A stage-based scheduled smoking intervention for Chinese
Initial Award Abstract
Smoking accounts for more than 400,000 premature deaths yearly in the United States. Despite advances in treatment technology, little is known about effective smoking cessation treatment for Asian-American smokers who are under-represented in smoking cessation treatment research. We choose to focus on developing empirically based treatment targeting the Chinese American smokers as Chinese constitute the largest Asian/Pacific Islander group (24%) in the 2000 U.S. population. Almost 70% of Chinese Americans are first generation immigrants with over 90% originating from China. Recent data has shown that new immigrants from China reported significantly higher rates of current smoking and given the tobacco epidemic in China with current smoking prevalence rate of Chinese men estimated at 61%, the needs for searching for effective smoking cessation strategies targeting Chinese American smokers are fast growing.. The latest finding in one of our clinical trials targeting Chinese smokers showed a stage-based expert system intervention that delivered individualized written reports matching with smokers’ readiness for quitting smoking yield a significantly better abstinence rate at 12-month particularly among Chinese smokers who smoked 5 or more cigarettes daily when compared to a standard manual only treatment. While many smokers (> 70%) in the study were not ready to quit smoking within the following month, they were open to reduce smoking. Our finding also indicated that smoking reduction of 50% or more during the first 3 months in treatment predicted smoking abstinence at 12-month follow-up. Therefore, the purpose of this study is to examine the efficacy of a proposed intervention that will apply the best empirically validated technologies for smoking reduction and smoking cessation to Chinese American smokers at various level of readiness for quitting smoking, from those who have no intention to those who are ready to quit smoking.
The study will develop and test a stage-based scheduled smoking intervention that will consist of three components: 1) the Pathways-To-Change expert system intervention including a self-help manual and a series of individualized feedback reports based on participants’ readiness or stages of change; 2) scheduled smoking which systematically reduce smoking by scheduling specific smoking times during the day and 3) nicotine replacement (NRT) in the form of either nicotine gum or lozenge to be used with smoking reduction and abstinence. Using a randomized controlled study design, 400 ethnic Chinese smokers who reside in California will be recruited and assigned randomly to receive either the stage-based scheduled smoking intervention or the expert system intervention only. The efficacy of the proposed intervention will be examined by comparing smoking outcomes between the two treatment groups 3-, 6- and 12-month follow-ups. We hypothesize that participants who receive the proposed intervention will be more likely to achieve at least a 50% reduction from baseline smoking rates, more likely to have a 24- hour quit attempt, report a longer length of abstinence in their quit attempts, and have a higher rate of smoking abstinence at 3-, 6- and 12-month follow-ups. We will explore the role of smoking reduction in smoking cessation and whether the proposed intervention may work more effectively with smokers who are less ready to quit smoking. This proposed study will be the first randomized trial testing a stage-based smoking reduction intervention for the Chinese American smokers. Findings of the study will have a significant contribution in developing empirically-based smoking cessation treatment strategies that are culturally and linguistically appropriate for the Chinese American population. |