A Family-Focused Intervention for Asian American Male Smokers

描述(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在亚裔美国男性中的吸烟率仍然很高，特别是在英语水平较低的人和来自吸烟流行率较高的文化的移民中，包括中国人和越南人。2011-2012年加州健康访谈调查估计，加州近一半(46%)的亚裔男性吸烟者不是中国人就是越南人。LEP中国男性和越南男性的吸烟率分别为32%和43%，而加州普通男性的吸烟率为16%。我们利用非专业卫生工作者(LWH)的外展，结合形成性定性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，开发了以家庭为中心的干预措施。干预包括与吸烟者和家庭成员进行2次小组教育会议，以及2次由LHW在2个月内提供的跟踪个人电话。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，招募无动机吸烟者的可行性很高(42%处于“预想”状态)，并在得到家庭成员独立证实的情况下，在3个月内有希望的7天点戒烟率为30%。这项研究的第一个目的是评估以家庭为重点的干预措施在促进中国和越南男性吸烟者戒烟方面的效果。第二个目标是探索调解人，以确定关键的心理社会和行为过程，这些过程是干预如何影响戒烟和维持禁欲过程的基础。我们将进行一项双臂整群随机对照试验，在干预开始后的基线、6个月和12个月进行评估。RCT涉及60名非专业卫生工作者(LHW)；每个人招募一名男性每日吸烟者和其家庭中的一名家庭成员，向6对夫妇提供干预，总共360对吸烟者-家庭对偶。其中一半的LHW按亚洲亚群和吸烟史分层，将被随机分配到以家庭为重点的干预组，另一半将被分配到注意力控制条件下，接受健康饮食的教育。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，与对照条件下的吸烟者相比，干预吸烟者将更有可能实现生化验证的戒烟(7天点流行率)，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(戒烟线、药物、健康专业建议)。使用从随机对照研究获得的前瞻性定量数据，以及试验后对30名吸烟者和30名基于戒烟经验选择的家庭成员的个人访谈，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戒烟 保持节欲。长期目标是了解如何有效地利用基于家庭和社会的推广战略，减少难以接触到的人群中的烟草使用差距。

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.