A Family-Based Approach to Reduce Smoking in Vietnamese Men

Investigator: Janice Tsoh, PhD

Location(s): United States


Census 2010 showed Vietnamese is the 4th largest Asian American subgroup; 40% of Vietnamese Americans reside in California, The 2007 and 2009 California Health Interview Survey (CHIS) reported current smoking prevalence rate of Vietnamese was 30.5% among Vietnamese American males and 1.4% among Vietnamese females. Among Vietnamese men who spoke limited English, nearly half were current smokers (45.3%) when compared to 17.1% among males in California. The 2008 California state-wide Vietnamese Adult Tobacco Use Survey revealed that half of the Vietnamese male smokers had no intention to quit smoking within 6 months. Our research team has conducted a pilot study of a newly developed family-based intervention “The Healthy Family Project: Quit Smoking for a Healthy Family” (TRDRP grant 19XT-0083H) to identify effective and culturally appropriate outreach channels and intervention strategies to address Vietnamese smokers’ low intention to quit and underutilization of evidence-based smoking cessation resources. The intervention integrates formative research findings from in-depth interviews, selected theoretical constructs from three models: Social Network Theory, Social Cognitive Theory, and Transtheoretical Model, and utilizes lay health worker (LHW) outreach to involve both smokers and families to promote smoking cessation.

The intervention involves 2 small group education sessions with smoker-family dyads and 2 follow-up individual telephone calls delivered by LHWs over 2 months. Our pilot study with 72 dyads of Vietnamese male daily smokers and their family members (total 144 smoker and family participants) showed a high feasibility of recruiting unmotivated smokers (42%), high retention of participants through the 3-month study and intervention period (98.3%), high acceptability of the intervention with 96% said they would recommend the program to others, and high quit rate (36.1%). At 3-month after starting the program, one in three of the Vietnamese smokers reported quitting smoking for at least 7 days at the time of assessment, and the information was verified independently by their family members. The primary goal of the proposed study is to conduct a randomized controlled trial (RCT) to evaluate the efficacy of a culturally appropriate family-based intervention using LHW outreach to promote smoking cessation among Vietnamese American men. A RCT will target 120 dyads of a Vietnamese male daily smoker and one family member from his household. Participants will be recruited using LHW outreach involving 20 LHW. Each LHW will target to enroll 6 pairs of smoker and family member participants. Half of the LHWs and their enrolled participants will be randomly assigned to receive the proposed family-based smoking cessation intervention and the remaining half will be assigned to a comparison group where they will receive education on healthy eating and physical activity. All participants will receive a handout providing smoking cessation resources information. All participants will be interviewed at baseline, 3- and 6-month following program initiation.

We hypothesize that, at 6-month, participants who receive the proposed intervention will be more likely to report having stopped smoking for at least 7 days, to report having made at least one 24-hour quit attempt, and to report using a recommended evidence-based smoking cessation resource (telephone counseling quitline, FDA-approved smoking cessation medications, advice from health professionals) than those in the comparison group. In addition, we will explore relevant processes that explain the intervention effects at individual levels (e.g., level of nicotine dependence, readiness to quit smoking, acculturation), family levels (e.g., experience of smoking-related family conflicts, perceived and provision of family support), and social network levels (e.g., social network closeness, perceived social support relevant to smoking cessation). 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.