Taxi Health Access Interventions for Linkages and Lifestyle (HAILL)

 描述（由申请人提供）：出租车司机是一个边缘化的，大的，不断增长的，少数男性人口与多种健康风险。仅在纽约市，就有超过50，000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）及其相关风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/肥胖的比例很高，没有保险的比例很高，工作时间长，这往往影响他们获得初级保健的能力，对保健资源的了解有限，以及在护理方面存在文化和语言障碍。为了改善这一弱势群体的健康状况，必须采取有针对性的办法。增加获得初级保健的机会可以改善健康状况，特别是生活贫困的少数群体的健康状况。健康 由卫生工作者进行筛查、转诊和病例管理的博览会已被证明能提高保健服务的利用率。出租车冰雹建立在移民健康和癌症差异（IHCD）服务的成功，正在进行的工作在纪念斯隆-凯特琳癌症中心（MSKCC）与出租车司机，以解决他们压倒性的健康风险。我们与纽约市司机的合作突出了他们对医疗保健服务的严重利用不足，超重率高，腹部肥胖，以及未诊断和未治疗的高血压。我们制定并实施了一项多方面的干预措施，即根据职业需要量身定制的带有病例管理的工作场所筛查健康博览会，这促进了获得保健服务的机会，降低了健康风险。然而，这种方法是昂贵的。出租车司机，虽然面临着巨大的健康风险，也有显着的潜在健康促进资产在自己的出租车司机社区。在NIMDH资助的R24项目“出租车网络”中，参与健康公平干预的纽约市出租车司机中有10%是教师，还有几位是本国的医生。司机通过现有的社交网络不断交换有关交通、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，为促进健康和系统连接提供了一种潜在的强大而廉价的资源。该项目将使用三组随机对照试验，比较拟议的出租车冰雹干预措施对增加司机与主要初级保健提供者的比例的有效性，主要结果。这些干预措施包括工作场所筛查健康公平干预（第1组），第2组中的导航病例管理，以及第3组中的移动的信息保健提醒系统（“移动的技术”）和基于电话的同伴支持（“出租车健康改善促进者”或“TIP”）。我们还将评估干预措施的增量成本。次要结局包括以下方面的变化：健康准入障碍、血压控制、BMI和腰围。

 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.