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 prevalences among LEP Chinese and Vietnamese men were 32% and 43%,
respectively, compared to 16% of the general California male population. The investigators
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 Transtheoretical 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. The investigators 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. The investigators 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 12 smokers and 12 family members selected based on
abstinence experiences, the investigators 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.

Inclusion Criteria (for smoker participants):

- Chinese or Vietnamese males

- Age > 18

- Speak Cantonese or Mandarin (major Chinese dialects) or Vietnamese

- Have smoked at least 1 cigarette daily during the past 7 days, have a family member in
the household with whom he will participate in the study, plan to stay in the area for
the next 3 months (to complete all intervention activities) and can provide a valid
phone number and a mailing address (for follow-up assessments and for sending saliva
sample collection kits and payments).

Exclusion Criteria (for smoker participants):

- Those who are currently in a smoking cessation program or trying to quit smoking with
assistance will be excluded.

Inclusion Criteria (for family participants):

- Family members (male or female) of an eligible smoker

- Age > 18

- Speak Cantonese or Mandarin (major Chinese dialects) or Vietnamese

- Have never smoked or have formerly smoked but have not had any cigarette in the year
prior to participation

Exclusion Criteria (for family participants):

- Only one smoker-family dyad from a household may participate.

- They must not live in the same household as their own LHW (or another LHW) or have
participated in the study at any time (e.g., focus groups not directly related to the
intervention implementation)