Metabolism-Informed Care to Aid Alaska Native People to Quit Smoking

项目摘要--RP2 阿拉斯加原住民和美国印第安人(Anai)居民的吸烟流行率远远高于 全国平均水平，是阿拉斯加白人(37%比17%)的两倍多。估计的健康状况 全国Anai人口的负担是惊人的，Anai中吸烟可归因于死亡的比率 比白人高出60%。尽管部落卫生组织和 阿拉斯加州卫生部门，目前的戒烟策略并没有减少吸烟 在过去十年中，阿奈人中的流行率。我们建议改进和评估可接受性和 新陈代谢信息戒烟干预改善慢性阻塞性肺疾病戒烟治疗的可行性 阿奈人。该项目的目标是检查使用尼古丁代谢物的可接受性和可行性。 告知选择药物治疗以增加ANAI人群戒烟的比率。 在临床实践中，一线治疗的选择在很大程度上可能取决于成本、副作用概况、医生 亲密度、药房可获得性和患者偏好。最近，一种遗传信息的生物标记物尼古丁 代谢物比率，已显示出在非ANAI人群中选择最佳药物治疗的前景 想要戒烟的人。这项研究发现，尼古丁代谢缓慢的患者也有类似的反应 对于varenicline和NRT，代谢正常的患者对varenicline的反应较好。以前的工作都没有 在Anai人群中试行使用代谢标记物进行治疗选择。我们将使用 以社区为基础的参与性研究(CBPR)方法，以完善新陈代谢知情护理模式 Wells等人描述的。这让护士烟草专家提供了用药建议。我们会 然后在临床上对改进的干预措施进行贝塔测试，进行进一步的改进，并对改进后的干预措施进行评估 干预一项单臂飞行员试验，有40名ANAI参与者。我们将确定阻碍或促进的因素 使用RE-AIM(REACH， 有效性、采用、执行、维护)和CFIR(综合执行框架 研究)实施框架。 具体目标是：1)提炼和测试新陈代谢知情的药物干预措施 优化设计和参与，2)进行单臂试点试验，评估可接受性和可行性 以及3)检查阻碍或促进干预措施实施的因素 在阿拉斯加原住民部落健康系统中。拟议的项目将为 在真实世界的环境中，关于在Anai人群中进行有效的戒烟干预的文献很少。这些 这些活动还将为一项可能适用于部落卫生的更大规模、务实的试验奠定坚实基础。 全国各地的系统。

PROJECT SUMMARY – RP2 Smoking prevalence among Alaska Native and American Indian (ANAI) residents of Alaska is far greater than the national average and more than double that of White Alaskans (37% vs. 17%). The estimated health burden to the ANAI population nationally is staggering, with rates of smoking attributable deaths among ANAI people being 60% higher than for White people. Despite concerted efforts by tribal health organizations and the State of Alaska health department, current smoking cessation strategies have not reduced smoking prevalence among ANAI people in the last decade. We propose to refine and assess the acceptability and feasibility of a metabolism-informed smoking cessation intervention to improve tobacco cessation treatment for ANAI people. The goal of this project is to examine the acceptability and feasibility of using nicotine metabolite ratio to inform selection of pharmacologic treatment to increase smoking abstinence among ANAI people. In clinical practice, the choice of first-line treatment may depend largely on cost, side effect profile, physician familarity, pharmacy availability, and patient preference. Recently, a genetically informed biomarker, nicotine metabolite ratio, has shown promise to select optimal pharmacologic treatment among non-ANAI populations who desire to quit smoking. This study found that patients with slow nicotine metabolism had similar response to varenicline and NRT, while those with normal metabolism responded better to varenicline. No prior work has piloted implementation of using metabolic markers for treatment selection among ANAI people. We will use a community-based participatory research (CBPR) approach to refine a metabolism-informed care model described by Wells et al. that has nurse tobacco specialists provide a medication recommendation. We will then beta-test the refined intervention in clinic, make additional refinements, and assess the refined intervention in a single-arm pilot trial with 40 ANAI participants. We will identify factors that impede or facilitate implementation of the refined intervention in the Alaska Native tribal health system using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and CFIR (Consolidated Framework of Implementation Research) implementation frameworks. The Specific Aims are to: 1) Refine and beta-test a metabolism-informed pharmacologic intervention to optimize design and participation, 2) Conduct a single-arm pilot trial assessing the acceptability and feasibility of the refined intervention, and 3) Examine factors which impede or facilitate implementation of the intervention within the Alaska Native tribal health system. The proposed project will contribute important knowledge to the scant literature on effective tobacco cessation interventions among ANAI people in real-world settings. These activities will also build a solid foundation for a larger, pragmatic trial, with potential applicability in tribal health systems across the nation.