BACKGROUND:

Elements of effective in-hospital smoking cessation interventions include physician advice, bedside counseling, pharmacotherapy, post-discharge contacts and behavioral therapy with skill training. To date, little is known about successful smoking cessation strategies among ethnic minorities. Chinese Americans constitute the largest (23 percent) of the Asian American subgroup, numbering 1,645,472 in 1990. Their population growth is attributed mostly to immigration from China where there is an epidemic of smoking (74 percent prevalence). Thus, it is not surprisingly that reported smoking prevalence among Chinese immigrants in the US is as high as 55 percent.

The study was initiated in response to a Request for Applications issued in January, 2001 on " Overcoming Barriers to Treatment Adherence in Minorities and Persons Living in Poverty." The National Heart, Lung, and Blood Institute, the National Cancer Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Institute of Nursing Research invited applications for research project (R01) grants to evaluate interventions in clinical care settings designed to improve adherence to medically prescribed lifestyle and medical regimens used to treat heart, lung, blood or sleep diseases, disorders or conditions, cancer, or diabetes.

DESIGN NARRATIVE:

The 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 hospitalized Chinese smokers. The study has two aims: 1) To test the efficacy of the intervention among smokers with cardiovascular disease, pulmonary disease and diabetes mellitus related illnesses; 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. Patients 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. The intensive condition (IC) will consist of a self-help brochure, physician advice, nicotine replacement therapy, face-to-face counseling, follow-up phone calls post-discharge and an additional phone call for relapsed smokers. The minimal condition (MC) consists of a self-help brochure and physician advice. Saliva continine will be used to verify cessation at 6 and 12 months.