Culturally Specific Interventions and Acculturation in African American Smokers

非裔美国吸烟者的文化特定干预和文化适应

• 批准号: 8330797
• 负责人: MONICA WEBB HOOPER
• 金额: $ 51.03万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-09 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8330797
• 关键词: Abstinence; Acculturation; Address; Adherence; Affect; African American; Attitude; Belief; Caucasians; Caucasoid Race; Cessation of life; Cognitive Therapy; Control Groups; Disease; Ethnic group; Evaluation; Failure; Goals; Group Affiliation; Health education; Heterogeneity; Hour; Individual Differences; Intervention; Intervention Trial; Lead; Literature; Maintenance; Meta-Analysis; Outcome; Participant; Prevalence; Process; Race; Randomized; Randomized Controlled Trials; Research; Research Personnel; Smoker; Smoking; Specificity; Staging; Testing; Time; Tobacco; Tobacco Use Cessation; Treatment Efficacy; Uncertainty; Underserved Population; base; design; efficacy testing; follow-up; group counseling; group intervention; head-to-head comparison; health disparity; intervention effect; nicotine patch; racial and ethnic; response; secondary outcome; smoking cessation; smoking intervention; success; theories

DESCRIPTION (provided by applicant): The importance of reducing tobacco-associated health disparities between African Americans and Caucasians cannot be understated. Researchers suggest that interventions need to be targeted to specific racial/ethnic groups (i.e., cultural tailoring); however, the literature examining the efficacy of cultural tailoring is equivocal. The inconsistent findings may be related to methodological weaknesses of past research, such as confounding intervention intensity and contact, or failure to recognize the heterogeneity of African Americans. Moreover, no studies have considered individual-difference factors affecting responses to culturally specific interventions, such as level of acculturation and ethnic identity. The investigators' preliminary studies indicate that standard (i.e., not culturally specific) cognitive behavioral therapy (CBT) for smoking cessation can be successful among African Americans compared to health education. Therefore, the investigators propose to test the incremental efficacy of culturally specific CBT (CS-CBT), and to examine individual differences in intervention response. The specific aims are: (1) To test the efficacy of a group-based, CS-CBT in African American smokers; and (2) to examine level of acculturation and ethnic identity as ethno-cultural predictors of smoking abstinence (exploratory). The investigators hypothesize main effects of (1) intervention type, such that the CS-CBT will produce greater abstinence rates compared to standard CBT; and (2) time, such that the greater abstinence rates in the CS-CBT condition will be maintained over time. No interactions are expected. The investigators also hypothesize that the intervention effects will be moderated by African American cultural factors (e.g., beliefs, values, and practices). Specifically, they hypothesize that lower acculturation levels and greater ethnic identity (i.e., a more traditional cultural orientation) will yield greater smoking abstinence rates among participants in the culturally specific condition, compared to the standard condition. The opposite association is hypothesized in the standard condition. The investigators will use a 2 (intervention type) x 4 (time) randomized design. Factor 1: intervention type (CS-CBT or standard CBT); factor 2: time (baseline, 3, 6, and 12 months). The former treatment represents the experimental condition and the latter will be an established control condition. All participants will receive transdermal nicotine patch therapy. The primary abstinence outcome will be 7-day point-prevalence abstinence (ppa); secondary outcomes will be 24- hour and 7-day ppa, and 28-day continuous abstinence. The investigators will also examine process outcomes, including utilization, study retention, and intervention evaluations. Answering the questions of (a) whether CS interventions lead to greater smoking abstinence compared to their traditional counterparts, and (b) for whom CS approaches are most beneficial will inform theories related to 'cultural sensitivity' and best practices for tobacco intervention among African Americans.

描述（由申请人提供）：减少非裔美国人和白种人之间与烟草相关的健康差异的重要性不容低估。研究人员建议，干预措施需要针对特定​​的种族/族裔群体（即文化定制）；然而，研究文化定制功效的文献却模棱两可。不一致的发现可能与过去研究的方法论缺陷有关，例如混淆干预强度和接触，或未能认识到非裔美国人的异质性。此外，没有研究考虑影响对特定文化干预措施反应的个体差异因素，例如文化适应水平和种族认同。研究人员的初步研究表明，与健康教育相比，针对非裔美国人的戒烟标准（即非文化特异性）认知行为疗法（CBT）可能会取得成功。因此，研究人员建议测试文化特异性认知行为疗法（CS-CBT）的增量功效，并检验干预反应的个体差异。具体目标是： (1) 测试基于团体的 CS-CBT 对非裔美国吸烟者的功效； (2) 检查文化适应水平和种族认同作为戒烟的民族文化预测因素（探索性）。研究人员假设 (1) 干预类型的主要影响，即与标准 CBT 相比，CS-CBT 会产生更高的戒断率； (2) 时间，以便随着时间的推移，CS-CBT 条件下的较高戒断率将得以维持。预计不会有任何互动。研究人员还假设干预效果将受到非裔美国人文化因素（例如信仰、价值观和实践）的调节。具体来说，他们假设与标准条件相比，较低的文化适应水平和较高的种族认同（即更传统的文化取向）将在特定文化条件下的参与者中产生更高的戒烟率。在标准条件下假设相反的关联。研究人员将使用 2（干预类型）x 4（时间）随机设计。因素1：干预类型（CS-CBT或标准CBT）；因素 2：时间（基线、3、6 和 12 个月）。前一种处理代表实验条件，后者将是既定的对照条件。所有参与者都将接受透皮尼古丁贴片治疗。主要戒断结果将是 7 天点流行率戒断 (ppa)；次要结果是 24 小时和 7 天的 PPA，以及 28 天的连续禁欲。研究人员还将检查过程结果，包括利用率、研究保留和干预评估。回答以下问题：(a) 与传统干预措施相比，CS 干预措施是否能提高戒烟率，以及 (b) CS 方法对谁最有益，将为与“文化敏感性”相关的理论和非裔美国人烟草干预的最佳实践提供信息。