Chinese Community Smoking Cessation Project

BACKGROUND:

Studies of smoking cessation intervention among hospitalized patients with CVD and pulmonary disease produced varying cessation rates, ranging from 20 to 51% among patients with pulmonary disease, from 22 to 71% among survivors of coronary disease and as much as 80% among lung cancer patients (3-8). Recently published Treating Tobacco Use and Dependence Clinical Practice Guideline (1) provides detailed evaluation and synthesis of evidence-based components of effective smoking cessation interventions and summary results for selected treatment modalities are presented in Table 1. Face-to-face counsel, strong advice from physician or nurse, the number of reinforcing sessions and duration of these sessions were related to success (9). Compared to no treatment, estimated abstinence rates for treatment modalities ranged from 10.2% to 26.5%. Thus, use of combination treatment modalities in smoking cessation intervention is expected to result in higher abstinence rate.

The proposed four-year prospective, randomized clinical trial with 12 months follow-up, will test the efficacy of a culturally and linguistically tailored physician directed, nurse managed, smoking cessation and relapse prevention intervention among Chinese smokers. The study has two aims: 1) To test the efficacy of the intervention among smokers; and 2) To examine a set of measures (background, general health, psychosocial, and smoking process) that are associated with smoking cessation at 6 and 12 months. Subjects who smoked in the 3 months prior to admission at 6 San Francisco Bay Area hospitals (1 university, 4 private and 1 county) will be screened, recruited and randomized to one of two interventions: a) Intensive [n=190] (physician advice, bedside counseling with a family member, 5 telephone contacts within 90 days, with nicotine replacement therapy and one repeat relapse counseling with 1 more telephone contact for relapsers). b) Minimal [n=190] (physician advice and a self-help manual). Random assignment will be stratified by recruitment site, gender and disease category. Primary outcomes include biochemically confirmed abstinence and quit attempts at 6 and 12 months. Power calculation is based on 15% difference in abstinence rates between the two intervention groups. The findings from this propose study will yield significant knowledge for effectively treating Chinese smokers and will provide insight into treatment for smokers of other racial and ethnic minorities that is likely to have significant public health impact by reducing health disparities among US sub-populations.

DESIGN NARRATIVE:

A prospective, randomized clinical trial with 12-month follow-up linguistically tailored, nurse-managed smoking cessation and relapse prevention trial. It involves several stages in the study: