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

以代谢为基础的护理帮助阿拉斯加原住民戒烟

• 批准号: 10676937
• 负责人: Jaedon Avey
• 金额: $ 33.94万
• 依托单位: SOUTHCENTRAL FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676937
• 关键词: Address; Adult; Affect; Agonist; Alaska; Alaska Native; Alaskan; American Indians; Biological Markers; Bupropion; Caring; Chronic Obstructive Pulmonary Disease; Clinic; Clinical; Communities; Consolidated Framework for Implementation Research; Data; Dissemination and Implementation; Dopamine Uptake Inhibitors; Environment; Ethnic Population; Familiarity; Foundations; Genetic Research; Goals; Health; Health system; Healthcare Systems; Heart Diseases; Intervention; Knowledge; Learning; Literature; Malignant neoplasm of lung; Metabolic; Metabolic Marker; Metabolism; Methods; Modeling; Native-Born; Nicotine; Nicotinic Receptors; Norepinephrine; Nurses; Observational Study; Participant; Patient Preferences; Patients; Persons; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacy facility; Physicians; Population; Protocols documentation; Provider; Race; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Research Project Grants; Selection for Treatments; Services; Smoke; Smoking; Smoking Cessation Intervention; Solid; Specialist; Stroke; Testing; Therapeutic; Tobacco; Tobacco Use Cessation; Work; acceptability and feasibility; arm; attributable mortality; clinical practice; community based participatory research; community engagement; cost; design; health disparity; health organization; implementation facilitation; implementation framework; implementation intervention; implementation research; improved; intervention refinement; member; nicotine replacement; nicotine use; personalized approach; pharmacologic; pilot trial; pragmatic trial; response; side effect; smoking abstinence; smoking cessation; smoking prevalence; success; tobacco cessation intervention; treatment optimization; tribal health; tribal healthcare; varenicline

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.

项目摘要 – RP2 阿拉斯加的阿拉斯加原住民和美洲印第安人 (ANAI) 居民的吸烟率远远高于 是全国平均水平，是阿拉斯加白人的两倍多（37% 对 17%）。估计健康状况 全国 ANAI 人口的负担是惊人的，ANAI 中吸烟导致的死亡率 的人比白人高 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 过去十年中 ANAI 人群的患病率。我们建议完善和评估可接受性和 代谢信息戒烟干预改善戒烟治疗的可行性 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 比率以告知选择药物治疗以提高 ANAI 人群的戒烟率。 在临床实践中，一线治疗的选择可能很大程度上取决于费用、副作用、医生 熟悉程度、药房可用性和患者偏好。最近，一种基因信息生物标志物尼古丁 代谢率，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 伐尼克兰和 NRT 的反应较好，而代谢正常的人对伐尼克兰的反应更好。之前的工作没有 在 ANAI 人群中试点实施使用代谢标记物进行治疗选择。我们将使用一个 基于社区的参与性研究（CBPR）方法来完善代谢信息护理模式 威尔斯等人描述。护士烟草专家提供了药物建议。我们将 然后在临床上对精细化干预进行贝塔测试，进行额外的细化，并评估精细化的​​干预措施 对 40 名 ANAI 参与者的单臂试点试验进行干预。我们将找出阻碍或促进的因素 使用 RE-AIM（Reach、 有效性、采用、实施、维护）和 CFIR（综合实施框架 研究）实施框架。 具体目标是： 1) 完善和测试代谢相关的药物干预措施，以 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 细化干预措施的实施，以及 3) 检查阻碍或促进干预措施实施的因素 阿拉斯加原住民部落卫生系统内。拟议的项目将为 关于现实世界中 ANAI 人群有效戒烟干预措施的文献很少。这些 活动还将为更大规模、务实的试验奠定坚实的基础，并可能适用于部落健康 全国各地的系统。