Learning Objectives

1. Social Context of Tobacco Use among Asian Americans in Ohio: Policy ImplicationsSurendra Bir Adhikari, Ph.D.“Impact of Tobacco Use on Special Populations” [Eval-32]

2. Learning Objectives • Enhanced understanding of disparities in tobacco use behavior and cessation efforts among select Asian communities. • Drawing policy implications for appropriate interventions in concert with the prevalent social acceptance of smoking in these communities. • Culturally sensitive programming to transcend cultural and linguistic barriers and to address high tobacco use in select Asian communities .

3. Problem: Current State of Affairs • Lack of statewide baseline data on tobacco use among Asian Americans in Ohio. • Cultural and linguistic barriers to data collection. • Wide diversity in tobacco use among various Asian communities and social acceptance of tobacco use. • A few Asian communities are still hard to outreach. • Considerable variation in the demographic characteristics for various ethnic communities.

4. Study Method • Adult Tobacco Use Survey (2000 and 2002; n=1,070); select Counties in Northeast Ohio (Cuyahoga, Asian pop. 24,531; and Summit, Asian pop., 7,078). • Eight Asian communities represented; majority of respondents: Chinese, Vietnamese, and Korean. • To transcend language barriers, the survey was translated into: Cambodian, Chinese, H’mong, Korean, Laotian, and Vietnamese languages. • Some non-financial incentives to survey participants.

5. Results: Tobacco Use Behavior • Of the 1,010 total adult respondents, 22% (n=229) were ever smokers, and 13.10% (n=140) current smokers. • Smoking prevalence by gender: 22%, men; 5%, women.

6. Results: Stages of Behavior Change • Fifty-nine percent (n=72/122) were in pre-contemplation stage (typical), 13% (16/122) in contemplation stage (low), and 28% (34/122) in preparation stage (high).

7. Results: Influencers and Smoking • Social acceptance of smoking: Of those responses on smoking, 36% reported the pressure to be sociable as one major influencer to continue smoking.

8. Results: Nicotine Addiction • Fagerstrom Test for Nicotine Dependence (FTND)—measured by Time to First (TTF) Cigarette. • 32% (n=37) of current smokers (n=117) smoked within five minutes of waking–representing a higher level of dependence as indicated by TTF (3 points). • 39% (n=46) smoked within 6 to 30 minutes (a medium level of dependence—2 points). • 17% (n=19) within 31 to 60 minutes representing the lowest level of dependence (one point).

9. Understanding Tobacco Use Behavior • Challenge: Outreaching all of the diverse Asian communities still problematic (non-participation; distrust; past negative experience). • Solution 1: Community based prevalence studies (surveys in multiple languages). • Solution 2: Capacity building: resource networking with mainstream agencies; engaging community leaders. • Solution 3: Tobacco use and cessation efforts require the involvement of a broader cross-section of ethnic communities and resource providers.

10. Interventions to Change Social Norm • Challenge: Understanding: social acceptance of tobacco use in Asian communities, low capacity to respond to tobacco use (APPEAL), and aggressive AAPI targeting. • Solution 1: Need assessment and community based prevalence studies for a better understanding of the prevalent social norm and the impact of tobacco. • Solution 2: Building communities’ capacities and confidence in tobacco use prevention and control through coalitions, advocacy and empowerment. • Solution 3: Support to cultural festivals and events (New Year; Health Fairs; Annual Party) and gaining trust.

11. Culturally Sensitive Programming • Challenge: Engagement (cultural/linguistic barriers). • Solution 1: Development and distribution of relevant literature in multiple Asian languages; surveys in multiple languages. • Solution 2: Enabling culturally competent program to comprehensively address tobacco use. • Solution 3: Support to cultural festivals and events (New Year; Health Fairs); relating tobacco issues to their concerns (APPEAL).

12. Conclusion and Policy Implications • Community programming to facilitate those interested in quitting within one month (preparation: 28%) and in six months (contemplation: 13%). • Find ways to motivate those not interested in quitting within six months (pre-contemplation, 58%). • Culturally sensitive programming to change the social norm and address higher social acceptance of smoking among select Asian communities (particularly males). • OTUPCF’ Hi-Risk grants and disparities in tobacco use.

13. References and Resources…[1] • Adhikari, Surendra B. 2002. “Tobacco Use, Preventive Health Practices, and Depression Issues among Adult Asian Americans in Northeast Ohio.” Research Results from Asians for Tobacco Free Ohio Survey, Report 3: Results from Expanded Adult Survey 2002. Asian Services in Action: Akron, Ohio (October). • DiClemente, C. C., J. O. Prochaska, S. K. Fairhurst, W. F. Velicer, M. M. Velasquez, and J. S. Rossi. 1991. “The Process of Smoking Cessation: An Analysis of Precontemplation, Contemplation, and Preparation Stages of Change.” Journal of Consulting and Clinical Psychology 59:295-304. • Fagerstrom, K. O. and N. G. Schneider. 1989. “Measuring Nicotine Dependence: A Review of the Fagerstrom Tolerance Questionnaire.” Journal of Behavioral Medicine 12:159-182. • Prochaska, J. O. and C. C. DiClemente. 1983. “Stages and Processes of Self-Change of Smoking: Toward an Integrative Model of Change.” Journal of Consulting and Clinical Psychology 51:390-95.

14. References and Resources…[2] • www.aapcho.org • www.appealforcommunities.org • Asian Pacific Partners for Empowerment and Leadership (APPEAL) publications: * A Policy Framework for Preventing and Reducing Tobacco Use in the Asian American and Pacific Islander Community. * Critical Research and Data Issues on Tobacco Use, Prevention and Control for Asian Americans and Pacific Islanders. *Making Tobacco Relevant for Asian American and Pacific Islander Communities. * Achieving Parity through Tobacco Control for all communities. * Integrating Evaluation into Tobacco Programs for Asian American and Pacific Islander Communities. *Conducting Needs Assessments for Tobacco Control in Asian American and Pacific Islander Communities. *Enhancing Cultural and Community Competence for Tobacco Control for Asian American and Pacific Islanders. • CDC. 1998. Tobacco Use Among U.S. Racial/Ethnic Minority Groups: A Report of the Surgeon –General.

15. Surendra Bir Adhikari, Ph.D.sadhikari@standohio.orgOTUPCF, 300 E. Broad St., Ste. 310, Columbus OH 43215. tel.: 614 466 7716 fax.: 614 995 4575

16. Social Context of Tobacco Use among Asian Americans in Ohio: Policy ImplicationsSurendra Bir Adhikari, Ph.D.Impact of Tobacco Use on Special Populations” [Eval-32]