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Helping Asian Americans Stop Smoking: The Role of Quitlines

Helping Asian Americans Stop Smoking: The Role of Quitlines. Shu-Hong Zhu University of California, San Diego APICAT Meeting in Seattle December 13, 2010. Asian Language Speakers Are the Focus of this Presentation. Worksite Policy. A Quitline in a Population-Based Framework. Media.

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Helping Asian Americans Stop Smoking: The Role of Quitlines

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  1. Helping Asian Americans Stop Smoking: The Role of Quitlines Shu-Hong Zhu University of California, San Diego APICAT Meeting in Seattle December 13, 2010

  2. Asian Language Speakers Are the Focus of this Presentation

  3. Worksite Policy A Quitline in a Population-Based Framework Media Quitline School Programs Provider Advice Source: California Smokers’ Helpline

  4. English Quitlines in 1992 Statewide Quitline No Statewide Quitline WA VT MT ME ND OR MN NH ID WI MA NY SD WY MI RI PA IA CT NV NE NJ OH IL IN UT DE CA WV CO VA MD KY KS MO D.C. NC TN AZ OK SC NM AR GA MS AL LA TX AK FL HI

  5. English Quitlines in 2004 WA VT MT ME ND OR MN NH ID WI MA NY SD WY MI RI PA IA CT NV NE NJ OH IL IN UT DE CA WV CO VA MD KY KS MO D.C. NC TN AZ OK SC NM AR GA MS AL LA TX AK FL HI

  6. Asian Language Quitlines in 1993 Statewide Quitline No Statewide Quitline WA VT MT ME ND OR MN NH ID WI MA NY SD WY MI RI PA IA CT NV NE NJ OH IL IN UT DE CA WV CO VA MD KY KS MO D.C. NC TN AZ OK SC NM AR GA MS AL LA TX AK FL HI

  7. Asian Language Quitlines in 2009 Statewide Quitline No Statewide Quitline WA VT MT ME ND OR MN NH ID WI MA NY SD WY MI RI PA IA CT NV NE NJ OH IL IN UT DE CA WV CO VA MD KY KS MO D.C. NC TN AZ OK SC NM AR GA MS AL LA TX AK FL HI

  8. Asian Language Quitlines in 2010 Statewide Quitline No Statewide Quitline WA VT MT ME ND OR MN NH ID WI MA NY SD WY MI RI PA IA CT NV NE NJ OH IL IN UT DE CA WV CO VA MD KY KS MO D.C. NC TN AZ OK SC NM AR GA MS AL LA TX AK FL HI

  9. Why Such a Slow Adoption for Asian Language Quitlines? • Perception/misperception • Asian smokers will not call quitlines • Quitlines will not work for them • Not cost-effective • Misunderstanding • Model minority/they will not complain • Zero-sum game for funding

  10. Data from California Asian language speakers do call quitlines Telephone counseling works for them

  11. Incoming Calls to California QuitlineAugust 1992 - December 2008 (Quarterly) Number of calls

  12. The Asian Smokers’ Quitline in California (1992-2010) • A total of about 38,000 served, • About 40% English-speaking and 60% Asian language-speaking callers

  13. Proxy Calls Zhu et al. (2006) Tobacco Control

  14. Likelihood of Calling the Helpline (Using CHIS 2003 for Population Estimates) Source: Zhu et al. (2010). AJPH

  15. Likelihood of Calling the Helpline (Using CHIS 2005 for Population Estimates) Source: Zhu S, et al. (2010) AJPH

  16. Likelihood of Calling the Helpline (Using CHIS 2007 for Population Estimates) Source: Zhu et al. (2010) AJPH

  17. Interested Smokers Chinese Vietnamese Korean Self-help materials Counseling + Self-help materials Self-help materials Counseling + Self-help materials Self-help materials Counseling + Self-help materials A Randomized Trial Testing Efficacy (One Protocol, Three Language Groups)

  18. Recruited from 3 Language Groups • Total 2273 • 727 Chinese • 846 Korean • 700 Vietnamese

  19. Counseling Adherence Previous Study Present Study English/Spanish Asian Language % counseled 67% 87% Average # of Sessions 4.0 4.9

  20. Summary • Asian language speakers will use a quitline--just as likely as English-speaking Whites • Provided there is adequate promotion for it • There is plenty of evidence from quitlines operating in Asian countries • Quitlines work for this population • One protocol works for all three language groups • It is not necessary to test the protocol on every language • Given the new evidence on Asian language speakers and Cochrane Review showing quitlines work in general, we should focus on dissemination

  21. More Importantly • An Asian language-specific quitline will encourage • Media campaigns in Asian communities • Community campaigns • Physician referrals • It will enhance medication benefits • NRT distribution through quitlines

  22. Worksite Policy A Quitline in a Population-Based Framework Media Quitline School Programs Provider Advice Source: California Smokers’ Helpline

  23. Disparity The lack of a language-specific quitline puts the Asian language-speaking population at a distinct disadvantage

  24. What is Needed? CBO’s Need to Speak Up!

  25. One Attempt Well, by an academic group

  26. The Dissemination Project • Translate the proven Asian-language counseling protocol into a multi-state quitline • Get motivated states to work together first • Get more states to join in

  27. Design • Separate promotion from operation (counseling) • Three states promote the quitlines in 3 languages • California, Hawaii, Colorado • In Chinese, Korean, Vietnamese-1 toll-free number for each language • UCSD provides counseling to all callers • NRT is provided according to each state’s own policies

  28. Project Time Line • Opened the lines to other states in Jan. 2010 • Started monthly reporting in Feb. 2010 • Project will end in September 2012 • Unless….

  29. Outcome Measures • Track the call volume of each state • Compare the rates of participation among states • Track nonsmokers’ participation • Assess any changes in other states’ readiness to adopt? • Have new states join?

  30. Asian Language Lines (Jan-Nov. 2010)

  31. Calling For Yourself?

  32. Gender: Smokers Only

  33. Education

  34. Where Do you Heard About the Program?

  35. What’s Next? Continue to expand the multi-state quitline Provide data to collaborators

  36. What’s Next? Established a national center of excellence for tobacco cessation for Asian American smokers?

  37. Models of Sustainability A national quitline in which all costs (promotion, counseling, and medication) are paid for by federal funding A national quitline in which federal funding pays for promotion and counseling and states pay for medication A multi-state quitline in which each state is responsible for all costs (promotion, counseling and medication) and there is centralized operation for phone service

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