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Tobacco use & Cessation among Asian Oregonians: A community-based participatory approach for reducing tobacco related health disparities in the Asian Population. Jennifer Kue, Elizabeth Takahashi, & Carrie Furrer APHA 2008, San Diego, California. Who are we?.

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jennifer kue elizabeth takahashi carrie furrer apha 2008 san diego california

Tobacco use & Cessation among Asian Oregonians: A community-based participatory approach for reducing tobacco related health disparities in the Asian Population

Jennifer Kue, Elizabeth Takahashi, & Carrie Furrer

APHA 2008, San Diego, California

who are we
Who are we?
  • Asian Pacific Islander (API) Tobacco Prevention and Education Program (TPEP)
    • Asian Family Center, a program of the Immigrant and Refugee Community Organization (IRCO)
    • Non-profit community-based organization
  • Specific population grantee of the Oregon DHS TPEP
  • NPC Research, private research & evaluation firm
goals of presentation
Goals of Presentation
  • Describe project development process using a community-based participatory research (CBPR) approach
  • Explain quantitative phase (mail survey)
  • Explain qualitative phase (interviews)
  • Preliminary findings
  • Next steps/Lessons learned
what is cbpr
What is CBPR?
  • Approach to research & evaluation that engages community stakeholders in each project phase
  • Promotes shared learning & power
  • Iterative process
  • Values community expertise, traditions, priorities
collaborators
Collaborators
  • Asian Family Center
  • Oregon Tobacco Quit Line
  • Oregon Department of Human Services
  • NPC Research
  • International Language Bank (ILB)
  • API Health Network
  • Community members
what is the problem
What Is the Problem?
  • 21% of adult Oregonians currently smoke cigarettes, compared to 10% of API adults (DHS, 2007)
  • Some evidence that specific API subpopulations bear a greater burden of tobacco use (e.g., 31% for Korean men; Lew & Tanjasiri, 2003)
  • Gap in knowledge of tobacco use & cessation resource utilization among Asian Oregonians
project overview
Project Overview
  • What factors are related to tobacco use and utilization of cessation resources among Asian Oregonians?
    • demographics
    • linguistic acculturation
    • perceptions of harm of tobacco use
  • Two-phase mixed-methods research project to collect information: 1) mail survey & 2) in-person interview.
instrument development survey
Instrument Development: Survey
  • Brief assessment of
    • tobacco use
    • linguistic acculturation
    • perceptions of harm
    • attitudes toward and use of cessation resources
  • Items adapted from
    • Behavioral Risk Factor Surveillance System (BRFSS)
    • California Korean Tobacco Cessation Survey
    • Hmong Tobacco Use Survey Project
instrument development translation
Instrument Development: Translation
  • Translated into Simplified Chinese, Japanese, Korean, Lao, Mien, Tagalog, & Vietnamese
  • Iterative process with ILB’s professional translators and community members
  • Goal: balance cultural appropriateness and consistency
instrument development interview
Instrument Development: Interview
  • In-depth assessment of
    • attitudes toward tobacco use
    • cultural use of cigarettes
    • acculturation, perceptions of harm
    • motivation to quit
    • knowledge & utilization of cessation resources
  • Goal: Compliment and enrich information collected through brief survey.
instrument development interview11
Instrument Development: Interview
  • Mix of qualitative and quantitative questions adapted from:
    • Behavioral Risk Factor Surveillance System (BRFSS)
    • Diverse Racial & Ethnic Groups and Nations (DREAGAN) Study
    • Hmong Tobacco Use Survey
  • Iterative process, including pilot testing
  • Conducted in English
research design mail survey
Research Design: Mail Survey
  • Selected 10 counties with the highest population of Asian Oregonians while maintaining geographical diversity
  • 1100 addresses from Survey Sampling International
    • Surnames identified as Asian
    • List only included larger Asian ethnic subgroups
    • Random sample within county
  • 200 addresses from IRCO database
  • IRB approval through Portland State University
research design mail survey13
Research Design: Mail Survey
  • Process
    • Introduction letter
    • Survey + $2 incentive
    • Reminder cards
    • Second round of surveys
    • $100 lottery incentive
  • 45% response rate (N=491)
  • Acceptable range for mail surveys: 45-55%
research design interview
Research Design: Interview
  • Recruitment methods (N=19)
    • Press releases in Asian ethnic newspapers, radio stations, fliers, and mainstream media outlets
    • Word-of-mouth
  • Interview process
    • Recorded 1-hour interviews
    • Monetary incentive ($20 gift card)
  • Transcription
preliminary findings sample
Preliminary Findings: Sample

N=432

Number in parentheses = # respondents of that ethnicity

preliminary findings sample16
Preliminary Findings: Sample

Number in parentheses = # respondents from that region

preliminary findings sample17
Preliminary Findings: Sample

Number in parentheses = # respondents in that age group

preliminary findings prevalence
Preliminary Findings: Prevalence
  • 12.6% currently smoke cigarettes
  • 14.0% currently use some form of tobacco
  • 8.6% current smokers (BRFSS definition)
    • 100+ cigarettes & currently smoke cigarettes
  • Smoking prevalence among Asian and Pacific Islanders was 10% (DHS, 2004-05).
preliminary findings prevalence19
Preliminary Findings: Prevalence

Number in parentheses = # respondents of that ethnicity

slide20

Preliminary Findings: Prevalence

N=425

Number in parentheses = # respondents in that age group

slide21

Preliminary Findings: Prevalence

Number in parentheses = # respondents of that gender

preliminary findings prevalence22
Preliminary Findings: Prevalence

N=426

Number in parentheses = # respondents from that region

preliminary findings quit line
Preliminary Findings: Quit Line
  • What is the Oregon Tobacco Quit Line?
    • Telephone-based counseling service for tobacco cession (cognitive-behavioral therapy, educational materials, nicotine-replacement therapy).
    • Less than 1% of the callers in the 2007–08 contract year were APIs.
  • 36% had heard of the Oregon Tobacco Quit Line, but varied for different groups of respondents.
preliminary findings quit line24
Preliminary Findings: Quit Line

N=405

Number in parentheses = # respondents of that ethnicity

preliminary findings quit line25
Preliminary Findings: Quit Line

N=405

Number in parentheses = # respondents of that gender

preliminary findings quit line26
Preliminary Findings: Quit Line

N=410

Number in parentheses = # respondents with that level of education

preliminary findings quit line27
Preliminary Findings: Quit Line

N=413

Number in parentheses = # respondents from that region

results from a cbpr perspective
Results from a CBPR Perspective
  • AFC and NPC Research works together to develop research products
  • Results shared with community members for feedback and interpretation assistance
  • Products go to DHS for review
  • Dissemination based on the needs of the community, DHS, AFC/IRCO
lessons learned
Lessons Learned
  • Need for collaboration
  • Difficulty in accessing target population
  • Challenges with translation
  • How to get a satisfactory response rate from a mail survey with limited resources
  • Challenges recruiting for interview
  • Need for support in managing and analyzing data collected
contact information
Contact Information
  • Jennifer Kue, MPH & Elizabeth Takahashi, MPH
    • Asian Family Center, 4424 NE Glisan St., Portland, OR 97213
    • Phone: (503) 235-9396 ext. 121
    • jenniferk@mail.irco.org & elizabetht@mail.irco.org
    • www.irco.org
  • Carrie Furrer, Ph.D.
    • NPC Research, 4380 SW Macadam Ave., Ste. 530, Portland, OR 97239
    • Phone: (503) 243-2436 ext. 110
    • furrer@npcresearch.com
    • www.npcresearch.com