Promoting Telephone Cessation Hotline to Korean Smokers in the U.S.

Promoting Telephone Cessation Hotline to Korean Smokers in the U.S. Hye-ryeon Lee, Ph.D. University of Hawaii at Manoa Co-Investigator Multi-State Asian Language Quitline Project

English Quitlines in 1992 Statewide Quitline No Statewide Quitline WA VT MT ME ND OR MN NH ID WI MA NY SD WY MI RI PA IA CT NV NE NJ OH IL IN UT DE CA WV CO VA MD KY KS MO D.C. NC TN AZ OK SC NM AR GA MS AL LA TX AK FL HI

English Quitlines in 2004 WA VT MT ME ND OR MN NH ID WI MA NY SD WY MI RI PA IA CT NV NE NJ OH IL IN UT DE CA WV CO VA MD KY KS MO D.C. NC TN AZ OK SC NM AR GA MS AL LA TX AK FL HI

Asian Language Quitlines in 1993 Statewide Quitline No Statewide Quitline WA VT MT ME ND OR MN NH ID WI MA NY SD WY MI RI PA IA CT NV NE NJ OH IL IN UT DE CA WV CO VA MD KY KS MO D.C. NC TN AZ OK SC NM AR GA MS AL LA TX AK FL HI

Disparity The lack of a language-specific quitline puts the Asian language-speaking population at a distinct disadvantage. This is particularly problematic given that there is also a lack of other cessation resources for Asian language-speaking population.

Why Such a Slow Adoption for Asian Language Quitlines? • (Mis)perceptions • Asian smokers will not call quitlines • Quitlines will not work for them • Not cost-effective • Perception that model minority groups will not complain • Fear that it is a Zero-sum game for funding

Incoming Calls to California QuitlineAugust 1992 - December 2008 (Quarterly) Number of calls

Likelihood of Calling the Helpline (Using CHIS 2007 for Population Estimates) Source: Zhu et al. (2010) AJPH

Conclusions • Asian language speakers are just as likely as English-speaking Whites to call quitlines. • Provided there is adequate promotion for it • There is plenty of evidence from quitlines operating in Asian countries • Quitlines work for this population. • One protocol works for all Asian languages tested so far (Korean, Vietnamese, Chinese) • It is not necessary to test the protocol on every language • Given the new evidence on Asian language speakers and Cochrane Review showing quitlines work in general, we should focus on dissemination

Conclusions (continued) • Quitlines can be made cost-effective if we can coordinate the service either regionally or nationally. • Pooled counseling service • Promotion • Materials sharing • Model minority groups will and should speak up for services. CBOs working with Asians should speak up and advocate for this important service for their constituents

Conclusions (continued) • It is not always a zero-sum game for funding. • Cultivating interests for service and documenting needs often will lead to more funding not less. • Promotion for Asian language quitline will increase general awareness for cessation among Asians and those who serve the community.

Worksite Policy A Quitline in a Population-Based Framework Media Quitline School Programs Provider Advice Source: California Smokers’ Helpline

Multi-State Asian Language Quitline Project Goal is to translate the proven Asian-language counseling protocol into a multi-state quitline. • UCSD operates Chinese, Korean, Vietnamese Quitlines -1 toll-free number for each language • CDC funds for UCSD to provide counseling to all callers • States promote the quitlines using their own funds • NRT is provided according to each state’s own policies

Promoting Quitline to Koreans:Hawaii Experience Background • 23,500 Koreans in Hawaii (Census 2000) • Each year over 300 Koreans move to Hawaii • Small minority – Approximately 2% of HI population • Korean Media rich - 2 daily newspapers, 2 radio stations, 1 Korean TV station

Lessons Learned • High male smoking prevalence (44%). • Given the high prevalence, the norm environment is distinctive. • Exposure to anti-smoking campaigns and messages tend to be lower compared to the mainstream population. • Overall attitudes regarding smoking and cessation is not as up to date.

Lessons Learned (continued) • Cultural beliefs regarding smoking and cessation are distinctive. • “One should be able to quit with will power alone” • Not much awareness re the importance of assistance (e.g. counseling, medications) • Culture of sharing (pushing) cigarettes • Smoking often is a group activity • Efforts to change the community level norm are imperative for successful cessation initiative.

Lessons Learned (continued) • Often there is not much social support for cessation attempts. • Smokers are often reluctant to publicly acknowledge quit attempts  challenging for group cessation classes. • Telephone counseling seem to work well with Koreans (anonymity, convenience). • Broader Focus on ‘Health Promotion’ may work better than a narrow cessation focus.

Key Messages • We need to rethink and try to change Korean community norm related to smoking  Everyone should help. • Highlighting how higher prevalence rate impacts Korean children may work well. • Quitting takes many trials  It is OK to fail, just keep on trying. • Don’t go at it along. Getting help such as counseling, hotline, NRT is a smart thing to do.

Key Components for Successful Promotion to Koreans • A well-connected and credible spokesperson/Champion. • Buy-in from health care providers (Community Advisory Group of health care providers). • Buy-in from prominent community organizations (Korean Association, Church) • Buy-in from Korean media (newspaper column, radio interviews, community bulletin).

Key Components for Successful Promotion to Koreans (continued) • Link with the existing state programs for added media exposure. • Look for pre-existing materials rather than developing a new one for cost savings (TV ads from Korea, California, and other states).

Questions?

Promoting Telephone Cessation Hotline to Korean Smokers in the U.S.