||5R03CA202515-02 Interpret this number
||Sloan-Kettering Inst Can Research
||Informing the Adaptation of a Chw Model to Facilitate Lung Cancer Screening for Chinese Taxi Drivers
The Chinese population is anticipated to become the largest immigrant group in New York City (NYC) in the
next few years. Nationwide, immigrants from China constitute the second largest foreign-born group, after
those from Mexico. Chinese immigrants work in a number of occupations that put them at higher risk for lung
cancer, including taxi driving. Chinese taxi drivers may be at exceptionally high risk for lung cancer due to the
combined impact of high rates of smoking and increased exposure to air pollution. The prevalence of ever
smoking among Chinese men in the U.S. is 42.5%. In our preliminary work assessing health needs among
foreign-born Chinese livery drivers in NYC, a staggering 73% were current or former smokers. The U.S.
Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose
computed tomography in adults age 55-80 years with a 30 pack year history. Previous research describes
lower rates of screening for other cancers among foreign-born Asian Americans and Pacific Islanders (AAPIs)
compared to U.S. born AAPIs, even after adjusting for insurance-related access to care. A substantial body of
research suggests that immigrants face unique barriers to care, including language and cultural factors.
Community health worker (CHW) efforts address these barriers, and have led to significant increases in cancer
screening rates. This study uses qualitative methods to inform the adaptation of an existing Immigrant Health
and Cancer Disparities (IHCD) CHW model, Taxi HAILL (Health Access Interventions for Linkages and
Longevity), through the exploration of the multiple levels of influence at which CHWs can articulate, including
the individual (drivers), organizations (livery bases), and the environment (health care access and health care
environment). In the adapted model, CHWs will serve as central nodes, acting at these various levels, to
facilitate lung cancer screening completion in an extremely high-risk group, NYC Chinese livery drivers who
smoke or who have quit within the past 15 years. This study is grounded in the Diffusion of Innovations theory,
which guides the process of adopting innovative ideas, and states that five key perceived attributes of an
innovation explain 49% to 89% of the variance in the rate of an innovation’s adoption: relative advantage (is the
intervention better than what we already have?), compatibility (is the intervention consistent with the values and
needs of the population?), complexity (is the intervention difficult to understand and use?), trialability (can the
intervention be experimented with on a limited basis?), and observability (are the results of the intervention
visible to others?). The adapted model will also incorporate key elements of the Penn Center for Community
Health Workers evidence-based CHW model, IMPaCTTM (Individualized Management towards Patient-
Centered Targets). The adapted CHW model will have potential for subsequent targeting and dissemination to
high risk Chinese smoking populations in other occupations (e.g. restaurant work, construction), as well as to
other driver populations in NYC and throughout the U.S.
Patient perspectives on adapting meaning-centered psychotherapy in advanced cancer for the Chinese immigrant population.
, Lui F.
, Huang X.
, Breitbart W.
, Gany F.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2019 Sep; 27(9), p. 3431-3438.