In few communities is there a greater need for research which can "elucidate unique factors and forces underlying tobacco use initiation, experimentation, cessation and resiliency" (TRDRP) as among Deaf youth. Little is known about the smoking practices of this population, although there is considerable concern that this population may be at high risk for tobacco uptake. What we do know is that the Deaf community is characterized by distinct linguistic, social and cultural traits that likely have a profound influence on all behaviors, including tobacco use. To explore the ways in which elements of Deaf youth culture and social experience shape tobacco-related knowledge, attitudes and practices, our team of academic investigators (DCPCR/JCCC/UCLA) and Deaf community members (Greater Los Angeles Council on Deafness, Inc., GLAD) have implemented the Interactive Video Questionnaire (IVQTM), a TRDRP-funded multi-media computer-based survey of this population. This groundbreaking effort, unique in the nation, is an important first step. However, its closed-ended format, restricted length, and use of sign communication modalities appropriate to the Deaf necessarily limit the range and complexity of issues that we can explore. Thus, this initial survey effort does not suffice to tell us all we need to know. Our Pilot CARA project, proposed by the same (UCLA/GLAD) research team that is currently conducting the survey project, will build on and go beyond that initial effort in order to gain an in-depth understanding of the tobacco use patterns and unmet tobacco control programming needs of this population, and to characterize the intervention strategies that can adequately address these needs. Further, we will expand our efforts to include Deaf community participation in this research program statewide to ensure that the priorities and concerns of this community guide our research; that mechanisms are in place to disseminate research findings; and that these results are translated into effective tobacco control programming that reaches all Deaf Californians.
The aims of this Pilot CARA project are: (1) To conduct in-person, semi-structured interviews in a sample of 40 male and female Deaf high school students with varying smoking experiences, to build upon and examine in depth what is learned from the IVQTM study, the first-ever quantitative survey of tobacco use and progranuning needs among Deaf youth. Recruiting from among subjects participating in our survey study so that we can tailor our interviews and compare our qualitative and quantitative results, we will utilize well-established qualitative methodology, including maximum variation sampling; QSR NU*DUST computer software to code, classify and index our non-numerical, unstructured text; start lists to initially categorize our results; and cross case analysis to identify underlying themes and patterns regarding tobacco related knowledge, attitudes and practices, across individual responses. (2) To forge a statewide tobacco control network of community based organizations (i.e., the California Coalition of Agencies Serving the Deaf and Hard-of-Hearing, etc.) and other leadership and educational resources serving the Deaf, led by a community based advisory committee of 4 - 6 members to: define research priorities and strategies; disseminate research findings; and shape anti-tobacco programs based on these research efforts, statewide. (3) To work with the statewide network and advisory group, building on what we learn through our data collection efforts (i.e., quantitative survey study, in-depth qualitative interviews, review of tobacco-related research among hearing youth, prevention programming among Deaf youth) to develop a tobacco control intervention for Deaf youth which we propose to test in a scientifically rigorous, randomized controlled trial through a subsequent Full CARA application. Meeting all criteria for an effective community-academic partnership, this proposed Pilot CARA study will allow us to integrate and further our efforts to achieve the goal of tobacco control among Deaf youth, members of a unique, underserved and understudied community, as part of California's effort to reduce tobacco use among young people in every community, statewide. |
This Pilot CARA is a collaborative effort between researchers at UCLA and the Greater Los Angeles Council on Deafness (GLAD) designed to gain an understanding of tobacco use patterns and unmet tobacco control programming needs among Deaf youth, and to develop intervention strategies that can address these needs. To achieve these ends we proposed to: 1) conduct in-person, semi-structured interviews with 40 male and female Deaf youth with various smoking experiences, examining in depth the findings from the IVQTM study, a TRDRP-funded (6RT-0047) multi-media computer-based survey of this population; 2) forge a statewide tobacco control network of community-based organizations and agencies that work with and serve the Deaf community; and (3) work with this network to define research priorities and strategies, disseminate research findings, and develop a tobacco control intervention for this population for future testing in a scientifically rigorous, randomize controlled trial through a subsequent Full CARA application.
To implement the Pilot CARA, we: drew a randomized (by gender and smoking status as identified in
the IVQTM survey) sample of 43 subjects; conducted interviewer training; and completed 40 in-depth qualitative signed interviews from among the male and female respondents in our IVQTM study. The videotaped interviews were transcribed into written English; a 10% sample of the interviews were (blindly) retranscribed to examine consistency. Utilizing well established qualitative data analysis methodology, we identified a start list of concepts, including: respondent knowledge, attitudes, and practices regarding tobacco use; perception of tobacco/anti-tobacco advertisements; exposure to anti-tobacco programming; Deaf self-identity, perceived role models, view of education, activities and future aspirations. This start list was expanded to 32 categories, into which all survey content was preliminarily coded. Themes of interest have emerged based on these steps, and in-depth content analyses of the categories are continuing. Based on initial recommendations from the California Coalition of Agencies Serving the Deaf and Hard-of-Hearing (CCASDHH), our attention has focused on designing and testing a tailored school-based intervention in collaboration with the California School for the Deaf, Fremont [10GT-3101, Pilot SARA/TRDRP). We are currently organizing an ongoing Advisory Committee to review all study findings, to identify community-based strategies that can effectively supplement our school-based effort, and to work with us in disseminating study results statewide.
In encouraging an effective community-academic partnership, this Pilot CARA study allows us to
integrate and further our efforts to achieve the goal of tobacco control among Deaf youth, members of a unique, underserved and understudied community, as part of California's effort to reduce tobacco use among young people in every community, statewide. |