Smoking rates among Korean women in the United States have substantially increased in the past decade. As a result, their smoking rate is about four times higher than that of all other Asian women and similar to that of the general U.S. female population. Nonetheless, they are reluctant to seek an in-person cessation treatment due to the strong cultural taboo against women who smoke in their native country. They prefer online and telephone interventions that they can access remotely without publicly disclosing their smoker status to other Koreans in the community. However, these interventions showed no significant treatment effect over self-help materials. With NIDA K23 funding, Dr. Kim the PI of the proposed study developed and tested an in-person Korean-culture tailored cessation intervention against a brief standard cessation intervention. The culturally tailored cessation intervention produced an excellent outcome in Korean women compared to the other condition (biochemically verified 12-month prolonged abstinence rates: 56% versus 0%). However, recruitment of the women was very challenging. Almost 50% of the women who agreed to participate did not come for the baseline assessment versus 20% of the men. Exit interviews with the women who participated in the study helped us understand the conflicting desires: they valued most the client-and-therapist relationship and for this, they wanted to "see" the therapist. Yet, they preferred to have the therapist remotely so that the person may not have an acquaintance with their Korean neighbors. They suggested that videoconferencing counseling be a good alternative as other researchers have found in different populations the same treatment outcome as that in in-person counseling. Therefore, we propose a 2-arm randomized controlled trial (RCT) to test a videoconferencing cessation intervention against a telephone cessation intervention. A total of 90 Korean women will be recruited and randomized at a ratio of 1:1 either to the video or to the telephone arm. Both arms will have the same eight weekly sessions of a 30-minute culturally tailored cessation intervention plus 8-weeks of nicotine patches. The study has three specific aims: 1) Determine the feasibility and acceptability of a videoconferencing culturally tailored cessation intervention for Korean American women;2) Establish a preliminary effect size of the videoconferencing culturally tailored cessation Intervention on a 3-month prolonged abstinence rate compared to telephone counseling of the same intervention;and (3) Refine the intervention manual and intervention fidelity procedures for use in a full scale RCT of a videoconferencing smoking cessation intervention. The study findings will prepare the PI for a larger RCT to evaluate the efficacy of a videoconferencing cessation intervention compared to a telephone intervention in Korean and other Asian American women.
Smoking rates have been on a rise among Korean American women compared to the overall decline in the general US population. However, they are less likely to seek an in-person cessation treatment due to the fear that their smoker status would be known to other Koreans in the community. Our experience and tobacco literature indicate that quitline and online interventions are not as effective for Korean women. The proposed study of a videoconferencing culturally tailored cessation intervention will lay the groundwork for future tobacco control initiatives to target a subgroup of smokers that has been hard to treat in traditional approaches.