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中心的干预措施，亚裔美国男性的吸烟率在亚组中仍然很高，特别是在英语水平低（LEP）的人群和来自吸烟率高的文化的移民中，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%）的亚裔男性吸烟者要么是中国人，要么是越南人。LEP中国和越南男性的吸烟率分别为32%和43%，而加州男性总人口的吸烟率为16%。我们开发了一种以家庭为中心的干预措施，利用非专业卫生工作者（LWH）外拓展，整合了形成性质的研究和从社会网络理论、社会认知理论和跨理论模型中选择的结构。干预措施包括2个针对吸烟者及其家庭成员的小组教育课程，以及2个月内由卫生工作者进行的2次个人电话随访。我们对96对中国和越南男性每日吸烟者及其家庭成员进行的单组试点试验显示，招募无动机吸烟者（42%处于“预先考虑”状态）具有很高的可行性，并且在家庭成员的独立证实下，3个月时7天的点流行戒烟率有望达到30%。本研究的第一个目的是评估以家庭为中心的干预在促进中国和越南男性吸烟者戒烟方面的效果。第二个目的是探索中介，以确定关键的社会心理和行为过程，这些过程是干预如何影响戒烟和保持戒断过程的基础。我们将进行一项两组随机对照试验（RCT），在干预开始后的基线、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；每个小组招募并提供干预措施给6对夫妇，每对夫妇中有一名每日吸烟的男性和他家庭中的一名家庭成员，总共360对吸烟家庭夫妇。根据亚洲亚组和吸烟史分层，一半的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组。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生化验证的戒烟（7天点患病率），报告至少进行过一次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）。利用从随机对照试验中获得的前瞻性定量数据，以及基于戒烟经历选择的30名吸烟者和30名家庭成员的试验后二元和个人访谈，我们将探索个人、家庭和社会网络层面的中介因素，解释干预如何影响戒烟和健康

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.