The Asian American population is the fast-growing racial group during 2000 and 2010. The California Health Interview Survey, a statewide survey, conducted in 2011-12 reported that Vietnamese (43%), Chinese (32%), and Korean (27%) men who spoke limited English have much higher smoking prevalence rates than that of men of all races combined (17%). Thus, some Asian groups, including Chinese, Korean and Vietnamese, have an unequal burden of tobacco-related diseases.
Asian Health Services (AHS) is a federally-qualified health center in Alameda County, California, providing services in English and 12 different Asian languages. The vast majority of the patients are Chinese, Vietnamese, and Korean with low income. Because of high smoking rates and associated health impacts on patients and their families, promoting smoking cessation is a health priority for AHS. The Vietnamese Community Health Promotion Project (VCHPP) at UCSF has conducted numerous intervention studies to promote smoking cessation among Asian Americans. Given the shared research interest, AHS and VCHPP have partnered to address smoking in Asian Americans. The partners received a TRDRP pilot Community-Academic Research Award grant to develop an interactive “Mobile Doctor” (iMD) intervention in Korean and Vietnamese languages that delivers video education tailored to patient’s responses on a computer tablet during the clinic visit to enhance patient-provider discussion of tobacco use. Our pilot study with 30 Korean and Vietnamese male patients who smoked daily showed a high feasibility for its implementation in primary care setting (within 15 minutes in duration; 94% completed prior to seeing their providers); recruiting unmotivated smokers (53% had no plan to quit in the 6 next months), and high acceptability (86% or more perceived iMD was helpful in their decision to quit and in communicating with their providers about tobacco use). Provider’s advice on patient’s tobacco use as documented by electronic health record (EHR) increased remarkably from 37% at one visit prior to the invention to 77% at the visit right after the iMD intervention. At 3 months, 17.6% of the participants reported not smoking for at least 7 days at the follow-up survey.
The primary goal of the proposed study is to evaluate the iMD intervention with an expansion to the Chinese language in its efficacy to promote patient-provider discussion and quitting smoking in Chinese, Korean, and Vietnamese male smokers. We will enroll 150 AHS Chinese-, Korean- or Vietnamese-speaking patients who smoke daily and have a scheduled clinic visit. Participants will then be assigned (by chance) into receiving 1) Usual Care; or 2) iMD plus usual care. Surveys will be conducted with participants at 3 times: before the scheduled intervention visit, immediately after or within one week of the intervention visit, and 6 months following the intervention visit. Additional data will be obtained from EHR. We anticipate that, when compared to participants receiving usual care alone, those who receive the iMD will be more likely to receive physician advice on their tobacco use both at their intervention visit and at one visit following the intervention visit within 6 months as documented in EHR; and at 6 months follow-up, those receiving the iMD will be more likely to report having been able to quit smoking for at least one day during the study period, and to have reported having quit smoking for at least 7 days with their abstinence status verified using a saliva sample. In addition, we will identify tailoring elements for Chinese, Korean, and Vietnamese female smokers to inform future expansion of the iMD to include female patients. Furthermore, we will evaluate the community-research partnership between AHS and VCHPP to promote smoking cessation in Asian American communities with respect to strengthening the partnership and expanding to include new partners in finding dissemination. The long-term goal is to understand effective ways to enhance patient-provider communication in tobacco use and promote smoking cessation in practice-based settings among underserved populations.