A Family-Focused Intervention for Asian American Male Smokers

描述（由申请人提供）：针对亚裔美国男性吸烟者的以家庭为重点的干预措施亚裔美国男性亚组的吸烟率仍然很高，特别是英语水平低（LEP）的人和来自吸烟率高的文化的移民，包括中国人和越南人。2011-12年加州健康访谈调查估计，加州近一半（46%）的亚裔男性吸烟者是中国人或越南人。吸烟率的LEP中国和越南男性分别为32%和43%，相比之下，一般加州男性人口的16%。我们开发了一个以家庭为中心的干预，利用外行卫生工作者（LWH）的推广，整合了形成性的定性研究和社会网络理论，社会认知理论和跨理论模型的选择结构。干预包括2个小组教育会议与成对的吸烟者和家庭成员，和2个后续个人电话提供的LHWs超过2个月。我们对96对中国和越南男性日常吸烟者及其家庭成员进行的单组初步试验显示，招募无动机吸烟者的可行性很高（42%处于“考虑前”），3个月时有30%的7天时点戒烟率，并得到家庭成员的独立证实。本研究的第一个目的是评估以家庭为中心的干预措施在促进中国和越南男性吸烟者戒烟方面的有效性。第二个目标是探索中介，以确定关键的心理和行为过程，这些过程是干预如何影响戒烟和保持禁欲的过程的基础。我们将进行一项2组随机对照试验（RCT），在基线、干预开始后6个月和12个月进行评估。随机对照试验涉及60名非专业卫生工作者（LHWs）;每个人招募并提供干预措施，以6对夫妇的一名男性每日吸烟者和一名家庭成员，从他的家庭，共360吸烟者家庭对。按亚裔亚组和吸烟史分层的一半LHWs将被随机分配到以家庭为中心的干预组，另一半将被分配到接受健康饮食教育的注意力控制条件。所有参与者都将收到有关戒烟资源的书面信息。我们假设，在6个月和12个月的随访中，干预吸烟者将更有可能实现经生化验证的戒烟（7天点患病率），报告至少有一次24小时戒烟尝试，并报告使用至少一种循证戒烟资源（戒烟热线，药物，健康专业建议）。使用从随机对照试验中获得的前瞻性定量数据，以及根据戒烟经验选择的30名吸烟者和30名家庭成员的试验后二元和个体访谈，我们将探索个人，家庭和社会网络水平的中介因素，解释干预如何影响戒烟， 保持禁欲长期目标是了解利用以家庭为基础的社会宣传战略的有效方法，以减少难以接触到的人群中的烟草使用差异。

DESCRIPTION (provided by applicant): A Family-Focused Intervention for Asian American Male Smokers Smoking prevalence remains high in subgroups of Asian American men, particularly among those with low English proficiency (LEP) and immigrants from cultures where smoking prevalence is high, including Chinese and Vietnamese. The 2011-12 California Health Interview Survey estimates that nearly half (46%) of all Asian male smokers in California are either Chinese or Vietnamese. The smoking prevalence's among LEP Chinese and Vietnamese men were 32% and 43%, respectively, compared to 16% of the general California male population. We developed a family-focused intervention utilizing lay health worker (LWH) outreach that integrates formative qualitative research and selected constructs from Social Network Theory, Social Cognitive Theory, and the Trans-theoretical Model. The intervention involves 2 small group education sessions with dyads of smokers and family members, and 2 follow-up individual telephone calls delivered by LHWs over 2 months. Our single-group pilot trial with 96 dyads of Chinese and Vietnamese male daily smokers and their family members showed a high feasibility of recruiting unmotivated smokers (42% were at "precontemplation"), and a promising 7-day point prevalence abstinence rate of 30% at 3 months with independent corroboration from family members. The first aim of the study is to evaluate the efficacy of the family-focused intervention in promoting smoking cessation in Chinese and Vietnamese male smokers. The second aim is to explore mediators to identify key psychosocial and behavioral processes that underlie how the intervention affects the processes of quitting and maintaining abstinence. We will conduct a 2-arm cluster randomized controlled trial (RCT) with assessments at baseline, 6 and 12 months following intervention initiation. The RCT involves 60 lay health workers (LHWs); each recruits and delivers interventions to 6 dyads of one male daily smoker and one family member from his household, for a total 360 smoker-family dyads. Half of the LHWs, stratified by Asian subgroup and smoking history, will be randomized to the family-focused intervention group and the other half will be assigned to an attention control condition receiving education on healthy eating. All participants will receive written information on smoking cessation resources. We hypothesize that, at 6 and 12 month follow-up, the intervention smokers will be more likely to achieve biochemically verified smoking abstinence (7-day point prevalence), to report having made at least one 24-hour quit attempt, and to report using at least one evidence-based smoking cessation resource (quitline, medication, health professional advice) than smokers in the control condition. Using prospective quantitative data obtained from the RCT, and post-trial dyadic and individual interviews of 30 smokers and 30 family members selected based on abstinence experiences, we will explore mediators at individual, family and social network levels that explain how the intervention affects quitting and maintaining abstinence. The long-term goal is to understand effective ways to utilize family-based and social outreach strategies to reduce tobacco use disparities in hard-to-reach populations.