Culturally Specific Interventions and Acculturation in African American Smokers

非裔美国吸烟者的文化特定干预和文化适应

• 批准号: 8186929
• 负责人: MONICA WEBB HOOPER
• 金额: $ 51.8万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-09 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8186929
• 关键词: Abstinence; Acculturation; Address; Adherence; Affect; African American; Attitude; Belief; Caucasians; Caucasoid Race; Cessation of life; Cognitive Therapy; Control Groups; Disease; Ethnic group; Evaluation; Failure; Goals; Group Affiliation; Health education; Heterogeneity; Hour; Individual Differences; Intervention; Intervention Trial; Lead; Literature; Maintenance; Meta-Analysis; Outcome; Participant; Prevalence; Process; Race; Randomized; Randomized Controlled Trials; Research; Research Personnel; Smoker; Smoking; Specificity; Staging; Testing; Time; Tobacco; Tobacco Use Cessation; Treatment Efficacy; Uncertainty; Underserved Population; base; design; efficacy testing; follow-up; group counseling; group intervention; head-to-head comparison; health disparity; intervention effect; nicotine patch; racial and ethnic; response; secondary outcome; smoking cessation; smoking intervention; success; theories

DESCRIPTION (provided by applicant): The importance of reducing tobacco-associated health disparities between African Americans and Caucasians cannot be understated. Researchers suggest that interventions need to be targeted to specific racial/ethnic groups (i.e., cultural tailoring); however, the literature examining the efficacy of cultural tailoring is equivocal. The inconsistent findings may be related to methodological weaknesses of past research, such as confounding intervention intensity and contact, or failure to recognize the heterogeneity of African Americans. Moreover, no studies have considered individual-difference factors affecting responses to culturally specific interventions, such as level of acculturation and ethnic identity. The investigators' preliminary studies indicate that standard (i.e., not culturally specific) cognitive behavioral therapy (CBT) for smoking cessation can be successful among African Americans compared to health education. Therefore, the investigators propose to test the incremental efficacy of culturally specific CBT (CS-CBT), and to examine individual differences in intervention response. The specific aims are: (1) To test the efficacy of a group-based, CS-CBT in African American smokers; and (2) to examine level of acculturation and ethnic identity as ethno-cultural predictors of smoking abstinence (exploratory). The investigators hypothesize main effects of (1) intervention type, such that the CS-CBT will produce greater abstinence rates compared to standard CBT; and (2) time, such that the greater abstinence rates in the CS-CBT condition will be maintained over time. No interactions are expected. The investigators also hypothesize that the intervention effects will be moderated by African American cultural factors (e.g., beliefs, values, and practices). Specifically, they hypothesize that lower acculturation levels and greater ethnic identity (i.e., a more traditional cultural orientation) will yield greater smoking abstinence rates among participants in the culturally specific condition, compared to the standard condition. The opposite association is hypothesized in the standard condition. The investigators will use a 2 (intervention type) x 4 (time) randomized design. Factor 1: intervention type (CS-CBT or standard CBT); factor 2: time (baseline, 3, 6, and 12 months). The former treatment represents the experimental condition and the latter will be an established control condition. All participants will receive transdermal nicotine patch therapy. The primary abstinence outcome will be 7-day point-prevalence abstinence (ppa); secondary outcomes will be 24- hour and 7-day ppa, and 28-day continuous abstinence. The investigators will also examine process outcomes, including utilization, study retention, and intervention evaluations. Answering the questions of (a) whether CS interventions lead to greater smoking abstinence compared to their traditional counterparts, and (b) for whom CS approaches are most beneficial will inform theories related to 'cultural sensitivity' and best practices for tobacco intervention among African Americans. PUBLIC HEALTH RELEVANCE: African American smokers suffer disproportionately from smoking-associated diseases and deaths. This study will test a culturally specific cognitive-behavioral intervention for tobacco cessation by comparing it to standard cognitive-behavioral therapy. This study will also examine whether level of acculturation and ethnic identity predict who responds to either type of intervention. Thus, the investigators will address important, yet unanswered, questions with the goal of reducing health disparities.

描述（由申请人提供）：减少非裔美国人和白种人之间与烟草相关的健康差异的重要性不容低估。研究人员建议，干预措施需要针对特定的种族/族裔群体（即，文化定制）；然而，研究文化定制效果的文献是模棱两可的。不一致的发现可能与过去研究方法上的弱点有关，例如混淆干预强度和接触，或未能认识到非裔美国人的异质性。此外，没有研究考虑影响对文化特定干预反应的个体差异因素，如文化适应水平和种族认同。调查人员的初步研究表明，与健康教育相比，标准的（即，非文化特异性的）认知行为疗法（CBT）在非裔美国人中可以成功戒烟。因此，研究者建议测试文化特异性CBT （CS-CBT）的增量疗效，并检查干预反应的个体差异。具体目的是：(1)测试基于群体的CS-CBT对非裔美国吸烟者的疗效；(2)考察文化适应水平和民族认同作为戒烟的民族文化预测因子（探索性）。研究人员假设：(1)干预类型的主要影响，例如CS-CBT与标准CBT相比会产生更高的戒断率；(2)时间，这样在CS-CBT条件下，更高的戒断率将随着时间的推移而保持。期望没有交互。研究者还假设干预效果将被非裔美国人的文化因素（例如，信仰、价值观和实践）所缓和。具体来说，他们假设，与标准条件相比，在文化特定条件下，较低的文化适应水平和较高的种族认同（即更传统的文化取向）将在参与者中产生更高的戒烟率。在标准条件下，假设相反的关联。研究者将采用2（干预类型）x 4（时间）随机设计。因素1：干预类型（CS-CBT或标准CBT）；因素2：时间（基线、3、6和12个月）。前一种处理方式代表实验条件，后一种处理方式将成为确定的控制条件。所有参与者将接受经皮尼古丁贴片治疗。主要戒断结果将是7天的点流行戒断（ppa）；次要结果将是24小时和7天的ppa，以及28天的持续戒断。研究人员还将检查过程结果，包括利用、研究保留和干预评估。回答以下问题：(a)与传统方法相比，CS干预是否会导致更大程度的戒烟，以及(b) CS方法对谁最有益，将为非裔美国人的“文化敏感性”和烟草干预的最佳实践相关理论提供信息。