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Clinical research focused on aging, Alzheimer's disease and related dementias (ADRD), and caregiving often does not recruit Asian Americans and Pacific Islanders (AAPIs).With funding from the National Institute on Aging, we designed and launched the Collaborative Approach for AAPIs Research and Education (CARE), a research recruitment registry to increase AAPIs' participation in ADRD, aging, and caregiving research. We present the design of this novel recruitment program.CARE uses community-based participatory research methods that are culturally and linguistically appropriate. Since CARE's launch, it has enrolled7000 AAPIs in a 1-year period. The majority enrolled in CARE via community organizations and reported never having participated in any kind of research before. CARE also engages researchers by establishing a recruitment referral request protocol.CARE provides a promising venue to foster meaningful inclusion of AAPIs who are under-represented in aging and dementia-related research.

There are few studies to date of interventions to increase viral hepatitis screening among Asian Americans, who have high rates of chronic hepatitis B (HBV) infection.To develop, implement, and test the efficacy of a mobile application (Hepatitis App) delivered in four languages to increase HBV screening among Asian Americans.Cluster-randomized clinical trial.Four hundred fifty-two Asian American patients ≥ 18 years of age, who had no prior HBV testing, and received primary care within two healthcare systems in San Francisco, CA.The intervention group received the Hepatitis App, delivering interactive video education on viral hepatitis in English, Cantonese, Mandarin, or Vietnamese and a provider printout (Provider Alert) and Provider Panel Notification. The comparison group received a mobile application delivering nutrition and physical activity education and Provider Panel Notification.Primary outcomes were patient-provider discussion about HBV and documentation of a HBV screening test within 3 months post-intervention. Secondary outcome was documentation of an order for a HBV screening test.Participants had a mean age of 57 years and were 64% female, 80% foreign-born, and 44% with limited English fluency. At post-visit, over 80% of intervention participants reported they liked using the Hepatitis App. At 3-month follow-up, the intervention group was more likely than the comparison group (all P 0.001) to have discussed HBV with their provider (70% vs.16%), have a HBV test ordered (44% vs.10%), and receive a HBV test (38% vs.8%). In multivariable analyses, the intervention odds ratio for HBV test ordering was 7.6 (95% CI: 3.9, 14.8) and test receipt was 7.5 (95% CI: 3.6, 15.5).A multi-lingual educational intervention using a mobile application in primary care clinics was well received by Asian American patients, enhanced patient-provider communication about HBV, and increased HBV screening. Technology can improve healthcare quality among Asian Americans.ClinicalTrials.gov NCT02139722 ( https://clinicaltrials.gov/ct2/show/NCT02139722 ).

Asian Americans (AAs) are experiencing increased rates of anti-Asian racism during COVID-19. Experiences of racism, whether personal or collective, constitute stress and psychosocial trauma that negatively impact mental and physical health.Examine subgroup differences in rates of personal experience of discrimination and COVID-related collective racism and how each is associated with mental and physical health for AAs.Nationally representative data from the 2021 Asian American and Native Hawaiian/Pacific Islander COVID-19 Needs Assessment Project were used to estimate prevalence rates of discrimination and average COVID-related collective racism scores for AAs (unweighted N = 3478). We conducted logistic and linear regression models to examine subgroup differences by sociodemographic factors. We also conducted hierarchical logistic regression models to examine associations between racism and psychological distress and health decline.Twenty-four percent of AAs (95% CI: 21.6, 25.6) reported experiencing discrimination during the first year of the COVID-19 pandemic. Subgroup analyses revealed that Chinese, younger adults, and AAs who completed the survey in an Asian language were significantly more likely to experience discrimination compared to their counterparts. For COVID-related collective racism, subgroup analyses revealed that Chinese, women, and adults ages 25-44 were more likely to report experiences of collective racism compared to their counterparts. Both discrimination and collective racism were independently associated with negative mental and physical health.Discrimination and COVID-related collective racism are associated with negative mental and physical health outcomes for AAs. Results point to vulnerable AA subgroups and the need for targeted public health efforts to address racism in the context of COVID-19.

