Urban and Reservation Implementation of All Nations Breath of Life to Improve Smoking Cessation Rates among American Indians

项目摘要 肺癌是癌症死亡的主要原因，心血管疾病是癌症死亡的总体主要原因。 美洲印第安人的死亡（AI）。造成这种过早死亡的一个主要危险因素是， 在美国所有主要种族中，AI的吸烟率最高，为31.8%，几乎是两者的两倍 非裔美国人和白人。尽管吸烟和烟草相关疾病的发病率很高， 研究人员已经解决了这个问题，部分原因是烟草对许多人工智能来说是神圣的植物， 像大多数戒烟计划一样，完全消极地对待。大学的研究人员 堪萨斯医疗中心（KUMC）和约翰逊县社区学院（JCCC）一直在与AI合作 自2010年以来，社区利用基于社区的参与式研究（CBPR）来解决娱乐性烟草问题， 2003.我们共同开发了一个成功的文化定制的戒烟计划，所有国家的呼吸， 生命（ANBL），尊重烟草作为一种神圣的植物，并促进尊重它，而不是滥用它 娱乐我们的面对面，基于组的计划有一个意向治疗戒烟率为27.9%，17.4%， 在一项基于预约的疗效试验中，治疗结束时（12周）的当前最佳实践比较组 （N = 463）。6个月时的停药率为20% vs. 12%（p = 0.02）。在大城市实施的可行性 试点（N = 312，在5个州的研究中心），我们的戒烟率为22%，在6个月（p <0.002相比，最高 先前报道的城市AI人群的戒烟率）;我们的留存率为71%。因为ANBL有 在保留地人群中被证明是有效的，并在城市人群中显示出希望， 烟草滥用问题在保留地和城市AI社区的重要性，我们相信， 因此，我们必须谨慎地采取行动，迅速执行和传播《禁止核武器条约》。所以我们提出 通过有效性-实施类型2混合设计进行持续有效性测试。这种设计允许 进行功效测试，同时进行实施测试，以将该计划推向大规模 在研究结束时分发。我们将针对以下具体目标：（1）评估7天 6个月（24周）时每个社区站点的点患病率过期CO验证戒烟率， 在两个城市和两个保留地随机化并实施ANBL后的参与个体 社区（N = 576），使用等待列表控制设计。我们假设ANBL的戒烟率为21% 在每个站点，个人的等待列表控制臂中占9%;（2）确定方案和 增强ANBL实施并影响计划成败的组织因素 在RE-AIM（Reach，Effectiveness，Adoption，Implementation，Maintenance）和整合的指导下， 实施研究框架（CFIR）方法;（3）比较不同的资源， 每个承授人站点用于交付ANBL的成本。

PROJECT SUMMARY Lung cancer is the leading cause of cancer death and cardiovascular disease is the overall leading cause of death among American Indians (AI). A major risk factor contributing to this premature mortality is the fact that AI have the highest smoking rates of all major ethnic groups in the US, at 31.8%, nearly double that of both African Americans and Whites. Despite these high rates of smoking and tobacco-related illness, few researchers have addressed this issue, in part because tobacco is a sacred plant to many AI and cannot be treated completely negatively, as most smoking cessation programs do. Researchers at the University of Kansas Medical Center (KUMC) and Johnson County Community College (JCCC) have been working with AI communities using community-based participatory research (CBPR) to address recreational tobacco since 2003. Together we have developed a successful culturally tailored cessation program, All Nations Breath of Life (ANBL), that respects tobacco as a sacred plant and promotes honoring it rather than abusing it recreationally. Our in-person, group-based program had an intent-to-treat quit rate of 27.9% versus 17.4% in a current best practices comparison arm at end of treatment (12 weeks) in a reservation-based efficacy trial (N=463). Cessation rate was 20% vs. 12% at 6 months (p=0.02). In a large urban implementation feasibility pilot (N=312 across sites in five states), our quit rate was 22% at 6-months (p<0.002 compared to the highest previously reported quit rates for an urban AI population); our retention rate was 71%. Because ANBL has been proven efficacious in reservation populations and shows promise in urban populations and because of the significance of the tobacco abuse problem in both reservation and urban AI communities, we believe it prudent to move towards expeditious implementation and dissemination of ANBL. Therefore, we propose continued efficacy testing through an effectiveness-implementation type 2 hybrid design. This design allows for efficacy testing with simultaneous implementation testing to move the program towards large-scale dissemination at the conclusion of the study. We will address the following specific aims: (1) To assess 7-day point prevalence expired CO validated quit rates at 6 months (24 weeks) at each community site among participating individuals following randomization and implementation of ANBL in two urban and two reservation communities (N=576), using a waitlist control design. We hypothesize that quit rates will be 21% in the ANBL arm and 9% in the waitlist control arm of individuals at each site; (2) To identify programmatic and organizational factors that enhance implementation of ANBL and contribute to program success or failure guided by RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and Consolidated Framework for Implementation Research (CFIR) approaches; and (3) To compare different resources and costs used in each grantee site for delivery of ANBL.