Practice-based Intervention for Vietnamese & Korean Patients

While California has made significant strides in tobacco control and is leading the nation in reducing smoking use, the decline is not observed in all groups. Select groups still have much higher smoking rates and thus bear an unequal burden of tobacco-related illnesses and deaths. Of important note, Asian American men as a combined group have a higher smoking rate than non-Hispanic Whites (22% vs. 18%, respectively); in particular, the highest smoking prevalence has been observed in Vietnamese (31%) and Korean (30%) men among major Asian subgroups. Research also shows that smoking rates are higher for Asian American men with low acculturation (e.g., immigrant status, low English proficiency) than for those who are more acculturated; yet the reverse trend is observed in Asian American women. These findings underscore the need for more targeted tobacco control efforts.

The scientific literature suggests that provider advice to quit smoking can influence a smoker’s decision to quit. However, research has shown that Asian Americans are less likely to receive such provider advice. Providers often have very limited face-time with patients during the short clinic visit, which presents a challenge as to whether they can incorporate smoking cessation messages during the visit. Overall, little research has focused on smoking cessation in the clinic setting, particularly research that focuses on Asian Americans.

The proposed study leverages the important role that Asian Health Services (AHS), a community health center in Alameda County, California, plays in delivering primary care to low-income Asian immigrants. The purpose of the proposed study is to develop a more streamlined smoking cessation intervention that can be integrated into the clinic visit. The research question is whether providing culturally appropriate video education that includes provider advice and is tailored to patients’ readiness for quitting smoking will increase whether a patient receives smoking cessation education according to the recommended Clinical Practice Guideline and whether this results in a decrease in tobacco use in low-income Vietnamese and Korean patients.

The study would:

1. Foster a strong community-research collaboration between AHS (community partner) and the UCSF Vietnamese Community Health Promotion Project (academic partner) to promote smoking cessation in the Vietnamese and Korean immigrant communities.
2. Develop a culturally appropriate intervention targeting Vietnamese and Korean patients to promote smoking cessation at a community health center setting. To do so, we will: a) conduct focus groups to identify critical elements that would inform culturally appropriate messaging, and b) develop short interactive multimedia videos of AHS primary care providers delivering tailored messages promoting smoking cessation to Vietnamese and Korean smokers.
3. Test the video intervention with 30 Vietnamese and 30 Korean patients at AHS to evaluate the intervention with respect to how feasible and acceptable it is with patients and providers. As secondary outcomes, we will compare the changes before and 3-month after the video intervention in patient’s intention to quit, quit attempts, and days of smoking abstinence.
   

We will begin by conducting focus groups with patients and providers to identify what messages would be most influential. We will then develop a sample of the intervention that includes automated computerized surveys and delivery of short videos that include AHS physicians providing tailored quitting advice and resources based on patients’ responses provided, along with tools for enhancing patient-provider tobacco-related communication. We will then test the modified intervention with 30 Vietnamese and 30 Korean patients, and conduct a short survey with providers to explore how feasible and acceptable the intervention is to patients and providers.

This grant is very responsive to TRDRP’s disparities and equity priority area because it targets two ethnic populations with high smoking rates and will be conducted within a resource-poor community health center setting.