Background Hepatitis C virus (HCV) screening remains suboptimal. We assessed the efficacy of a mobile application and provider alert in enhancing HCV screening among Asian Americans. Methods A secondary analysis of a cluster-randomized clinical trial was performed during the birth cohort screening era to assess the efficacy of a Hepatitis App (intervention), a multilingual mobile application delivering interactive video education on viral hepatitis and creating a Provider Alert printout, at primary care clinics within 2 healthcare systems in San Francisco from 2015 to 2017. A comparison group received usual care and a similar intervention on nutrition and physical activity. The outcome was electronic health record (EHR) documentation of HCV screening along with patient-provider communication about testing and test ordering. Results Four hundred fifty-two participants (mean age 57 years, 36% male, 80% foreign-born) were randomized by provider clusters to the intervention (n = 270) or comparison groups (n = 182). At 3-month follow up, the intervention group was more likely than the comparison group to be aware of HCV (75% vs 59%, P = .006), to discuss HCV testing with their providers (63% vs 13%, P < .001), to have HCV testing ordered (39% vs 10%, P < .001), and to have EHR-verified HCV testing (30% vs 6%, P< .001). Within the intervention group, being born between 1945 and 1965 (odds ratio, 3.15; 95% confidence interval, 1.35–7.32) was associated with increased HCV testing. Conclusions The Hepatitis App delivered in primary care settings was effective in increasing HCV screening in a socioeconomically diverse Asian American cohort. This highlights the importance of mobile technology as a patient-centered strategy to address gaps in HCV care.

Purpose Cancer is the leading cause of death for Asian Americans. However, few studies have documented supportive care needs from the perspective of Asian American cancer patients. This study describes the needs reported by Asian American patients with colorectal, liver, or lung cancer over a 6-month period during their treatment. Methods Participants were recruited through the Greater Bay Area Cancer Registry and from cancer care providers in San Francisco. Participants self-identified as Asian or Asian American; were age 21 or older; spoke English, Chinese, or Vietnamese; and had stage I–III colon, rectum, liver, or lung cancer. Participants were matched with a language concordant patient navigator who provided support during a 6-month period. Needs were assessed by surveys at baseline, 3, and 6 months. Results Among 24 participants, 58% were 65 years or older, 42% did not complete high school, and 75% had limited English proficiency (LEP). At baseline, the most prevalent needs were cancer information (79%), nutrition and physical activity (67%), language assistance (54%), and daily living (50%). At the 3- and 6-month follow-up surveys, there was a higher reported need for mental health resources and healthcare access among participants. Conclusion In this pilot study of Asian American cancer patients who predominantly had LEP, participants reported many needs, with cancer information and language assistance as the most prominent. The findings highlight the importance of culturally and linguistically appropriate patient navigators in addressing supportive care needs among cancer patients with LEP. Trial registration ClinicalTrials.gov identifier: NCT03867916.

BACKGROUND Race/ethnicity-related discrimination against Asian Americans increased during the COVID-19 pandemic. Previous studies have found an association between experiences of discrimination and use of alcohol and other drugs (AOD) as a form of coping. OBJECTIVE This study aims to evaluate the proportion of race/ethnicity-related discrimination and coping with AOD and evaluate the association of stress because of race/ethnicity-related discrimination and other stressors and coping with AOD among Asian Americans during the pandemic. METHODS We use data from the Asian American and Native Hawaiian/Pacific Islander (AA & NH/PI) COVID-19 Needs Assessment Project, a nationally representative study of Asian Americans and NH/PI in the United States (n = 3,159) that was conducted from January to April 2021. Three AOD outcomes related to coping with the stresses of the COVID-19 pandemic were examined: using tobacco, drinking alcohol, and using marijuana or cannabidiol. Our primary independent variables were stress related to racial/ethnic discrimination, whether discrimination during the COVID-19 pandemic impacted their families, and a five-item “Coronavirus Racial Bias Scale”. We also examined the role of the number of other COVID-19 stressors aside from racial/ethnic discrimination. Binary logistic regression was used to examine the association between each AOD outcome, discrimination, and other COVID-19 stressors accounting for sociodemographic factors, physical and mental health, and survey medium. Analyses were weighted to be representative of the entire Asian American population in the U.S. RESULTS Most Asian Americans used alcohol to cope with the stressors of the COVID-19 pandemic (13.0%) while tobacco and marijuana use were similar (4.3% and 4.1%, respectively). About 24% of Asian Americans reported that racial/ethnic discrimination was the greatest source of stress from the COVID-19 pandemic. Furthermore, about 24% of Asian Americans reported that discrimination impacted their families. There was heterogeneity in the association of each AOD substance with discrimination. In fully adjusted models, racial/ethnic discrimination was not associated with AOD use. However, reporting more of COVID-19 stressors (aside from racial/ethnic discrimination) was associated with greater AOD use for each AOD outcome. CONCLUSIONS Asian Americans reported using AOD to cope with stress during the pandemic. However, the primary motivation of using AOD to cope with stress was related to other non-racially/ethnically based stressors. Future studies need to further examine how different subgroups within the Asian American population are experiencing discrimination and how its related to use of AOD.

