Developing a Culturally Relevant Model of Smoking Cessation among Latinos

描述(申请人提供)：Yessenia Castro，博士，德克萨斯大学安德森癌症中心(MDACC)健康差异研究部博士后研究员。她正在通过国家癌症研究所的促进多样性指导性研究科学家发展奖(K01)寻求五年的资金。在大卫·维特博士的指导下，卡斯特罗博士开展了一项研究，在少数族裔和服务不足的人群中，研究了社会、人际、个人和文化因素对戒烟的影响。MDACC提供了一个异常丰富的培训环境，其中包括大量的研讨会、研讨会和课程；发展赠款撰写、出版和项目管理技能的绝佳机会；以及帮助年轻研究人员的一流资源。 卡斯特罗博士的长期职业目标是在大学环境中成为一名独立的、以研究为导向的教员，并制定一个研究项目，重点是了解癌症危险行为在文化上的相关影响，特别是在拉美裔美国人中吸烟的影响。这样的计划可以改善为拉美裔量身定做的戒烟干预措施，并最终有助于消除这一人群中的健康差距。 在目前的提案中，卡斯特罗博士勾勒出了在整个获奖期内要实现的四个短期目标，这些目标旨在作为独立研究事业的基础。这些是：1)在缺乏服务的成年人口中涉及烟草依赖和戒烟的社会、认知和情感机制和过程方面积累强大的知识基础；2)将她目前在性别和种族/民族研究方面的知识扩展到癌症预防领域；特别是在拉丁裔戒烟领域；3)从公共卫生角度获得在文化上有能力的社区层面研究的知识和经验；以及4)学习适当的统计方法和建模技术，以评估复杂的纵向数据。这些目标将通过以下方面来实现：1)严格的正式课程和定向阅读；2)大量的专业发展经验；3)大量的项目实施、数据分析和手稿撰写/发表经验；4)由具有不同专业知识的高度成功的科学家组成的团队进行密集的指导，这样每一位指导人员可以在实现特定的短期目标方面提供宝贵的指导，但大多数人可以就不止一个目标提供建议。 拟议的研究计划寻求解决现有研究不足的问题，这些研究涉及拉美裔戒烟的潜在机制。对成瘾和健康行为的研究已经确定了一些个人层面的因素，这些因素是戒烟的关键决定因素，包括社会/环境因素、人际/个人因素和认知/情感因素。新出现的研究表明，许多已知的戒烟决定因素对少数吸烟者可能同样重要，但这一领域还需要更多的研究，如卫生局局长的报告和治疗烟草使用和依赖临床实践指南等几篇著名出版物所指出的那样。此外，除了关于文化适应对吸烟流行率的影响的数据外，几乎没有人知道文化适应和其他文化相关变量(例如，文化适应压力、感知到的歧视)对戒烟过程的影响。因此，拟议的项目将利用对拉丁裔吸烟者进行的三项纵向研究的数据来检查文化相关因素对戒烟机制的影响。这个项目的最终目标是开发和评估一个将文化因素与戒烟机制联系起来的综合概念模型，该模型是由以前的工作提供信息的，涉及文化对身心健康的影响，社会经济地位对健康的影响，以及成瘾行为的理论。此外，该项目将使用最先进的生态瞬时评估技术收集的数据来评估特定的、细粒度的假设。 与公共卫生相关：尽管拉美裔人吸烟的可能性较小，但他们表现出更难戒烟的表现，更不可能寻求或接受戒烟帮助，而且患烟草相关慢性病的风险很高。此外，人们对拉丁裔戒烟的决定因素知之甚少，也不知道特定于少数族裔身份的因素如何影响戒烟决定因素。提高这些领域的知识将有助于确定治疗目标，改进目前的戒烟干预措施，并最终有助于消除拉丁裔之间的健康差距。

DESCRIPTION (provided by applicant): Yessenia Castro, Ph.D., is a postdoctoral fellow in the Department of Health Disparities Research at the University of Texas M.D. Anderson Cancer Center (MDACC). She is seeking five years of funding through the National Cancer Institute's Mentored Research Scientist Development Award to Promote Diversity (K01). Dr. Castro conducts research examining social, interpersonal, intrapersonal, and cultural determinants of smoking cessation in minority and underserved populations under the mentorship of Dr. David Wetter. MDACC provides an unusually rich training environment that includes an extraordinary number of workshops, seminars, and courses; outstanding opportunities for developing skills in grant writing, publication, and project management; and superb resources for assisting young investigators. Dr. Castro's long term career goals are to serve as an independent, research-oriented faculty member in a university environment, and to develop a program of research focused on understanding culturally relevant influences of cancer risk behaviors, with a particular focus on smoking among Latinos. Such a program could improve smoking cessation interventions tailored for or targeted at Latinos, and ultimately aid in eliminating health disparities among this population. In the current proposal, Dr. Castro delineates four short term goals to be achieved throughout the award period that are intended to serve as the foundation for an independent research career. These are: 1) accumulate a strong knowledge base in the social, cognitive, and affective mechanisms and processes involved in tobacco dependence and cessation among underserved adult populations; 2)extend her current knowledge of research on gender and race/ethnicity into the area of cancer prevention; particularly, smoking cessation among Latinos; 3) gain knowledge and experience in culturally competent community level research from a public health perspective, and; 4) learn the appropriate statistical methods and modeling techniques for evaluating complex longitudinal data. These goals will be achieved through a combination of: 1) rigorous formal coursework and directed readings; 2) numerous professional development experiences; 3) numerous project implementation, data analysis, and manuscript writing/publication experiences, and; 4) intensive mentoring by a team of highly successful scientists with diverse expertise, such that each mentor can provide invaluable guidance in achieving a specific short term goal, but most can advise about more than one goal. The proposed research plan seeks to address the paucity of existing research addressing the mechanisms underlying smoking cessation among Latinos. Research in addictions and health behavior has identified a number of individual-level factors that are key determinants of smoking cessation including social/environmental, inter-/intrapersonal, and cognitive/affective factors. Emerging research suggests that many of the known determinants of smoking cessation may be of equal importance to minority smokers, but more research is needed in this area, as noted by several prominent publications including the Surgeon General's Report and the Treating Tobacco Use and Dependence Clinical Practice Guideline. Further, with the exception of data addressing the influence of acculturation on smoking prevalence, almost nothing is known about the effect of acculturation and other culturally relevant variables (e.g., acculturative stress, perceived discrimination) on the process of smoking cessation. Thus, the proposed project will utilize data from three longitudinal studies of Latino smokers to examine the impact of culturally relevant factors on mechanisms of smoking cessation. The ultimate goal of this project is to develop and evaluate a comprehensive conceptual model linking cultural factors to mechanisms of smoking cessation that is informed by previous work addressing the impact of culture on mental and physical health, socioeconomic status influences on health, and theories of addictive behaviors. Additionally, the project will evaluate specific, fine-grained hypotheses using data collected with state-of-the-science ecological momentary assessment techniques. PUBLIC HEALTH RELEVANCE: Although Latinos are less likely to smoke, they exhibit more difficulty quitting, are less likely to seek or receive help with quitting, and are at high risk of developing tobacco related chronic illnesses. Further, very little is known about the determinants of smoking cessation among Latinos, or how factors specific to minority status influence determinants of cessation. Advancing knowledge in these areas would help to identify treatment targets, improve current smoking cessation interventions, and ultimately aid in eliminating health disparities among Latinos.