权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

A Pragmatic Trial of Chronic Disease Approaches To Ameliorate Tobacco Related Cardiovascular Disease Health Disparities

改善烟草相关心血管疾病健康差异的慢性病方法的务实试验

基本信息

批准号：
10676239
负责人：
STEVEN FU
金额：
$ 59.06万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-24 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10676239
关键词：
Address Adopted Behavior Control Behavioral Biochemical Black American Black, Indigenous, People of Color Cardiovascular Diseases Caring Cessation of life Chronic Chronic Disease Cigarette Clinic Collaborations Combination Drug Therapy Combination Medication Communities Complex Counseling Data Discrimination Disparity Effectiveness Effectiveness of Interventions Electronic Health Record Electronics Enrollment Ensure Equity Evaluation Failure Goals Guidelines Health Health Personnel Health Services Accessibility Health system Healthcare Systems High Prevalence Hybrids Hypertension Individual Intention Intervention Mediation Methods Minnesota Morbidity - disease rate Motivation Outcome Assessment Participant Patients Persons Pharmaceutical Preparations Physicians Population Preventive care Primary Care Professional counselor Provider Public Health Randomized Randomized, Controlled Trials Recommendation Reporting Rural Health Smoke Smoker Smoking Smoking Cessation Intervention Smoking and Health Research Structural Racism Surgeon Surveys System Target Populations Telephone Testing Tobacco Tobacco Use Cessation Tobacco use Training United States Public Health Service Urban Health adult of color arm cardiovascular disorder risk care fragmentation cigarette smoking clinical care effectiveness-implementation RCT effectiveness/implementation trial evidence base experience follow-up future implementation health disparity health equity health equity promotion implementation evaluation implementation intervention implementation outcomes improved intervention effect mortality motivational enhancement therapy outreach patient engagement pragmatic trial primary care patient primary care provider primary outcome programs quitline racism recruit rural area rural healthcare smoking abstinence smoking cessation smoking prevalence standard of care tobacco abstinence tobacco cessation intervention tobacco exposure treatment as usual treatment program uptake urban area

项目摘要

PROJECT SUMMARY/ABSTRACT – Project 2 Tobacco use is a leading cause of cardiovascular disease and related chronic conditions (e.g., hypertension; CVD & RCC). According to the 2014 Surgeon General’s Report on smoking and health, cigarette smoking causes about 1 in 4 deaths from CVD. BIPOC communities experience higher prevalence of CVD & RCC compared to White communities due, in part, to disparities in tobacco exposure. Smoking can be effectively treated with guideline-recommended cessation counseling and medication, but such treatments are rarely used and are particularly unlikely to be offered to or used by BIPOC patients. Project 2 of C2DREAM tests the effect of adding an intervention to promote health equity among BIPOC patients: Longitudinal Proactive Outreach (LPO; 4 culturally tailored outreach call cycles over one year by a counselor trained in motivational interviewing to help connect patients to cessation counseling and medication) to the current standard of care, Ask-Advise- Connect (AAC; primary care providers asking all patients if they smoke, advising smokers to quit, and connecting smokers to the state quit line through an electronic referral). The proposed Project has 3 aims: A1: Conduct a randomized controlled trial to examine the direct effect of AAC+LPO (a multilevel health system intervention) vs. AAC on population-level smoking abstinence at 18 months and treatment utilization among 2000 BIPOC adults. A2: Examine the moderating effects of structural racism and daily interpersonal discrimination on intervention effectiveness. A3: Use a mixed methods approach to evaluate implementation outcomes of appropriateness, acceptability, and feasibility of AAC and LPO for BIPOC patients. To test these aims, we will conduct a hybrid type 1 implementation-effectiveness trial where 2000 BIPOC patients who smoke across two urban and rural healthcare systems in Minnesota will be randomly assigned to BIPOC tailored LPO + AAC or AAC alone. Participants will be surveyed at 6, 12, and 18 months post-enrollment to assess outcomes. The primary outcome is biochemically confirmed tobacco abstinence at 18 months. Potential treatment mechanisms include increased treatment utilization, perceived behavioral control and intention to quit. Potential moderators include structural racism in communities and personal experiences of racism. LPO promotes health equity by addressing barriers caused by structural racism, including access to care, care fragmentation, and provider racism, by systematically reaching out to all BIPOC patients who smoke. LPO improves health equity by ensuring that those most at risk for CVD & RCC are offered preventive care. LPO integrates individual-level treatment with public health approaches to increase treatment engagement. Further, LPO will be culturally tailored in collaboration with BIPOC communities in Minnesota to effectively reach and engage the target population.

专题摘要/摘要-专题二