Understanding Tobacco Treatment Refusal Among African-Americans in the Context of Lung Cancer Screening

Chloé M.博士Martin试图通过以下方式更好地了解母公司临床试验的范围： 在符合条件的非裔美国人吸烟者中检查与参与拒绝相关的因素。马丁博士 我对这个项目感兴趣，因为众所周知，在烟草业招募非裔美国人， 戒烟计划通常具有挑战性（Woods等人，2002年）。非裔美国人肺癌发病率高 死亡率（Woods等人，2002年; Holford，Levy和Meza，2016年;疾病控制和预防中心， 2018年）。吸烟是造成美国黑人和白色男性预期寿命差距的重要原因。 (Ho& Elo，2013），是非常昂贵的（马克斯宋，塔克，&斯塔克，2010）。另一方面，非裔美国人 吸烟者表示他们想戒烟（Kulak，Cornelius，Fong，& Giovino，2016; Weinberger，Esan， Hunt，&霍夫，2016;），当提供循证烟草治疗时，非洲裔美国人 能够成功戒烟（Webb等人，2010; Burgess等人，2014年）导致肺减少 癌症死亡率（坦纳等人，2015年; Holford，Levy和Meza，2016年;疾病控制和预防中心 预防，2018年）。在烟草治疗试验中招募非裔美国人的挑战 已经有文献记载（Woods等人，2002年）。了解为什么符合条件的非裔美国吸烟者 拒绝参加烟草治疗试验的人决定不参加， 肺癌发病率和死亡率（基尔本，瑞士，海曼，Crowley-Matoka，& Fine，2006）。 家长研究是理想的检查与招聘和参与非洲- 美国吸烟者，因为这是一个多地点的试验，已经解决了一些障碍，非洲- 美国参与临床试验。例如，围绕临床试验招募少数族裔的挑战 被分为四个大的领域：与访问有关的问题，结构因素，提供者的信念， 社会文化因素（Woods等人，2002年）。与准入有关的征聘挑战包括： 卫生保健水平低下，识字率低，目标人群对医疗保健的目的了解有限， 研究和运输挑战。母研究通过使用 不同的肺癌筛查点，他们接受包括医疗补助在内的各种保险方式。的 构成征聘挑战的结构性因素包括： 研究、有限的参与者补偿、时间限制和有限的工作人员（Woods等人，2002年）。的 母研究通过将研究程序整合到当前的工作流程中， 筛选网站。招聘的挑战，出生的供应商的信念包括：缺乏 转诊参与，提供者不知道临床试验，以及提供者对学术的不信任 医学（Woods等人，2002年）。家长研究通过提供推荐来避免与提供者信仰相关的问题 在预约肺癌筛查时参加试验。 改进征聘战略以解决社会文化因素将有益于母公司研究 影响了临床试验中少数群体的招募（Woods等人，2002年）。这些社会文化因素 包括：由于以前对非洲裔美国人的不道德剥削行为， 研究和医疗行业（Roberson，1994年; Corbie-Smith，托马斯，威廉姆斯，MoodyAyers，1994年; Harris，Gorelick，Samuels，Bempong，1996年），沟通问题（Harris等人，1996年：朋友的意见 和家庭成员，以及对自我效能的态度和信念（Woods等人，2002年）。一些策略， 以前的研究已经采用规避社会文化障碍，非洲裔美国人参与临床 试验包括使用由非洲裔美国人社区组成的社区咨询委员会， 成员（考克斯等人，2011年），邮寄个性化的邀请函给潜在的参与者（斯宾塞& Oltmanns，2011年），确保知情同意文件的自主权，并分享 以前的参与者，并使用大众广告平台，涉及来自 非裔美国人社区（Okuyemi等人，2007年）。可持续的、以职业为基础的招聘工作， 需要解决非洲裔美国人参与戒烟试验的障碍。 具体目标 目的1：为了更好地了解在非洲人中进行的烟草治疗试验中参与者的拒绝情况， 美国吸烟者使用严格的定性方法。 目标2：制定和评估旨在招募非裔美国吸烟者的招募策略， 烟草治疗试验

Dr. Chloé M. Martin seeks to develop a better understanding of the reach of the parent clinical trial by examining factors associated with participation refusal among eligible African-American smokers. Dr. Martin is interested in pursuing this project because it is well established that recruiting African-Americans in tobacco cessation programs is often challenging (Woods et al., 2002). African-Americans have high lung cancer mortality (Woods et al., 2002; Holford, Levy, & Meza, 2016; Centers for Disease Control and Prevention, 2018). Smoking significantly contributes to the life expectancy gap between Black and White men in the U.S. (Ho & Elo, 2013) and is very costly (Max Sung, Tucker, & Stark, 2010). On the other hand, African-American smokers indicate that they want to quit smoking (Kulak, Cornelius, Fong, & Giovino, 2016; Weinberger, Esan, Hunt, & Hoff, 2016; ) and when provided with evidence-based tobacco treatment, African-Americans have been able to successfully quit smoking (Webb et al., 2010; Burgess et al., 2014) resulting in reduced lung cancer mortality (Tanner et al., 2015; Holford, Levy, & Meza, 2016; Centers for Disease Control and Prevention, 2018). The challenges associated with recruiting African-Americans in tobacco treatment trials have already been documented (Woods et al., 2002). Understanding why eligible African-American smokers who refuse participation in tobacco treatment trials decide not to participate can contribute to the reduction of lung cancer morbidity and mortality (Kilbourne, Switzer, Hyman, Crowley-Matoka, & Fine, 2006). The