Korean Americans constitute the 5th largest Asian group in the U.S. Despite a significant decline in both smoking prevalence and exposure to secondhand smoke (SHS) nationally and in California, smoking prevalence and rate of SHS exposure are disproportionately high among Korean Americans. Korean American men has reportedly the highest smoking prevalence (24.9% to 35.4%) when compared to the smoking prevalence of 16.1% among California men or 18.8% among men nationwide of all racial ethnic groups combined. The Centers for Disease Control and Prevention reported high smoking prevalence among Korean women (20.1%). Of note, the 2011-12 California Health Interview Survey data showed that Korean Californians had the highest SHS exposure in homes (16.6%) among all non-smoking adults in California when compared to African Americans (10.7%), non-Hispanic Whites (4.9%) or Hispanics (3.1%). A major contributor to this vulnerability is the high smoking prevalence in Korean Americans. Thus, the need to reduce and end both tobacco use and SHS exposure among Korean Americans is urgent.

Our research team has developed and tested a new family-based lay health worker outreach intervention “The Healthy Family Project: Quit Smoking for a Healthy Family” targeting Chinese and Vietnamese male daily smokers and their families. The intervention integrates research findings and multiple health behavior theories. The program utilizes lay health worker (LHW) outreach to involve a daily smoker and a non-smoking family member (forming smoker-family pairs) to promote smoking cessation. LHWs are non-health professionals, they are peers who share the same cultural and language background with the targeted community members. The intervention involves 2 small group education sessions with smoker-family dyads and 2 follow-up individual telephone calls delivered by LHWs over 6-8 months. Our first pilot study with 96 smoker-family Chinese and Vietnamese pairs showed a high feasibility of recruiting smokers who were unmotivated to quit smoking (42%) with high quit rate verified by family members at 3-month (24.1%). Our recently completed study with 107 Vietnamese smoker-family pairs has shown that the intervention was effective in yielding 33.3% quit rate verified by both family’s report plus biomarker in saliva.

To address both high prevalence of cigarette smoking and secondhand exposures in Korean American families, we propose to

1) develop a culturally and linguistically appropriate intervention to promote smoking cessation and reduce SHS exposure among Korean Americans; and

2) conduct a pilot randomized controlled trial (RCT) to obtain preliminary data on feasibility and acceptability, and to estimate efficacy of the newly developed family-based intervention in promoting smoking cessation and in reducing SHS exposure among Korean Americans.

We will first conduct 18 in-depth participant interviews with current smokers, formers smokers, and members how have reported SHS exposure to inform development of key intervention messages that are culturally relevant. Based these findings, community input and the literature, we will adapt a family-based intervention framework building from our team’s successfully violence prevention education in Korean Americans and tobacco cessation with Chinese and Vietnamese Americans. We will then conduct a RCT to test the feasibility of targeting 48 pairs of a daily smoker and a family member living in the same household with assessments at baseline and 3 months. The primary outcomes include treatment attendance, perceived helpfulness, 7-day smoking abstinence achieved among smokers, and changes in SHS exposure among non-smokers verified by salivary cotinine. In close collaboration with our community partner, the Korean Community Center of the East Bay, and our project’s community advisory board throughout the project, we aim to establish evidence-based intervention for eliminating tobacco use and reducing SHS exposure in Korean Americans.