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 work, construction).
Project Relevance This study is the first to begin to address the need for an effective community engaged intervention to facilitate shared decision making (SDM) and lung cancer screening (LCS) (if appropriate) 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 refine and then conduct a pilot randomized controlled trial to assess the feasibility of an adapted community health worker intervention versus written materials to facilitate SDM/LCS, 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 include other cancer screening tests as well, e.g. colorectal cancer.