Background: Low-income U.S. adults experiencing food insecurity have a disproportionately high prevalence of cigarette smoking, and quantitative studies suggest that food insecurity is a barrier to quitting. To guide effective tobacco control strategies, this study aimed to understand the experiences, perceptions, and context of tobacco use and cessation among low-income populations experiencing food insecurity. Methods: We conducted in-depth, semi-structured interviews with 23 adults who were currently smoking cigarettes and were experiencing food insecurity, mostly living in rural settings. Participants were recruited through food-pantry-based needs assessment surveys and study flyers in community-based organizations. The interview guide explored participants’ histories of smoking, the role and function of tobacco in their lives, their interest in and barriers to quitting, as well as lived experiences of food insecurity. We used reflexive thematic analysis to analyze transcribed interviews. Results: Within a broader context of structural challenges related to poverty and financial strain that shaped current smoking behavior and experiences with food insecurity, we identified the following five themes: smoking to ignore hunger or eat less; staying addicted to smoking in the midst of instability; smoking being prioritized in the midst of financial strain; life stressors and the difficulty of quitting smoking and staying quit; and childhood adversity at the intersection of food insecurity and tobacco use. Conclusion: The context of tobacco use among adults with food insecurity was highly complex. To effectively address tobacco-related disparities among those who are socially and economically disadvantaged, tobacco control efforts should consider relevant lived experiences and structural constraints intersecting smoking and food insecurity. Findings are applied to a conceptualization of clustering of conditions contributing to nicotine dependence, food insecurity, and stress.

Background Understanding concerns for receiving COVID-19 vaccines is key to ensuring appropriately tailored health communications to increase vaccine uptake. However, limited data exists about vaccine concerns among Asian Americans and Pacific Islanders (AAPI). Methods Data from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS), a cross-sectional, national survey for AAPI adults in the U.S. were used (N=1,646). Descriptive statistics were used to assess sample characteristics including proportions of AAPI with various COVID-19 vaccine concerns, categorized as none, side-effects only, unsafe only, and multiple reasons, and differences in vaccine concerns by socio-demographics. Ordinary multivariable logistic regression analyses were conducted to evaluate associations between a characteristic and having any vaccine concerns. Results Overall, 76% of the respondents reported having at ≥1 concerns about the vaccine. The most common concern was side effects (65%). Vietnamese Americans reported less concerns (vs. Chinese Americans). Those who were 30-39 and 40-49 years old (vs. Discussion AAPI is a diverse population and this study revealed differences in vaccine concerns across AAPI groups. Findings revealed potential targets for patient education needs. Effective strategies to address various vaccine concerns across subgroups of AAPI will be crucial to ensure equity in vaccination uptake.

