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A Family Intervention to Reduce Smoking in Vietnamese Men

Institution: University of California, San Francisco
Investigator(s): Janice Tsoh, Ph.D.
Award Cycle: 2010 (Cycle 19) Grant #: 19XT-0083H Award: $288,421
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Exploratory/Developmental Award

Initial Award Abstract
One in 3 Vietnamese Americans (36%) reside in California (U.S. Bureau of Census, 2009). Today, nearly 2 in every 100 Californians is Vietnamese. The decline in smoking prevalence in California has not translated equally to all the ethnic subgroups, particularly among Vietnamese men. Current smoking prevalence rates reported range from 25% to 35% among Vietnamese American males and below 1% among Vietnamese females. Our research group conducted the 2008 California state-wide Vietnamese Adult Tobacco Use Survey and found that a current smoking prevalence of 25% among males, and while one-third (36%) of current smokers were intending to quit in the next 30 days, about the same proportion (33%) indicated no intention at all to quit smoking. Having experienced family conflicts associated with smoking was a strong correlate to having intention to quit and to having quit successfully within the past 5 years. Data also showed that Vietnamese smokers underutilize existing cessation resources such as the California Smokers Helpline or nicotine replacement medications. There is an urgent need to identify effective and culturally appropriate outreach channels and intervention strategies to address the tobacco-related disease burdens in Vietnamese Americans. In this study, we will develop a family intervention using lay health worker (LHW) social outreach to involve both smokers’ families and the smokers to promote smoking cessation in Vietnamese American men. Lay health workers (LHW) are “insider messengers” who share similar linguistic and cultural background as the targeted population; they can deliver relevant health messages in a culturally consonant and personalized manner. In the proposed study, we aim to: 1) develop a culturally and linguistically appropriate family intervention targeting Vietnamese smokers; and 2) conduct a pilot trial to examine feasibility of the proposed intervention. The development of the proposed family intervention will be guided by qualitative interviews, community input, and medical literature integrating 3 theories of behavior change. We will conduct the study in 2 phases. In Phase 1, we will conduct in-depth individual and dyadic interviews with 5 pairs of current and former smokers and their family members to explore the roles of family in smoking cessation or continuation. Initial versions of the intervention and survey instrument developed will be reviewed and refined based on input from a community advisory board and 3 to 4 focus groups that consist of current smokers, and family members. In Phase 2, we will conduct a pilot trial with 48 pairs of smoker-family participants. Smoker participants are self-identified Vietnamese males who smoke daily in the past 7 days, and family participants will be one family member from the same household of the smoker. Eight LHWs will be trained to conduct the outreach and the family intervention. The intervention will consist of 4 monthly contacts, including 2 group meetings and 2 brief telephone calls following each meeting. Participants will complete a telephone survey at pre-intervention, and 1 month post-intervention. At the end of the study, we will obtain qualitative feedback from 3 focus groups with the 8 LHWs, and a randomly selected sample of 8 smokers and 8 family participants to identify working elements of the intervention. We will evaluate the feasibility of the intervention by recruitment efficiency, levels of attendance, and its acceptability. We will also measure changes in family members’ provision of support for their smokers, smokers’ perceived support received from their family, smokers’ utilization of resources, quit intention, and quit attempts made during the intervention period (corroborated by family members). The long-term goal of this research is to understand how we can effectively utilize family-based social outreach strategies to reduce tobacco use disparities through multiple (individual, familial and social) levels in hard-to-reach populations.