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.
This study is the first to address the need to disseminate an effective lung cancer screening facilitation intervention among a high risk occupational immigrant group, beginning with Chinese livery drivers. The Chinese immigrant population is rapidly growing, as is the taxi driver community. This study will inform the adaptation of a community health worker intervention with the potential for scalability to include other populations of livery and yellow taxi drivers in NYC and throughout the U.S., other high risk occupations (e.g. restaurant and construction work), and with potential adaptability to aid drivers with smoking cessation and to include other cancer screening tests as well, e.g. colorectal cancer.