Introduction Available evidence is mixed concerning associations between smoking status and COVID-19 clinical outcomes. Effects of nicotine replacement therapy (NRT) and vaccination status on COVID-19 outcomes in smokers are unknown. Methods Electronic health record data from 104 590 COVID-19 patients hospitalized February 1, 2020 to September 30, 2021 in 21 U.S. health systems were analyzed to assess associations of smoking status, in-hospital NRT prescription, and vaccination status with in-hospital death and ICU admission. Results Current (n = 7764) and never smokers (n = 57 454) did not differ on outcomes after adjustment for age, sex, race, ethnicity, insurance, body mass index, and comorbidities. Former (vs never) smokers (n = 33 101) had higher adjusted odds of death (aOR, 1.11; 95% CI, 1.06–1.17) and ICU admission (aOR, 1.07; 95% CI, 1.04–1.11). Among current smokers, NRT prescription was associated with reduced mortality (aOR, 0.64; 95% CI, 0.50–0.82). Vaccination effects were significantly moderated by smoking status; vaccination was more strongly associated with reduced mortality among current (aOR, 0.29; 95% CI, 0.16–0.66) and former smokers (aOR, 0.47; 95% CI, 0.39–0.57) than for never smokers (aOR, 0.67; 95% CI, 0.57, 0.79). Vaccination was associated with reduced ICU admission more strongly among former (aOR, 0.74; 95% CI, 0.66–0.83) than never smokers (aOR, 0.87; 95% CI, 0.79–0.97). Conclusions Former but not current smokers hospitalized with COVID-19 are at higher risk for severe outcomes. SARS-CoV-2 vaccination is associated with better hospital outcomes in COVID-19 patients, especially current and former smokers. NRT during COVID-19 hospitalization may reduce mortality for current smokers. Implications Prior findings regarding associations between smoking and severe COVID-19 disease outcomes have been inconsistent. This large cohort study suggests potential beneficial effects of nicotine replacement therapy on COVID-19 outcomes in current smokers and outsized benefits of SARS-CoV-2 vaccination in current and former smokers. Such findings may influence clinical practice and prevention efforts and motivate additional research that explores mechanisms for these effects.

BACKGROUND During the COVID-19 pandemic, there have been increased reports of racial biases against Asian Americans and Pacific Islanders (AAPIs). However, the extent to which different AAPI groups perceive and/or experience first-hand or being a witness to such experiences) associated with COVID-19 has negatively affected people of their race has not received much attention. OBJECTIVE We used data from the COVID-19 Effects on the Mental and Physical Health of AAPIs Survey Study (COMPASS), a nationwide, multi-lingual, community-based survey to empirically examine racial bias beliefs on AAPIs as related to the COVID-19 pandemic and the factors associated with these beliefs. METHODS COMPASS participants were AAPI adults who were able to speak English, Chinese (Cantonese or Mandarin), Korean, Samoan, or Vietnamese and who resided in the United States (US) during the time of the survey (October 2020-May 2021). Participants completed the survey online, by phone, or in-person. The Coronavirus Racial Bias Scale (CRBS) was used to assess COVID-19 related racial bias beliefs towards AAPIs. Participants were asked to rate the degree to which they agree with 9 statements on a 5-point Likert scale (i.e., “1 strongly disagree” to “5 strongly agree”). Higher score indicated greater degree of agreement with coronavirus racial bias beliefs. Multivariable linear regression was used to examine associations of demographic, health, and COVID-19 related characteristics with perceived racial bias. RESULTS A total of 5,068 participants completed the survey (mean age=45.4 years old; range: 18-97). Overall, 74% agreed or strongly agreed to one or more of the COVID-19 racial bias beliefs in the past 6 months (during the COVID-19 pandemic). Across the 9 racial bias beliefs, participants scored on the average 2.59 (SD=0.96; range 1-5). Adjusted analyses revealed that compared to Asian Indians, those who are ethnic Chinese, Filipino, Hmong, Japanese, Korean, Vietnamese, and other/multi-cultural had significantly higher mean CRBS scores whereas no significant differences were found among Native Hawaiians and Pacific Islanders. Non-heterosexual participants had a statistically significant higher mean CRBS scores compared to heterosexual participants. Compared to participants who were 60 years or older, those who were younger ( CONCLUSIONS Many COMPASS participants reported racial bias beliefs due to the COVID-19 pandemic. Relevant sociodemographic contexts, pre-existing and COVID-specific factors across individual, community and society levels were associated with perceived racial bias of “being Asian” during the pandemic. Findings underscore the importance of addressing the burden of racial bias on AAPI communities among other COVID-19 related sequalae.

