||1R03CA235215-01A1 Interpret this number
||Sloan-Kettering Inst Can Research
||A Pilot Chw Model to Facilitate Shared Decision Making and 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. Lung cancer is
the second most commonly diagnosed cancer in the U.S., and the leading cause of cancer-related deaths.
Results from the National Lung Screening Trial (NLST) showed a 20% reduction in mortality from lung cancer
with low-dose computed tomography (LDCT) screening. In 2013 the U.S. Preventive Services Task Force
(USPSTF) recommended annual lung cancer screening (LCS) with LDCT in adults age 55-80 years with a 30
pack year history who smoke or quit within the past 15 years. In 2015 the Centers for Medicare and Medicaid
Services began providing coverage for a LCS counseling and shared decision making (SDM) visit, and annual
LCS with LDCT, if appropriate, for eligible individuals. 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. In this
study, we will conduct a pre-pilot with 10 high risk, previously unscreened Chinese livery drivers eligible for
LCS, to refine an adapted, existing Immigrant Health and Cancer Disparities (IHCD) CHW model, Taxi HAILL
(Health Access Interventions for Linkages and Longevity), for the multiple levels of influence at which CHWs
can articulate, including the individual (drivers), organizations (livery bases), and the environment (health care
access/environment). We will then conduct a pilot randomized controlled trial (RCT) to assess the feasibility of
the refined CHW model versus written materials to facilitate SDM and LCS (when appropriate) among 50 NYC
Chinese livery drivers eligible (by USPSTF criteria) for LCS. The model also incorporates key elements of the
Penn Center for Community Health Workers evidence-based CHW model, IMPaCTTM (Individualized
Management towards Patient-Centered Targets). Feasibility results will be used to inform the plannning and
design of large scale RCTs, targeting Chinese drivers as well as other driver populations in NYC and
throughout the U.S., and other high risk Chinese smoking populations in other occupations (e.g. restaurant
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