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

• 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
• 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

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.

ChloéM。Martin博士试图通过 检查与合格的非裔美国人吸烟者拒绝参与有关的因素。马丁博士是 有兴趣追求这个项目，因为它已经确定了在烟草中招募非裔美国人 戒烟计划经常受到挑战（Woods等，2002）。非裔美国人患有高肺癌 死亡率（Woods等，2002； Holford，Levy和Meza，2016年；疾病控制与预防中心， 2018）。吸烟极大地导致了美国黑人和白人之间的预期寿命差距 （Ho＆Elo，2013年）并且非常昂贵（Max Sung，Tucker和Stark，2010年）。另一方面，非裔美国人 吸烟者表明他们想戒烟（Kulak，Cornelius，Fong和Giovino，2016年； Weinberger，Esan， 亨特（Hunt）和霍夫（Hoff），2016年;）以及接受循证烟草治疗时，非洲裔美国人已经 能够成功戒烟（Webb等，2010； Burgess等，2014），导致肺部减少 癌症死亡率（Tanner等，2015； Holford，Levy和Meza，2016年；疾病控制中心和 预防，2018年）。在烟草治疗试验中招募非裔美国人的挑战 已经记录在案（Woods等，2002）。了解为什么合格的非裔美国人吸烟者 谁拒绝参加烟草治疗试验决定不参加的人可以减少 肺癌发病率和死亡率（Kilbourne，Switzer，Hyman，Crowley-Matoka和Fine，2006年）。 父母研究是研究与非洲招募和参与有关的因素的理想选择。 美国吸烟者是因为这是一项多站点试验，已经解决了非洲的一些障碍 美国参与临床试验。例如，针对临床试验的少数族裔招募挑战 已分为四个广泛的领域：与访问，结构性因素，提供商信念以及 社会文化因素（Woods等，2002）。与访问有关的招聘挑战包括： 较低的医疗保健，识字率低，目标人群对目的有限 研究和运输挑战。父母研究解决了与访问有关的问题 各种各样的肺癌筛查站点，他们接受包括医疗补助在内的各种保险方式。这 作为招聘挑战的结构性因素包括：不合适的基础设施以支持 研究，有限的参与者报销，时间限制和有限的员工（Woods等，2002）。 家长研究通过将研究的程序整合到当前的工作流程中来规避结构性问题 筛选站点。提供者认为的招聘挑战包括：缺乏 参与的推荐，提供者不知道临床试验，以及提供者对学术的不信任 医学（Woods等，2002）。家长研究通过提供推荐来避免与提供者信念有关的问题 为了参加肺癌筛查预约时参加试验。 父母研究将受益于改善其招聘策略以解决社会文化因素 在临床试验中影响了少数民族的招募（Woods等，2002）。这些社会文化因素 包括：由于先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 研究与医疗行业（Roberson，1994; Corbie-Smith，Thomas，Williams，Moodyayers，1994; Harris，Gorelick，Samuels，Bempong，1996年），《沟通问题》（Harris等，1996），《朋友的意见》 和家人，并遵守自我效能感（Woods等，2002）。一些策略 先前的研究已被雇用以规避非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），将个性化邀请函邮寄给潜在参与者（Spence＆ Oltmanns，2011年），确保在知情同意文件中自治，并分享来自 以前的参与者，并使用涉及关键影响领导者的大众广告平台 非裔美国人社区（Okuyemi等，2007）。可持续的，基于经验的招聘工作 需要向非裔美国人参与烟草戒烟试验的地址障碍。 具体目标 目标1：为了更好地理解非洲的烟草治疗试验中的参与拒绝 美国吸烟者使用严格的定性方法。 目标2：制定和评估旨在招募非裔美国人吸烟者的招聘策略 烟草治疗试验。