parent study is ideal for examining factors associated with recruitment and engagement of African- American smokers because it is a multi-site trial that already addresses some of the barriers to African- American participation in clinical trials. For example, challenges around minority recruitment for clinical trials have been categorized into four broad areas: issues related to access, structural factors, provider beliefs, and sociocultural factors (Woods et al., 2002). Recruitment challenges that have been related to access include: subpar healthcare, low literacy, the target population having a limited understanding of the purpose of research, and transportation challenges. The parent study addresses issues related to access by utilizing a diverse set of lung cancer screening sites who accept a variety of insurance modalities including Medicaid. The structural factors that have served as recruitment challenges include: unsuitable infrastructures to support research, limited participant reimbursements, time constraints, and limited staff (Woods et al., 2002). The parent study circumvents structural issues by integrating the study's procedures into the current workflow of the screening sites. The recruitment challenges that are born of provider beliefs have included: lack of referrals for participation, providers being unaware of clinical trials, and providers' distrust of academic medicine (Woods et al., 2002). The parent study avoids issues related to provider beliefs by providing referrals for participation in the trial at the time that the lung cancer screening appointment is made. The parent study would benefit from improving its recruitment strategy to address sociocultural factors that have impacted recruitment of minorities in clinical trials (Woods et al., 2002). These sociocultural factors have included: mistrust of researchers due to previous acts of unethical exploitation of African-Americans by the research and medical industries (Roberson, 1994; Corbie-Smith, Thomas, Williams, MoodyAyers, 1994; Harris, Gorelick, Samuels, Bempong, 1996), communication issues (Harris et al., 1996), opinions of friends and family members, and attitudes and beliefs around self-efficacy (Woods et al., 2002). Some strategies that previous studies have employed to circumvent sociocultural barriers to African-American participation in clinical trials have included the use of community advisory boards composed of African-American community members (Cox et al., 2011), mailing personalized invitation letters to prospective participants (Spence & Oltmanns, 2011), ensuring autonomy in the informed consent documents, and sharing success stories from previous participants, and using mass advertisement platforms that involve key influential leaders from the African-American community (Okuyemi et al., 2007). Sustainable, empirically-based recruitment efforts that address barriers to participation of African-Americans in tobacco cessation trials are needed. Specific Aims Aim 1: To gain a better understanding of participant refusal in a tobacco treatment trial among African- American smokers using a rigorous qualitative approach. Aim 2: To develop and evaluate a recruitment strategy designed to recruit African-American smokers in a tobacco treatment trial.