Tobacco use

1
Tobacco use Cessation among Asian Oregonians A
community-based participatory approach for
reducing tobacco related health disparities in
the Asian Population

• Jennifer Kue, Elizabeth Takahashi, Carrie
  Furrer
• APHA 2008, San Diego, California

2
Who are we?

• Asian Pacific Islander (API) Tobacco Prevention
  and Education Program (TPEP)
• Asian Family Center, a program of the Immigrant
  and Refugee Community Organization (IRCO)
• Non-profit community-based organization
• Specific population grantee of the Oregon DHS
  TPEP
• NPC Research, private research evaluation firm

3
Goals of Presentation

• Describe project development process using a
  community-based participatory research (CBPR)
  approach
• Explain quantitative phase (mail survey)
• Explain qualitative phase (interviews)
• Preliminary findings
• Next steps/Lessons learned

4
What is CBPR?

• Approach to research evaluation that engages
  community stakeholders in each project phase
• Promotes shared learning power
• Iterative process
• Values community expertise, traditions, priorities

5
Collaborators

• Asian Family Center
• Oregon Tobacco Quit Line
• Oregon Department of Human Services
• NPC Research
• International Language Bank (ILB)
• API Health Network
• Community members

6
What Is the Problem?

• 21 of adult Oregonians currently smoke
  cigarettes, compared to 10 of API adults (DHS,
  2007)
• Some evidence that specific API subpopulations
  bear a greater burden of tobacco use (e.g., 31
  for Korean men Lew Tanjasiri, 2003)
• Gap in knowledge of tobacco use cessation
  resource utilization among Asian Oregonians

7
Project Overview

• What factors are related to tobacco use and
  utilization of cessation resources among Asian
  Oregonians?
• demographics
• linguistic acculturation
• perceptions of harm of tobacco use
• Two-phase mixed-methods research project to
  collect information 1) mail survey 2)
  in-person interview.

8
Instrument Development Survey

• Brief assessment of
• tobacco use
• linguistic acculturation
• perceptions of harm
• attitudes toward and use of cessation resources
• Items adapted from
• Behavioral Risk Factor Surveillance System
  (BRFSS)
• California Korean Tobacco Cessation Survey
• Hmong Tobacco Use Survey Project

9
Instrument Development Translation

• Translated into Simplified Chinese, Japanese,
  Korean, Lao, Mien, Tagalog, Vietnamese
• Iterative process with ILBs professional
  translators and community members
• Goal balance cultural appropriateness and
  consistency

10
Instrument Development Interview

• In-depth assessment of
• attitudes toward tobacco use
• cultural use of cigarettes
• acculturation, perceptions of harm
• motivation to quit
• knowledge utilization of cessation resources
• Goal Compliment and enrich information
  collected through brief survey.

11
Instrument Development Interview

• Mix of qualitative and quantitative questions
  adapted from
• Behavioral Risk Factor Surveillance System
  (BRFSS)
• Diverse Racial Ethnic Groups and Nations
  (DREAGAN) Study
• Hmong Tobacco Use Survey
• Iterative process, including pilot testing
• Conducted in English

12
Research Design Mail Survey

• Selected 10 counties with the highest population
  of Asian Oregonians while maintaining
  geographical diversity
• 1100 addresses from Survey Sampling International
• Surnames identified as Asian
• List only included larger Asian ethnic subgroups
• Random sample within county
• 200 addresses from IRCO database
• IRB approval through Portland State University

13
Research Design Mail Survey

• Process
• Introduction letter
• Survey 2 incentive
• Reminder cards
• Second round of surveys
• 100 lottery incentive
• 45 response rate (N491)
• Acceptable range for mail surveys 45-55

14
Research Design Interview

• Recruitment methods (N19)
• Press releases in Asian ethnic newspapers, radio
  stations, fliers, and mainstream media outlets
• Word-of-mouth
• Interview process
• Recorded 1-hour interviews
• Monetary incentive (20 gift card)
• Transcription

15
Preliminary Findings Sample
N432
Number in parentheses respondents of that
ethnicity
16
Preliminary Findings Sample
Number in parentheses respondents from that
region
17
Preliminary Findings Sample
Number in parentheses respondents in that age
group
18
Preliminary Findings Prevalence

• 12.6 currently smoke cigarettes
• 14.0 currently use some form of tobacco
• 8.6 current smokers (BRFSS definition)
• 100 cigarettes currently smoke cigarettes
• Smoking prevalence among Asian and Pacific
  Islanders was 10 (DHS, 2004-05).

19
Preliminary Findings Prevalence
Number in parentheses respondents of that
ethnicity
20
Preliminary Findings Prevalence
N425
Number in parentheses respondents in that age
group
21
Preliminary Findings Prevalence
Number in parentheses respondents of that
gender
22
Preliminary Findings Prevalence
N426
Number in parentheses respondents from that
region
23
Preliminary Findings Quit Line

• What is the Oregon Tobacco Quit Line?
• Telephone-based counseling service for tobacco
  cession (cognitive-behavioral therapy,
  educational materials, nicotine-replacement
  therapy).
• Less than 1 of the callers in the 200708
  contract year were APIs.
• 36 had heard of the Oregon Tobacco Quit Line,
  but varied for different groups of respondents.

24
Preliminary Findings Quit Line
N405
Number in parentheses respondents of that
ethnicity
25
Preliminary Findings Quit Line
N405
Number in parentheses respondents of that
gender
26
Preliminary Findings Quit Line
N410
Number in parentheses respondents with that
level of education
27
Preliminary Findings Quit Line
N413
Number in parentheses respondents from that
region
28
Results from a CBPR Perspective

• AFC and NPC Research works together to develop
  research products
• Results shared with community members for
  feedback and interpretation assistance
• Products go to DHS for review
• Dissemination based on the needs of the
  community, DHS, AFC/IRCO

29
Lessons Learned

• Need for collaboration
• Difficulty in accessing target population
• Challenges with translation
• How to get a satisfactory response rate from a
  mail survey with limited resources
• Challenges recruiting for interview
• Need for support in managing and analyzing data
  collected

30
Contact Information

• Jennifer Kue, MPH Elizabeth Takahashi, MPH
• Asian Family Center, 4424 NE Glisan St.,
  Portland, OR 97213
• Phone [phone] ext. 121
• jenniferk_at_mail.irco.org elizabetht_at_mail.irco.org
  
• www.irco.org
• Carrie Furrer, Ph.D.
• NPC Research, 4380 SW Macadam Ave., Ste. 530,
  Portland, OR 97239
• Phone [phone] ext. 110
• furrer_at_npcresearch.com
• www.npcresearch.com