Understanding Tobacco Treatment Refusal Among African-Americans in the Context of Lung Cancer Screening

了解肺癌筛查背景下非裔美国人拒绝烟草治疗的情况

基本信息

批准号：
9905136
负责人：
Jamie S. Ostroff
金额：
$ 6万
依托单位：
SLOAN-KETTERING INST CAN RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-09 至 2022-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9905136
关键词：
Address Advertisements African American Appointment Area Attention Attitude Belief Biochemical Centers for Disease Control and Prevention (U.S.)Clinical Trials Communication Communities Consent Consent Forms Consumption Effectiveness Ensure Family member Friends Funding Goals Health Benefit Healthcare Individual Industry Influentials Infrastructure Insurance Letters Life Expectancy Malignant neoplasm of lung Medicaid Medical Medicine Methodology Minority Recruitment Modality Morbidity - disease rate Parents Participant Procedures Provider Public Health Randomized Research Research Personnel Research Support Resources Self Efficacy Site Smoker Smoking Structure Target Populations Testing Time Tobacco Tobacco Use Cessation Transportation Treatment Refusal United States Wood material base cost design evidence base follow-up improved innovation interest literacy low-dose spiral CT lung cancer screening member men mortality motivational enhancement therapy multi-site trial nicotine replacement parent grant parent project primary outcome programs prospective recruit screening smoking abstinence smoking cessation success treatment trial

项目摘要

Dr. Chloé M. Martin seeks to develop a better understanding of the reach of the parent clinical trial by examining factors associated with participation refusal among eligible African-American smokers. Dr. Martin is interested in pursuing this project because it is well established that recruiting African-Americans in tobacco cessation programs is often challenging (Woods et al., 2002). African-Americans have high lung cancer mortality (Woods et al., 2002; Holford, Levy, & Meza, 2016; Centers for Disease Control and Prevention, 2018). Smoking significantly contributes to the life expectancy gap between Black and White men in the U.S. (Ho & Elo, 2013) and is very costly (Max Sung, Tucker, & Stark, 2010). On the other hand, African-American smokers indicate that they want to quit smoking (Kulak, Cornelius, Fong, & Giovino, 2016; Weinberger, Esan, Hunt, & Hoff, 2016; ) and when provided with evidence-based tobacco treatment, African-Americans have been able to successfully quit smoking (Webb et al., 2010; Burgess et al., 2014) resulting in reduced lung cancer mortality (Tanner et al., 2015; Holford, Levy, & Meza, 2016; Centers for Disease Control and Prevention, 2018). The challenges associated with recruiting African-Americans in tobacco treatment trials have already been documented (Woods et al., 2002). Understanding why eligible African-American smokers who refuse participation in tobacco treatment trials decide not to participate can contribute to the reduction of lung cancer morbidity and mortality (Kilbourne, Switzer, Hyman, Crowley-Matoka, & Fine, 2006). The parent study is ideal for examining factors associated with recruitment and engagement of African- American smokers because it is a multi-site trial that already addresses some of the barriers to African- American participation in clinical trials. For example, challenges around minority recruitment for clinical trials have been categorized into four broad areas: issues related to access, structural factors, provider beliefs, and sociocultural factors (Woods et al., 2002). Recruitment challenges that have been related to access include: subpar healthcare, low literacy, the target population having a limited understanding of the purpose of research, and transportation challenges. The parent study addresses issues related to access by utilizing a diverse set of lung cancer screening sites who accept a variety of insurance modalities including Medicaid. The structural factors that have served as recruitment challenges include: unsuitable infrastructures to support research, limited participant reimbursements, time constraints, and limited staff (Woods et al., 2002). The parent study circumvents structural issues by integrating the study's procedures into the current workflow of the screening sites. The recruitment challenges that are born of provider beliefs have included: lack of referrals for participation, providers being unaware of clinical trials, and providers' distrust of academic medicine (Woods et al., 2002). The parent study avoids issues related to provider beliefs by providing referrals for participation in the trial at the time that the lung cancer screening appointment is made. The parent study would benefit from improving its recruitment strategy to address sociocultural factors that have impacted recruitment of minorities in clinical trials (Woods et al., 2002). These sociocultural factors have included: mistrust of researchers due to previous acts of unethical exploitation of African-Americans by the research and medical industries (Roberson, 1994; Corbie-Smith, Thomas, Williams, MoodyAyers, 1994; Harris, Gorelick, Samuels, Bempong, 1996), communication issues (Harris et al., 1996), opinions of friends and family members, and attitudes and beliefs around self-efficacy (Woods et al., 2002). Some strategies that previous studies have employed to circumvent sociocultural barriers to African-American participation in clinical trials have included the use of community advisory boards composed of African-American community members (Cox et al., 2011), mailing personalized invitation letters to prospective participants (Spence & Oltmanns, 2011), ensuring autonomy in the informed consent documents, and sharing success stories from previous participants, and using mass advertisement platforms that involve key influential leaders from the African-American community (Okuyemi et al., 2007). Sustainable, empirically-based recruitment efforts that address barriers to participation of African-Americans in tobacco cessation trials are needed. Specific Aims Aim 1: To gain a better understanding of participant refusal in a tobacco treatment trial among African- American smokers using a rigorous qualitative approach. Aim 2: To develop and evaluate a recruitment strategy designed to recruit African-American smokers in a tobacco treatment trial.

