Taxi Health Access Interventions for Linkages and Lifestyle (HAILL)

针对联系和生活方式的出租车健康访问干预措施 (HAILL)

• 批准号: 8888154
• 负责人: FRANCESCA M GANY
• 金额: $ 74.76万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-19 至 2020-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8888154
• 关键词: Address; African; Area; Bangladesh; Blood Pressure; Caring; Case Management; Central obesity; Chicago; Communities; Community Outreach; Country; District of Columbia; Dominican Republic; Effectiveness of Interventions; Face; Familiarity; Food; Funding; General Population; Gryllidae; Haiti; Health; Health Fairs; Health Promotion; Health Services; Health Services Accessibility; Health Status; Health system; Healthcare; Healthcare Systems; Home environment; Hour; Hypertension; Immigrant; India; Intervention; Knowledge; Life; Life Style; Linguistics; Longevity; Malignant neoplasm of lung; Memorial Sloan-Kettering Cancer Center; Methodology; Minority; Monoclonal Antibody R24; National Health Interview Survey; New York City; Obesity; Occupational; Outcome; Overweight; Pakistan; Physicians; Population; Populations at Risk; Poverty; Prevention; Primary Health Care; Provider; Randomized Controlled Trials; Reminder Systems; Resources; Risk; Risk Factors; San Francisco; Services; Soccer; Social Network; Stress; Structure; Technology; Telephone; Vendor; Vulnerable Populations; Work; Workplace; arm; base; blood pressure regulation; cancer health disparity; cardiovascular disorder risk; compare effectiveness; cost; cost effectiveness; health care delivery; improved; male; meetings; metropolitan; multi-component intervention; news; peer; primary outcome; programs; promoter; public health relevance; screening; secondary outcome; sedentary; teacher; trafficking; uptake; waist circumference

 DESCRIPTION (provided by applicant): Taxi drivers are a marginalized, large, growing, minority male population with multiple health risks. In New York City (NYC) alone, there are over 50,000 yellow taxi drivers and a similar number of livery drivers. Ninety nine percent of the taxi driver population in NYC is male. A large majority, 94 percent, are immigrants, mainly originating from India, Bangladesh, Pakistan, the Dominican Republic, Haiti, and West African countries. Taxi drivers are at greater risk for cardiovascular disease (CVD) and its associated risk factors, and for lung cancer, compared with the general population. They are a sedentary population with high rates of stress and overweight/obesity, have high rates of uninsurance, long work hours that often interfere with their ability to access primary care, limited knowledge about health care resources, and cultural and linguistic barriers to care. To improve health outcomes in this vulnerable population, a tailored approach is necessary. Increasing access to primary care improves health status, particularly in minority populations living in poverty. Health fairs with screenings, referrals, and case management by health workers have been shown to increase health care uptake. Taxi HAIL builds upon the successful, ongoing work of the Immigrant Health and Cancer Disparities (IHCD) Service at Memorial Sloan-Kettering Cancer Center (MSKCC) with taxi drivers to address their overwhelming health risks. Our work with drivers in NYC has highlighted their significant underuse of health care services, high rates of overweight, abdominal obesity, and undiagnosed and untreated hypertension. We have developed and implemented a multifaceted intervention, an occupationally tailored worksite screening health fair with case management, which has facilitated health care access and reduced health risk. However, this approach is costly. Taxi drivers, while facing tremendous health risk, also have notable potentially health promoting assets within their own taxi driver communities. In our NIMDH-funded R24 project, Taxi Network, 10 percent of NYC taxi drivers participating in a health fair intervention were teachers and several were physicians in their home country. Drivers, through their existing social networks, constantly exchange information about traffic, food vendors, cricket and soccer games, and home country news. They are highly networked by telephone, presenting a potentially powerful, inexpensive resource for health promotion and systems linkage. This project will use a three arm cluster randomized controlled trial to compare the effectiveness of the proposed Taxi HAIL interventions on increasing the proportion of drivers with a Usual Primary Care Provider, the Primary Outcome. These interventions incorporate a worksite screening health fair intervention (Arm 1), with navigation case management in Arm 2, and a mobile messaging health care reminder system (`Mobile Technology') and telephone-based peer support (`Taxi health Improvement Promoters' or `TIPs') in Arm 3. We will also assess the interventions' incremental costs. Secondary Outcomes include changes in: Health Access Barriers, Blood Pressure Control, BMI, and Waist Circumference.

 描述(由申请人提供)：出租车司机是一个边缘化的、庞大的、不断增长的少数族裔男性人口，具有多种健康风险。仅在纽约市(NYC)，就有超过5万名黄色出租车司机和类似数量的制服司机。纽约市99%的出租车司机是男性。绝大多数(94%)是移民，主要来自印度、孟加拉国、巴基斯坦、多米尼加共和国、海地和西非国家。与普通人群相比，出租车司机患心血管疾病(CVD)及其相关危险因素和肺癌的风险更高。他们是久坐不动的人群，压力和超重/肥胖率高，未参保率高，工作时间长，经常干扰他们获得初级保健的能力，对卫生保健资源的了解有限，以及护理方面的文化和语言障碍。为了改善这一弱势群体的健康结果，有必要采取量身定制的方法。增加获得初级保健的机会改善了健康状况，特别是生活在贫困中的少数群体。健康状况 有证据表明，由卫生工作者进行筛查、转诊和病例管理的交易会增加了卫生保健的接受度。在纪念斯隆-凯特琳癌症中心(MSKCC)移民健康和癌症差异(IHCD)服务的成功和持续工作的基础上，出租车HALL与出租车司机一起解决了他们压倒性的健康风险。我们在纽约市与司机的合作突显了他们对医疗保健服务的严重利用不足，超重、腹型肥胖率高，以及未经诊断和治疗的高血压。我们开发和实施了多方面的干预措施，这是一个为职业量身定做的工作场所，通过病例管理来筛查健康博览会，这促进了医疗保健的获得，降低了健康风险。然而，这种方法代价高昂。出租车司机在面临巨大健康风险的同时，也在自己的出租车司机社区内拥有显著的潜在健康促进资产。在我们由NIMDH资助的R24项目--出租车网络中，参加健康博览会干预的纽约市出租车司机中，10%是教师，还有几个是本国的医生。司机通过他们现有的社交网络，不断地交换有关交通、食品供应商、板球和足球比赛以及本国新闻的信息。它们通过电话高度联网，为健康促进和系统联系提供了一种潜在的强大而廉价的资源。该项目将使用三臂随机分组随机对照试验，以比较拟议的出租车打招呼干预措施在增加司机比例方面的有效性，以及通常的初级保健提供者，即主要结果。这些干预措施包括工作场所健康公平筛查干预措施(ARM 1)，ARM 2具有导航病例管理，ARM 3包括移动信息医疗保健提醒系统(“移动技术”)和基于电话的同行支持(“出租车健康改善促进者”或“TIPS”)。我们还将评估干预措施的增量成本。次要结果包括：健康获得障碍、血压控制、BMI和腰围的变化。