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.

项目概要 肺癌是癌症死亡的主要原因，心血管疾病是癌症死亡的主要原因 美洲印第安人（AI）的死亡。导致这种过早死亡的一个主要风险因素是 AI在美国所有主要族裔中吸烟率最高，达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，但很少有人 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一种神圣的植物，不能被 正如大多数戒烟计划一样，他们受到完全消极的对待。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) 一直在与人工智能合作 社区利用基于社区的参与性研究（CBPR）来解决休闲烟草问题 2003 年。我们共同制定了一项成功的根据文化量身定制的戒烟计划：All Nations Breath of Life (ANBL)，将烟草视为神圣植物并提倡尊重它而不是滥用它 休闲地。我们的面对面、以小组为基础的项目的意向治疗戒烟率为 27.9%，而在其他项目中，意向治疗戒烟率为 17.4%。 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 个月时戒烟率为 20% vs. 12% (p=0.02)。在大城市实施的可行性 试点（N=312，分布在五个州的站点），我们的 6 个月戒烟率为 22%（与最高戒烟率相比，p<0.002） 之前报道过城市人工智能人群的戒烟率）；我们的保留率为 71%。因为 ANBL 有 已被证明对保留地人口有效，并在城市人口中显示出前景，因为 烟草滥用问题在保留地和城市人工智能社区中的重要性，我们相信 谨慎推进 ANBL 的快速实施和传播。因此，我们建议 通过有效性实施 2 型混合设计继续进行有效性测试。这种设计允许 进行功效测试并同时进行实施测试，以将计划推向大规模 研究结束时进行传播。我们将实现以下具体目标： (1) 评估 7 天 点流行率 过期 CO 验证的戒烟率 在每个社区地点 6 个月（24 周） 在两个城市和两个保留地中随机化和实施 ANBL 后的参与个体 社区（N=576），使用候补名单控制设计。我们假设 ANBL 的戒烟率为 21% 臂和每个站点等候名单控制臂中的 9% 的个人； (2) 识别程序化和 加强 ANBL 实施并促成计划成功或失败的组织因素 以 RE-AIM（覆盖范围、有效性、采用、实施、维护）和 Consolidated 为指导 实施研究框架（CFIR）方法； (3) 比较不同的资源和 每个受资助者站点用于交付 ANBL 的费用。