control; Behavioral; Biochemical; Black American; Black, Indigenous, People of Color; Cardiovascular Diseases; Caring; Cessation of life; Chronic; Chronic Disease; Cigarette; Clinic; Collaborations; Combination Medication; Communities; Complex; Counseling; Data; Discrimination; Effectiveness; Effectiveness of Interventions; Electronic Health Record; Enrollment; Ensure; Evaluation; Failure; Goals; Guidelines; Health; Health Personnel; Health Services Accessibility; Health system; Healthcare Systems; High Prevalence; Hybrids; Hypertension; Individual; Intention; Intervention; Mediation; Methods; Minnesota; Morbidity - disease rate; Motivation; Outcome; Participant; Patient Care; Patients; Persons; Pharmaceutical Preparations; Pharmacotherapy; Physicians; Population; Preventive care; Primary Health Care; Professional counselor; Provider; Public Health; Randomized; Randomized Controlled Trials; Reporting; Rural Health; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Smoking and Health Research; Structural Racism; Surgeon; Surveys; System; Target Populations; Telephone; Testing; Tobacco; Tobacco Use Cessation; Tobacco use; Training; United States Public Health Service; Urban Health; adult of color; arm; cardiovascular disorder risk; care fragmentation; care providers; cigarette smoking; clinical care; effectiveness implementation trial; effectiveness-implementation RCT; evidence base; experience; follow-up; future implementation; health disparity; health equity; health equity promotion; implementation evaluation; implementation intervention; implementation outcomes; improved; intervention effect; mortality; motivational enhancement therapy; outreach; pragmatic trial; primary outcome; programs; quitline; racism; recruit; rural area; rural healthcare; smoking abstinence; smoking cessation; smoking prevalence; standard of care; tobacco abstinence; tobacco cessation intervention; tobacco exposure; treatment as usual; treatment program; uptake; urban area

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.

项目摘要/摘要 – 项目 2 烟草使用是心血管疾病和相关慢性病（例如高血压、高血压、高血压等）的主要原因。 CVD 和 RCC）。根据 2014 年卫生局局长关于吸烟与健康的报告，吸烟 约四分之一的人死于 CVD。 BIPOC 社区的 CVD 和 RCC 患病率较高 与白人社区相比，部分原因是烟草接触率的差异。吸烟可以有效 采用指南建议的戒烟咨询和药物治疗，但此类治疗很少使用 并且特别不可能提供给 BIPOC 患者或由 BIPOC 患者使用。 C2DREAM项目2测试效果 添加干预措施以促进 BIPOC 患者的健康公平：纵向主动外展 （LPO；由接受过动机性访谈培训的顾问在一年内进行 4 次根据文化定制的外展电话周期 帮助患者接受戒烟咨询和药物治疗）以适应当前的护理标准，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 通过电子推荐将吸烟者连接至州戒烟热线）。拟议项目有 3 个目标： A1： 进行随机对照试验来检验 AAC+LPO（多级卫生系统）的直接效果 干预）与 AAC 对 18 个月人群戒烟水平和治疗利用率的影响 2000 名 BIPOC 成人。 A2：检查结构性种族主义和日常人际交往的调节作用 干预效果的歧视。 A3：使用混合方法来评估实施情况 AAC 和 LPO 对 BIPOC 患者的适当性、可接受性和可行性的结果。为了测试这些 目标，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 明尼苏达州两个城乡医疗系统的烟雾将被随机分配给 BIPOC 定制 LPO + AAC 或单独 AAC。参与者将在注册后 6、12 和 18 个月接受调查，以了解 评估结果。主要结果是生化证实 18 个月时戒烟。 潜在的治疗机制包括增加治疗利用率、感知行为控制和 打算戒烟。潜在的调节因素包括社区中的结构性种族主义和个人经历 种族主义。 LPO 通过解决结构性种族主义造成的障碍（包括获得医疗服务的机会）来促进健康公平 通过系统地接触所有 BIPOC 患者，解决护理、护理分散和提供者种族主义问题 抽烟。 LPO 通过确保为 CVD 和 RCC 高危人群提供预防措施来改善健康公平 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 有效接触并吸引目标人群。