Shu-Hong Zhu - US grants

Reduction of smoking prevalence in teens is one of the most significant public health issues in the United States. National surveys have consistently shown that many teen smokers would like to quit smoking but experience little long term success. Nevertheless, current research efforts directed at reducing smoking prevalence in teens have focused primarily on uptake prevention. Only a handful of studies have attempted to help those teens who are already smoking. Those efforts that have been directed at helping teens quit smoking have been hampered by difficulty i recruiting young smokers into traditional school-based or clinic-based cessation programs. This study intends to demonstrate that telephone counseling is a particularly conductive format for counseling teen smokers because of their natural affinity for phone conversation. This study will examine the effectiveness of telephone counseling for the teen smoker using a randomized design. A large sample (N-1, 460) of teen smokers who call the California Smokers' Helpline will be randomized into telephone counseling versus a control group. The control group will receive self- help materials and the counseling group will receive self-help materials and 7 counseling sessions, two session before they make a quit attempt and 5 sessions after the quit attempt. The 7 session counseling program will use a modified version of the same structured telephone counseling protocol that has been shown to be effective with adult smokers. A significant addition to the counseling protocol is a form of parental involvement operationalized as a specific parental behavior that is yoked to the teen's quit attempt. It is hypothesized that the teen smokers in the counseling group will be twice as likely to succeed in quitting smoking than those in the self-help control group (5% vs. 10%). SA sample of those who remain abstinent at 12 months will be verified through saliva cotinine.

DESCRIPTION (provided by applicant): This study is motivated by the serious public health problems caused by smoking and by the paucity of evidence-based cessation service for smokers of ethnic minority backgrounds. The study tests the effects of telephone counseling for smokers from three Asian language-speaking groups: Chinese, Korean, and Vietnamese. Asian Americans are among the least studied groups in smoking research, which has created a knowledge gap in understanding their behavior and in developing methods to help them quit. No efficacy data have been reported for telephone counseling of smokers who prefer to use Asian languages, although telephone intervention holds promise for these groups because of its convenience and its potential to reach large number of smokers. The specific aims are to: (1) test the efficacy of a culturally sensitive counseling protocol for smokers calling the California Smokers' Helpline on its Chinese, Korean, and Vietnamese lines, (2) examine whether intervention effects are moderated by acculturation, (3) examine whether intervention effects vary by cognitive and behavioral predictors of cessation success, (4) examine whether family involvement plays a role in quitting success, and (5) assess differences in counseling effect across the three ethnic groups. In this two-arm design subjects are stratified by language (Chinese, Korean, and Vietnamese) and gender and randomized to telephone counseling or self-help materials, which serves as the control. Subjects (N=2,100) will provide baseline information on demographics, smoking behavior, quitting history, and other psychosocial variables. Independent evaluations at 4, 7, and 13 months after intake will determine whether subjects made a quit attempt and how successful they were at remaining abstinent. This rich data set will also be used to analyze whether acculturation, family involvement, and baseline behavioral and cognitive variables modify the intervention effect. The proposed study is significant in several ways. First, it will provide timely information on a cessation approach for a traditionally under-served population (Asian language speakers). Second, if proven successful, telephone counseling can be widely applied because of the proliferation of quitlines with centralized services in recent years. Third, by targeting Asian language speakers this study addresses the issue of ethnic disparities, which has been identified by many (including the NCI Bypass Budget) as a research priority.

