Adaptation and testing of a novel text-based tobacco cessation and education intervention in Kenyan Emergency Department patients

项目总结 非传染性疾病(NCDs)是全球死亡的主要原因，占全球死亡人数的70% 全世界的死亡，其中80%发生在低收入和中等收入国家(LMIC)。烟草使用，一个主要的 非传染性疾病的风险因素，每年造成800万人死亡。在世界所有地区中，非洲是 预计到2025年烟草使用量的最高增幅(37%)，尽管美洲的使用量预计将减少到 54%。需要采取干预措施，解决非洲和其他低收入国家烟草使用激增的问题，并避免 全球烟草死亡人数。急诊科(ED)人群是一个高危群体， 针对非传染性疾病和非传染性疾病风险因素的干预措施，如烟草。然而，对ED人群的研究在 LMIC是有限的。我们的团队领导了对非洲ED人群的研究，包括进行最大规模的 关于非传染性疾病的流行病学研究，并表明非传染性疾病的负担和非传染性疾病的危险因素，如 烟草，在勃起功能障碍人群中系统性地比普通人群更糟糕。移动医疗(MHealth) 干预措施已证明对高收入国家的戒烟和 我们的团队和其他人展示了美国基于ED的mHealth干预措施。移动健康干预措施一直在 在非洲用于治疗艾滋病毒和结核病等传染病，但没有 评估非传染性疾病有效性的试验。这代表着大量错失的机会：移动健康是 非洲环境，因为它可以绕过有限的人力资源，向 人口，而且这样做的成本最低。我们的团队开发了Text2Quit，一种基于文本消息的新型 解决美国戒烟问题的移动健康工具。该项目已经显示出生化指标翻了一番 证实在美国人群中戒烟，并已在两个国际环境中改编。在这 研究中，我们假设在肯尼亚ED人群中适应和实施Text2Quit将会增加 知识和停顿。我们计划使用混合方法、混合实施-有效性方法来 评估这些结果。我们的结果将为全国代表性的随机对照试验提供信息 未来的EDS样本。这项研究将是第一次针对这一人群的烟草使用，第一次使用 行动戒烟，并将有助于推动全球戒烟的实施科学。会的 还提供了一种实施mHealth干预的新方法，其结果可以是 推广到其他非传染性疾病和危险因素，如饮酒、高血压和糖尿病。我们的团队， 包括Text2Quit的创建者、实现科学方面的专家以及混合方法研究人员与 在非洲ED人群、移动健康和非传染性疾病方面的20多年经验已经做好了充分准备 这项研究。

PROJECT SUMMARY Non-Communicable Diseases (NCDs) are the leading cause of global mortality, constituting 70% of deaths worldwide, 80% of which occur in Low- and Middle-Income Countries (LMICs). Tobacco use, a leading risk factor for NCDs, is responsible for 8 million deaths annually. Among all regions of the world, Africa has the highest predicted increase in tobacco use by 2025 (37%), even as use in the Americas is expected to decrease by 54%. Interventions are needed to address the explosion in tobacco use in Africa and other LMICs and to avert global deaths from tobacco. Emergency Department (ED) populations are a high-risk group that are opportune for interventions targeting NCDs and NCD risk factors, like tobacco. However, research in ED populations in LMICs is limited. Our team has led research in African ED populations, including conducting the largest epidemiological study on NCDs, and demonstrated that the burden of NCDs and NCD risk factors, such as tobacco, are systematically worse in ED populations than the general population. Mobile health (mHealth) interventions have had demonstrated effectiveness for tobacco cessation in High-Income Countries and for ED-based mHealth interventions in the US as shown by our team and others. mHealth interventions have been used in Africa to target communicable diseases such as HIV and tuberculosis, however there have been no trials assessing effectiveness for NCDs. This represents a substantial missed opportunity: mHealth is ideal for African settings because it can circumvent limited human resources, disseminate information to large populations, and do so at minimal cost. Our team has developed Text2Quit, a novel text message-based mHealth tool addressing tobacco cessation in the US. The program has shown a doubling of biochemically confirmed smoking cessation in US populations, and has been adapted in two international settings. In this study, we hypothesize that adapting and implementing Text2Quit in a Kenyan ED population will increase knowledge and cessation. We plan to use a mixed-methods, hybrid implementation-effectiveness approach to assess these outcomes. Our results will inform a randomized, controlled trial in a nationally representative sample of EDs in future. This study will be the first to target tobacco use in this population, the first to use mobile cessation, and will contribute to advancing implementation science on tobacco cessation globally. It will also provide a novel approach to implementation for mHealth interventions, with findings that can be generalized to other NCDs and risk factors, such as alcohol use, hypertension and diabetes. Our team, which includes the creators of Text2Quit, experts in implementation science, and mixed methods researchers with more than two decades of experience in ED populations, mHealth and NCDs in Africa, is well poised to conduct this study.