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

项目总结-RP 2 阿拉斯加原住民和美国印第安人（ANAI）的吸烟率远远高于 全国平均水平和两倍以上的白色阿拉斯加人（37%对17%）。估计的健康 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 比白色人高60%。尽管部落卫生组织和 阿拉斯加州卫生部，目前的戒烟策略并没有减少吸烟 在过去的十年里，我们建议完善和评估可接受性， 代谢信息戒烟干预改善戒烟治疗的可行性 ANAI人。本研究的目的是探讨尼古丁代谢产物的可接受性和可行性 比率，以告知药物治疗的选择，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在很大程度上取决于成本、副作用特征、医生 熟悉度、药房可用性和患者偏好。最近，一种基因生物标志物尼古丁 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， 而那些代谢正常的人对伐伦克林的反应更好。以前的工作都没有 在ANAI人群中试点实施使用代谢标志物进行治疗选择。我们将使用一个 以社区为基础的参与性研究（CBPR）方法，以完善代谢知情护理模式 由威尔斯等人描述的方法，该方法让护士烟草专家提供药物建议。我们将 然后在临床上测试改进的干预措施，进行额外的改进，并评估改进后的 在一项有40名ANAI参与者的单臂试点试验中进行干预。我们将找出阻碍或促进 使用RE-AIM（Reach， 有效性、通过、执行、维护）和综合执行框架 研究）实施框架。 具体目的是：1）完善和β测试代谢知情的药理学干预， 优化设计和参与，2）进行单臂先导试验，评估可接受性和可行性 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健康系统的一部分拟议的项目将有助于重要的知识， 在现实世界中，关于ANAI人群有效戒烟干预的文献很少。这些 这些活动还将为更大规模的、务实的试验奠定坚实的基础，该试验可能适用于部落健康 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.