DESCRIPTION (provided by applicant): This study addresses a significant gap in the implementation of effective tobacco cessation services as recommended by the Community Guide to Preventive Services. The Guide recommends telephone counseling, or "quitlines," as a key population-based tobacco control strategy. Currently, all 50 U.S. states have established quitlines. However, only one quitline offers direct counseling in Asian languages. Justifications for the absence of Asian-language services range from the lack of proven protocols for this population to the practical difficulty of staffing a program in multiple Asian languages. The project will translate an experimentally validated, Asian-language, smoking cessation telephone counseling protocol into a multi-state quitline operation. State health departments in California, Hawaii and Colorado will work with the researchers who developed and tested the protocol to create a practical dissemination model. The project aims to demonstrate that collaboration between researchers and policy makers will help to translate research results quickly into real world public health practice. The project involves both dissemination and implementation and has two overlapping phases. In the first phase, researchers will work with three states that are ready to adopt an Asian quitline. Together they will: (1) evaluate the dissemination success of a multi-state model for an Asian quitline in which each state promotes the quitline individually, but a centralized operation provides the counseling service;(2) examine the natural variation in implementation of promotional strategies by comparing smokers'responses to advertising messages in the context of state-specific cessation policies;and (3) test implementation fidelity by comparing the number and length of counseling sessions with those in California's original Asian trial, and with those of participating states'English and Spanish quitlines. In the second phase, researchers will work with the health departments in other states to encourage further dissemination. Specifically, they will: (1) examine the organizational readiness of other state health departments to adopt either the multi-state Asian quitline or to start their own Asian quitlines, and to assess their change in readiness from year 1 to year 3;(2) conduct in-depth interviews with representatives from selected state health departments, state quitline operators, and community organizations to determine their perceptions of barriers to adoption of Asian-language quitlines;and (3) set in motion a process for further dissemination by recruiting at least one additional state to join the multi-state Asian quitline by year 3 of the project. The proposed multi-state quitline project, if implemented successfully, can serve as a model for other states in providing behavioral cessation services to Asian-language smokers, helping to reduce disparities in access to effective treatment for these populations.

DESCRIPTION (provided by applicant): When smokers are hospitalized they quit smoking, either voluntarily or involuntarily. Most of them, however, go back to smoking soon after discharge. Research has shown that extended follow-up counseling post-discharge can help prevent relapse. However, it is difficult for hospitals to conduct extended follow up for patients after discharge. The proposed study aims to establish a practical model in which hospitals will work with a state quitline in the following manner: Hospital staff will conduct bedside counseling and then refer patients to the quitline. Quitline counselors will proactively call patients post-discharge and provide counseling up to 2 months. With the proposed project we intend to establish a practical model that lends itself to broader dissemination, while testing the effectiveness ofthe interventions with the rigor of a randomized design. We plan to demonstrate in a randomized trial the effects of two interventions, dispensing nicotine patches at discharge and providing proactive telephone counseling soon after discharge, on the long term quit rates of hospitalized smokers in a 2 x 2 factorial design. All eligible patients receive brief counseling from hospital staff. This is usual care. Study participants are randomly assigned into one ofthe four conditions: usual care, nicotine patch post discharge, telephone counseling post discharge, or both patch and counseling post discharge. It is hypothesized that the patch and counseling each has an independent effect and their combined effect is greater than that for either single intervention. We also intend to compare the cost-effectiveness ofthe interventions: patch alone, counseling alone, and combined interventions, against the usual care condition. Further, the proposed study will allow us to examine if a patient's medical diagnosis is a moderating factor for intervention effects such that patients with certain diagnoses benefit more from the interventions than patients with other diagnoses. (End of Abstract)

DESCRIPTION (provided by applicant): This proposal focuses on testing a new idea to increase smoking cessation on the population level. We propose to conduct population surveys and intervention studies to demonstrate that nonsmokers hold the key to increasing population cessation. This large project is grouped by three overlapping phases: Phase 1: Surveys: We will conduct surveys of nationally representative samples to test the hypothesis that the attitudinal gaps between nonsmokers and smokers on tobacco control measures are significantly larger among those living in states with a high tobacco control index than among those in low index states, and that the attitudinal gap (grouped by state) predicts the smoking cessation rate. The survey of 3,500 smokers and 3,500 nonsmokers will be conducted with Knowledge Networks Inc. Phase 2. A Randomized Trial: We will recruit 2,960 smoking households (with an adult non-smoker) from the general community (half from California and half from Oklahoma) and randomly assign them into a 2 x 2 factorial design: one factor is whether the intervention targets smokers or nonsmokers and the other is the intensity of the intervention. They will be followed up for 12 months. Two primary hypotheses to test are: Messages targeting nonsmokers produce significantly higher quit rates among smokers in the household than messages targeting smokers and that higher intervention intensity produce a higher quit rate. Phase 3. A Comparative Media Study and Dissemination: We will create a new cessation media spot and compare it with the existing media campaign in California and Oklahoma. The health departments of these two states (who are co-investigators) have committed to coordinate their ongoing media campaign with this study. In a selected in market in each state, we will use an ABAB design (A= targeting smokers and B=targeting nonsmokers) to test the effects of the new media spots. Using the number of calls to each state quitline as a proxy measure, we will test the that hypothesis that media spots targeting nonsmokers produce significantly higher rates of quitline calls than media spots targeting smokers. We in cooperate dissemination into the project through collaboration with multiple state health departments