Cessation in Washington’s AAPI Communities

1. Cessation in Washington’s AAPI Communities Alison Shigaki MD, MPH Washington Asian Quitline December 13, 2010

2. Group Number % of State APA Pop Filipino 87,871 19 Chinese 72,135 15.6 Vietnamese 60,543 13.1 Korean 51,929 11.2 Asian Indian 41,583 9 Japanese 40,115 8.7 Other Asian 44,042 10.3 Samoan 7,303 1.6 Guamanian or Chamorro 6,707 1.5 Native Hawaiian 7,654 1.7 Other Pacific Islander 6,736 1.5 Asian & Pacific Islander Population WA State Source: 2005 American Community Survey

3. Top 7 WA Counties with the Largest AAPI Population

4. Washington State Tobacco Prevalence

5. King County Tobacco Prevalence 2004-2008

6. Washington State QuitlineAsian Callers

7. Previous Cessation Work in the AAPI Community Focus Groups 2000-2001 Cultural Factors Affecting Smoking & Quitting in Chinese and Vietnamese Men: Lack of knowledge about the health effects of tobacco and ETS Cultural expectations for men to smoke both in the personal and business world Smoking cigarettes is strongly associated with drinking coffee & tea Loneliness is associated with cigarette use Family influence was important in the quitting process. Quitting for the health of one’s wife and children was a motivating factor Many Chinese participants felt you could not quit “cold turkey”

8. Previous Cessation Work Cont.APICAT Tobacco Needs Assessment 2002 • Key Informant Interviews (KII) conducted in 8 AAPI Communities (Cambodian, Chinese, Filipino, Korean, Lao, Samoan, Vietnamese & Other) • KII included 2 adults and 1 youth from each community • Questions included: tobacco use in their communities, prevention activities, cessation services, industry targeting, media venues and tobacco prevention policies

9. Previous Cessation Work Cont.APICAT Tobacco Needs Assessment cont. Findings/ Common Themes: • Lack of funding & resources for tobacco prevention • Lack of knowledge about harmful effects of tobacco & ETS • Need for culturally appropriate tobacco prevention materials, education & cessation services • Need for community leaders to quit smoking & be involved in community education and outreach • Tobacco has become intertwined in cultural practices

10. Development of a culturally competent cessation curriculum • Modified existing cessation curriculum based on “Train the Trainer” Model • Utilized pilot cessation class findings for curriculum development • Held in-language focus groups to get feedback on curriculum and cessation booklet design • Developed 6-week in-language & culturally appropriate cessation program for Chinese and Vietnamese men

11. Development of a culturally competent cessation curriculum cont. • Culturally appropriate pictures and issues (i.e. tai chi exercise, symbol of longevity) • Emphasize health, family, money saved, and role model for their children as reasons to quit • Emphasize the benefits of quitting: children, elderly, future generations • Target whole family, particularly the women who will likely make their spouses quit smoking • Would like to see pathological graphics • The health effects are slow thus not many people realize it. • Emphasize self determination

12. Current Cessation Efforts • Curriculum has also been translated into Korean and Samoan • APICAT has been providing mini-contracts to perform community based cessation classes since 2004 • Mini-contractors are collecting data on number of cigarettes smoked, behavioral modifications, level of addiction (Fagerstrom), stages of change, depression level as well as quit rates • Also collecting demographic data

13. Conclusion • Smoking rates continue to be high in the AAPI population • Need for continued prevention and education • Important to continue providing in-language community cessation classes • Current WA Quitline not reaching AAPI population, especially non-English speaking • Important to have other cessation resources for the AAPI community