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：
10437212
负责人：
STEVEN FU
金额：
$ 62.37万
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/10437212
关键词：
Address Adopted Adult African American Behavior Control Behavioral Biochemical Black, Indigenous, People of Color Cardiovascular Diseases Caring Cessation of life Chronic Chronic Disease Cigarette Clinic Collaborations Combination Medication Communities Complex Counseling Data Discrimination Effectiveness Effectiveness of Interventions Electronic Health Record Enrollment Ensure Evaluation Failure Future 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 Participant Patient Care Patients Pharmaceutical Preparations Pharmacotherapy Physicians Population Preventive care Primary Health Care Professional counselor Provider Public Health Randomized Randomized Controlled Trials Reporting Rural Health Smoke Smoker Smoking Smoking Cessation Intervention Smoking and Health Research Structural Racism Structure Surgeon Surveys System Target Populations Telephone Testing Tobacco Tobacco Use Cessation Tobacco use Training United States Public Health Service Urban Health arm cardiovascular disorder risk care fragmentation care providers cigarette smoking clinical care effectiveness implementation trial evidence base experience follow-up health disparity health equity health equity promotion implementation evaluation implementation intervention implementation outcomes improved intervention effect mortality motivational enhancement therapy outreach pragmatic trial 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.

项目摘要/摘要 - 项目2 使用烟草是心血管疾病和相关慢性疾病的主要原因（例如高血压； CVD和RCC）。根据2014年外科医生关于吸烟和健康的报告，吸烟 CVD造成大约四分之一的死亡。 BIPOC社区经历了CVD和RCC的较高患病率与白人社区相比，部分原因是烟草暴露的差异。吸烟可以有效接受指南宣传的戒烟咨询和药物治疗，但这种治疗很少使用并且尤其不可能被BIPOC患者提供或使用。 C2Dream测试的项目2效果添加干预措施以促进BIPOC患者的健康平等：纵向主动外展（LPO;一年多的辅导员在励志面试中受过培训为了帮助患者与停止咨询和药物相关联），以达到当前的护理标准连接（AAC；初级保健提供者询问所有患者是否吸烟，咨询吸烟者退出，以及通过电子转介将吸烟者连接到州戒烟线）。拟议的项目有3个目标：A1：进行随机对照试验，以检查AAC+LPO的直接效应（多层卫生系统干预）与AAC关于18个月时人口水平的戒烟和治疗利用 2000年BIPOC成年人。 A2：检查结构种族主义和每日人际关系的调节作用歧视干预效率。 A3：使用混合方法评估实施 BIPOC患者AAC和LPO的适当性，可接受性和可行性的结果。测试这些目的，我们将进行一项混合1型实施效应试验，其中2000名BIPOC患者明尼苏达州的两个城市和粗糙的医疗系统中的烟雾将随机分配给BIPOC 量身定制的LPO + AAC或AAC。参与者将在注册后的6、12和18个月接受调查评估结果。主要结果是生物化学确认的18个月的戒烟。潜在的治疗机制包括增加的治疗利用，感知的行为控制和意图退出。潜在的主持人包括社区中的结构性种族主义和个人经验种族主义。 LPO通过解决由结构性种族主义引起的障碍来促进健康公平，包括进入通过系统地接触所有BIPOC患者，护理，关怀分裂和提供者种族主义抽烟。 LPO通过确保为CVD＆RCC最有风险的人提供预防性，从而改善健康平等关心。 LPO将个人级别的治疗与公共卫生方法相结合以增加治疗订婚。此外，LPO将以与明尼苏达州的Bipoc社区合作进行文化量身定制有效地达到目标人群。