Tobacco Dependence Treatment for Asian Americans
Nicotine dependence is very common among Asian Americans; yet, research on understanding and treating nicotine dependence in this group is almost nonexistent. The proposed study is a first attempt to develop a smoking cessation program that is tailored to Korean-culture specific aspects. It is proposed that Korean Americans who receive a culturally tailored smoking cessation program will be more likely to have prolonged abstinence at 12-month follow-up than their counterparts who receive brief cessation counseling. Subjects in both arms receive nicotine patches for 8 weeks. Self-reported abstinence is validated with exhaled carbon monoxide and salivary cotinine tests.
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Randomized Controlled Clinical Trial of a Combination of Pharmacotherapy and Culturally Tailored Cognitive Behavior Therapy With Korean Americans|
- Prolonged Abstinence [ Time Frame: 09/2009-5/2013 ] [ Designated as safety issue: No ]Of the 109 participants, 77 were due for the 1-year follow-up assessment that is the endpoint of this study. Those who were not available were treated as smoking. Using an intent-to-treat analysis, 35.9% of participants in the cultural intervention arm and 13.2% of participants in the brief counseling arm (odds ratio = 3.7, 95% confidence interval = 1.2-11.6, p = 0.03) had 12-month prolonged abstinence.
- predictors of cessation outcome and gender difference in baseline data [ Time Frame: 09/2009-05/2013 ] [ Designated as safety issue: No ]Controlling for self-efficacy and treatment condition, baseline nicotine dependence was also a strong predictor of the 12-month prolonged abstinence (OR = 1.7, 95% CI = 1.2-2.5, p = 0.004). However, unlike our expectation, individuals with higher dependence were more likely to have the abstinence than their counterparts. This finding remained significant even after controlling for gender. The overall survival of subjects who had prolonged abstinence was significantly higher in the treatment arm than in the control arm (log rank test, p = 0.003). Combining Stage I-a and I-b Studies, women were more likely to be single or divorced (χ2 =17.6, p < 0.00l) and smoke at home (χ2 =6.0, p = 0.02), and live with other smokers (χ2 =14.1, p = 0.00l) than men. Women reported more severe symptoms of nicotine withdrawal (t = 2.46, p = 0.03) after quitting than did men.
- Biochemical verification of self-reported abstinence [ Time Frame: 09/01/2009-05/01/2013 ] [ Designated as safety issue: No ]The primary outcome of the study, prolonged abstinence, was biochemically verified prolonged abstinence at 12-month follow-up. The CO level was measured by Micro+ Smokerlyzer CO Monitor (Bedfont Scientific, NJ) and its cutoff level is 6 parts per million (ppm). The salivary cotinine level was assessed by a NicAlert® test, using adopted a cutoff level 2 (30-100ng/ml).
|Study Start Date:||September 2009|
|Estimated Study Completion Date:||October 2013|
|Estimated Primary Completion Date:||September 2013 (Final data collection date for primary outcome measure)|
Experimental: cultural tailoring
eight weekly 40-minute individualized counseling sessions of cognitive behavioral therapy and cultural tailoring intervention (CBCT) plus 8-week NRT
Drug: nicotine patch
8-week nicotine patch therapy
Active Comparator: brief cessation counseling
This arm receives eight, weekly 10-minute brief cessation counseling sessions that are not tailored to Korean culture.
Drug: nicotine patch
8-week nicotine patch therapy
Korean men have been known for very high smoking rates and the highest cancer death smoking-attributable fraction. In contrast, Korean women reportedly smoke at low rates compared to the general U.S. population. However, recent population-based survey data indicate steady increases in smoking prevalence of Korean American women. Particularly, it has been found that they tend to initiate smoking as they acculturate into social norms of American women. Preliminary data of the applicant and others suggests interventions must be culturally adapted and a motivation-based and family-involved approach is most promising. The training plan will help the applicant develop an independent program of drug abuse research that focuses on better understanding and treating tobacco dependence among Asian Americans, including evaluating culturally competent and gender-specific interventions. The research plan will examine the impact of culture and gender on nicotine dependence and utilize National Institute on Drug Abuse behavioral therapy development methods. The proposed research plan has two-phases and evaluates tobacco dependence treatment with Korean Americans (N = 164, 50% women). Phase 1 is a no-control group study (Stage Ia) that is aimed at developing an intervention manual of Group-based Motivational Interviewing (GMI) intervention, therapists' adherence and competence scales, training program, and small feasibility intervention study with 20 Korean-American (offered separately for men and women). Phase 2 is a randomized controlled trial (Stage Ib) with 144 Korean Americans that is conducted to assess feasibility and relative effectiveness of the GMI behavioral intervention in conjunction with Nicotine Replacement Therapy (NRT) in comparison with a brief group medication management of NRT. Gender-interaction effects of psychosocial variables on treatment outcomes will be assessed, including acculturation and depression. This award will help prepare the applicant for an independent research career focusing on Asian Americans and Nicotine Dependence, including adapting and testing new interventions for different populations.
|United States, Massachusetts|
|University of Massachusetts Medical School|
|Worcester, Massachusetts, United States, 01652|
|Principal Investigator:||Sun S. Kim, PhD||University of Massachusetts, Worcester|