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

所有国家的城市和保留地实施“生命之息”以提高美洲印第安人的戒烟率

• 批准号: 10227261
• 负责人: CHRISTINE Makosky DALEY
• 金额: $ 69.35万
• 依托单位: LEHIGH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10227261
• 关键词: Abstinence; Address; African American; American Indians; Cancer Etiology; Cardiovascular Diseases; Cause of Death; Cessation of life; Chronic Disease; Communities; Community Participation; Comparison arm; Consolidated Framework for Implementation Research; County; Demographic Factors; Dissemination and Implementation; Education; Effectiveness; Electronic cigarette; Ensure; Ethnic group; Evaluation; Failure; Family; Geographic Locations; Grant; Health; Indian reservation; Individual; Infrastructure; Kansas; Letters; Life; Location; Malignant neoplasm of lung; Medical center; Morbidity - disease rate; Motivation; Nicotine; Outcome; Persons; Pharmacotherapy; Plants; Population; Premature Mortality; Prevalence; Process; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recording of previous events; Reporting; Research; Research Personnel; Reservations; Resources; Risk Factors; Self Efficacy; Site; Smoking; Social support; Testing; Tobacco; Training; Tribes; Universities; Urban Community; Urban Population; Use Effectiveness; Value of Life; Waiting Lists; Writing; addiction; arm; base; cigarette smoking; community based participatory research; community college; cost; design; economic outcome; effectiveness testing; efficacy testing; efficacy trial; enhancing factor; ethnic identity; health economics; hybrid type 2 design; implementation process; implementation research; improved; member; programs; psychosocial; research study; reservation-based; retention rate; smoking cessation; success; tobacco abuse; tobacco control; urban Native American; web site

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.

项目总结