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