Informing the Adaptation of a CHW Model to Facilitate Lung Cancer Screening for Chinese Taxi Drivers

告知采用 CHW 模型以促进中国出租车司机的肺癌筛查

• 批准号: 9306794
• 负责人: Jennifer CF Leng
• 金额: $ 8.57万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9306794
• 关键词: Address; Administrator; Adopted; Adoption; Adult; Advisory Committees; Age; Air Pollution; Asian Americans; Automobile Driving; Caring; China; Chinese People; Colorectal Cancer; Communities; Community Health Aides; Community Health Centers; Data; Diffusion of Innovation; Elements; Eligibility Determination; Environment; Exposure to; Face; Focus Groups; Foundations; Future; Health; Health Services Accessibility; Healthcare; Hour; Immigrant; Individual; Insurance; Intervention; Interview; Knowledge; Language; Linguistics; Longevity; Malignant Neoplasms; Malignant neoplasm of lung; Manuals; Mexico; Modeling; New York City; Occupational; Occupations; Outcome; Pacific Island Americans; Physicians; Population; Prevalence; Preventive service; Process; Publishing; Qualitative Methods; Recording of previous events; Research; Resources; Restaurants; Screening for cancer; Series; Smoke; Smoker; Smoking; Stress; Testing; Training; Visit; Work; base; cancer health disparity; checkup examination; evidence base; experimental study; high risk; high risk population; improved; innovation; low-dose spiral CT; lung cancer screening; men; patient oriented; personalized management; screening; sedentary; smoking cessation; smoking prevalence; theories

Project Summary The Chinese population is anticipated to become the largest immigrant group in New York City (NYC) in the next few years. Nationwide, immigrants from China constitute the second largest foreign-born group, after those from Mexico. Chinese immigrants work in a number of occupations that put them at higher risk for lung cancer, including taxi driving. Chinese taxi drivers may be at exceptionally high risk for lung cancer due to the combined impact of high rates of smoking and increased exposure to air pollution. The prevalence of ever smoking among Chinese men in the U.S. is 42.5%. In our preliminary work assessing health needs among foreign-born Chinese livery drivers in NYC, a staggering 73% were current or former smokers. The U.S. Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose computed tomography in adults age 55-80 years with a 30 pack year history. Previous research describes lower rates of screening for other cancers among foreign-born Asian Americans and Pacific Islanders (AAPIs) compared to U.S. born AAPIs, even after adjusting for insurance-related access to care. A substantial body of research suggests that immigrants face unique barriers to care, including language and cultural factors. Community health worker (CHW) efforts address these barriers, and have led to significant increases in cancer screening rates. This study uses qualitative methods to inform the adaptation of an existing Immigrant Health and Cancer Disparities (IHCD) CHW model, Taxi HAILL (Health Access Interventions for Linkages and Longevity), through the exploration of the multiple levels of influence at which CHWs can articulate, including the individual (drivers), organizations (livery bases), and the environment (health care access and health care environment). In the adapted model, CHWs will serve as central nodes, acting at these various levels, to facilitate lung cancer screening completion in an extremely high-risk group, NYC Chinese livery drivers who smoke or who have quit within the past 15 years. This study is grounded in the Diffusion of Innovations theory, which guides the process of adopting innovative ideas, and states that five key perceived attributes of an innovation explain 49% to 89% of the variance in the rate of an innovation’s adoption: relative advantage (is the intervention better than what we already have?), compatibility (is the intervention consistent with the values and needs of the population?), complexity (is the intervention difficult to understand and use?), trialability (can the intervention be experimented with on a limited basis?), and observability (are the results of the intervention visible to others?). The adapted model will also incorporate key elements of the Penn Center for Community Health Workers evidence-based CHW model, IMPaCTTM (Individualized Management towards Patient- Centered Targets). The adapted CHW model will have potential for subsequent targeting and dissemination to high risk Chinese smoking populations in other occupations (e.g. restaurant work, construction), as well as to other driver populations in NYC and throughout the U.S.

项目摘要 中国人口预计将成为纽约市最大的移民群体， 未来几年在全国范围内，来自中国的移民构成了第二大外国出生群体，仅次于 那些来自墨西哥。中国移民从事的一些职业使他们面临更高的肺部风险 癌症，包括出租车驾驶。中国出租车司机患肺癌的风险可能特别高， 高吸烟率和空气污染暴露增加的综合影响。曾经的流行 在美国，中国男性吸烟率为42.5%。在我们的初步工作中， 在纽约市的外国出生的中国出租车司机中，73%的人现在或曾经吸烟。美国 预防服务工作组（USPSTF）建议每年进行低剂量肺癌筛查 年龄在55-80岁，有30包年病史的成年人的计算机断层扫描。先前的研究描述了 外国出生的亚裔美国人和太平洋岛民（AAPI）的其他癌症筛查率较低 与美国出生的AAPI相比，即使在调整了与保险相关的医疗服务之后。了大量的 研究表明，移民在照料方面面临独特的障碍，包括语言和文化因素。 社区卫生工作者（CHW）努力解决这些障碍，并导致癌症的显着增加 筛查率。本研究采用定性方法，告知现有的移民健康的适应 和癌症差异（IHCD）CHW模式，出租车冰雹（健康获取干预措施的联系和 长寿），通过探索CHW可以表达的多层次影响，包括 个人（驾驶员）、组织（车辆基地）和环境（医疗服务的获取和医疗服务 环境）。在调整后的模式中，社区卫生工作者将作为中心节点，在各个层面发挥作用， 促进肺癌筛查完成在一个极高的风险群体，纽约市华人制服司机谁 吸烟者或在过去15年内戒烟者。本研究以创新扩散理论为基础， 它指导了采用创新思想的过程，并指出， 创新可以解释创新采用率的49%到89%的差异：相对优势（相对优势） 比我们现有的更好的干预？），兼容性（干预是否与价值观一致， 人民的需要）。复杂性（干预措施是否难以理解和使用？），可试用性（可 是否可以在有限的基础上进行干预试验？）和可观察性（是干预的结果 其他人可见？）。调整后的模型还将纳入宾夕法尼亚社区中心的关键要素 卫生工作者循证CHW模型IMPaCTTM（对患者的个性化管理） 中心目标）。经调整的CHW模型将有可能随后针对和传播， 其他职业（例如餐厅工作、建筑）的高风险中国吸烟人群，以及 纽约市和整个美国的其他司机群体。