Chloé M. Martin 博士寻求通过以下方式更好地了解母公司临床试验的范围：马丁博士正在研究与符合条件的非裔美国吸烟者拒绝参与相关的因素。有兴趣开展这个项目，因为众所周知，在烟草行业招募非裔美国人戒烟计划通常具有挑战性（Woods 等人，2002 年）。死亡率（Woods 等人，2002 年；Holford、Levy 和 Meza，2016 年；疾病控制和预防中心， 2018）。吸烟显着拉大了美国黑人和白人之间的预期寿命差距。（Ho & Elo，2013）并且成本非常高（Max Sung, Tucker, & Stark, 2010）。另一方面，非裔美国人。吸烟者表示他们想戒烟（Kulak, Cornelius, Fong, & Giovino, 2016；Weinberger, Esan, ）并且当非洲裔美国人接受基于证据的烟草治疗时，能够成功戒烟（Webb 等人，2010 年；Burgess 等人，2014 年），导致肺功能减少癌症死亡率（Tanner 等人，2015 年；Holford、Levy 和 Meza，2016 年；疾病控制中心和预防，2018）。在烟草治疗试验中招募非裔美国人所面临的挑战。已经有记录（Woods 等人，2002 年）。拒绝参加烟草治疗试验的人决定不参加可以有助于减少肺癌发病率和死亡率（Kilbourne、Switzer、Hyman、Crowley-Matoka 和 Fine，2006 年）。母公司研究非常适合检查与非洲人的招募和参与相关的因素。美国吸烟者因为这是一项多地点试验，已经解决了非洲吸烟者面临的一些障碍—— 例如，美国参与临床试验的少数族裔招募面临的挑战。被分为四大领域：与准入相关的问题、结构性因素、提供者信念和社会文化因素（Woods et al., 2002）。与获取相关的招聘挑战包括：医疗保健水平低下、识字率低、目标人群对医疗目的了解有限家长研究通过利用一个解决与访问相关的问题。一系列不同的肺癌筛查地点接受包括医疗补助在内的各种保险方式。构成招聘挑战的结构性因素包括：不适合支持的基础设施研究、有限的参与者报销、时间限制和有限的人员（Woods 等，2002）。家长研究通过将研究程序整合到当前的工作流程中来规避结构性问题筛选网站所面临的招聘挑战包括：参与转介、提供者不了解临床试验以及提供者对学术的不信任医学（Woods 等，2002）。家长研究通过提供转诊避免了与提供者信念相关的问题。在进行肺癌筛查预约时参与试验。母公司研究将受益于改进其招募策略以解决社会文化因素这些社会文化因素影响了临床试验中少数群体的招募（Woods et al., 2002）。包括：由于以前对非裔美国人的不道德剥削行为而对研究人员的不信任研究和医疗行业（Roberson，1994；Corbie-Smith、Thomas、Williams、MoodyAyers，1994； Harris, Gorelick, Samuels, Bempong, 1996），沟通问题（Harris et al., 1996），朋友的意见和家庭成员，以及关于自我效能的态度和信念（Woods 等，2002）。先前的研究已用来规避非洲裔美国人参与临床的社会文化障碍试验包括使用由非裔美国人社区组成的社区咨询委员会成员（Cox 等，2011），向潜在参与者邮寄个性化邀请函（Spence 和 Oltmanns，2011），确保知情同意文件的自主权，并分享来自以前的参与者，并使用大众广告平台，其中涉及来自主要有影响力的领导人非裔美国人社区（Okuyemi 等人，2007 年）。需要解决非洲裔美国人参与戒烟试验的障碍。具体目标目标 1：更好地了解非洲人烟草治疗试验中参与者的拒绝情况美国吸烟者采用严格的定性方法。目标 2：制定和评估旨在招募非洲裔美国吸烟者的招募策略烟草治疗试验。