Reports of escalated discrimination among Asian Americans and Pacific Islanders (AAPIs) due to COVID-19 are alarming, making this a public health priority. However, there are limited empirical studies on the scope and impact of COVID-19-related discrimination among AAPIs. Using the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) data (N = 4971; survey period: October 2020–February 2021), which is a U.S.-wide multi-lingual survey, we examined the prevalence of, and factors associated with discrimination experiences attributable to being an AAPI during the COVID-19 pandemic. Overall, 60.7% reported experiencing discrimination; the group prevalence ranged from 80.0% (Hmong) to 40.5% (Native Hawaiians and Pacific Islanders). Multivariable logistic regression models revealed that COVID-19-related factors were associated with many discrimination experiences: having a shelter-in-place order of ≥1 month, living in areas with perceived similar/higher COVID-19 severity, and negative impact in family income/employment due to COVID-19. Additionally, being Asian American (versus Native Hawaiians and Pacific Islanders), females, non-heterosexuals, younger, more severe effect on family income, living in the non-West, and poorer health were significantly correlated with discrimination experiences. Findings may assist in formulating anti-AAPI-discrimination policies and programs at the local, state, and federal levels. Culturally appropriate programs and policies to combat this are urgently needed.

Asian Americans (AsA), Native Hawaiians, and Pacific Islanders (NHPI) comprise 7.7% of the U.S. population, and AsA have had the fastest growth rate since 2010. Yet the National Institutes of Health (NIH) has invested only 0.17% of its budget on AsA and NHPI research between 1992 and 2018. More than 40 ethnic subgroups are included within AsA and NHPI (with no majority subpopulation), which are highly diverse culturally, demographically, linguistically, and socioeconomically. However, data for these groups are often aggregated, masking critical health disparities and their drivers. To address these issues, in March 2021, the National Heart, Lung, and Blood Institute, in partnership with 8 other NIH institutes, convened a multidisciplinary workshop to review current research, knowledge gaps, opportunities, barriers, and approaches for prevention research for AsA and NHPI populations. The workshop covered 5 domains: 1) sociocultural, environmental, psychological health, and lifestyle dimensions; 2) metabolic disorders; 3) cardiovascular and lung diseases; 4) cancer; and 5) cognitive function and healthy aging. Two recurring themes emerged: Very limited data on the epidemiology, risk factors, and outcomes for most conditions are available, and most existing data are not disaggregated by subgroup, masking variation in risk factors, disease occurrence, and trajectories. Leveraging the vast phenotypic differences among AsA and NHPI groups was identified as a key opportunity to yield novel clues into etiologic and prognostic factors to inform prevention efforts and intervention strategies. Promising approaches for future research include developing collaborations with community partners, investing in infrastructure support for cohort studies, enhancing existing data sources to enable data disaggregation, and incorporating novel technology for objective measurement. Research on AsA and NHPI subgroups is urgently needed to eliminate disparities and promote health equity in these populations.

Background Individuals who are unsheltered or experiencing homelessness are more likely to smoke than those in the general population and have a higher prevalence of tobacco-related illnesses. Those who are unhoused make quit attempts at rates similar to the general population, however rates of successful quitting are much lower. Women bear a higher burden of smoking-related diseases and are less successful in their cessation efforts than men. Despite these increased risks and challenges, cessation programs specifically designed to meet the needs of women experiencing homelessness are extremely rare. Methods To examine perceptions of smoking cessation programs among women who are unstably housed, we conducted in-depth, semi-structured interviews with twenty-nine women experiencing homelessness or unstable housing who had histories of tobacco and substance use. Interviews explored the social context of smoking, as well as interest in, barriers to, and facilitators of quitting. We used a grounded theory approach to analyze the transcripts. Results Participants reported a number of structural barriers to cessation. They reported obstacles to participating in existing cessation programs, including chronic stress related to experiences of being unsheltered and fear of being exposed to neighborhood violence. These conditions were paired with a strong need to self-isolate in order to maintain personal safety, which runs counter to traditional group-based cessation programs. Conclusion A dissonance exists between current smoking cessation programs and the needs of women who are unsheltered or unstably housed. Alternative cessation treatment delivery models that address extremely high levels of chronic stress violence, and avoidance of group settings are needed, as are programs that provide options for safe participation.

ObjectiveThis article presents a new conceptual framework "Connection to Health for Smokers" (CTHS), its application to address smoking cessation, and its acceptability in community health centers (CHCs).MethodsCTHS, an online interactive patient educational tool comprehensively implements the "5 A's" (ask, advise, assess, assist, and arrange) within the context of patients' social and behavioral health needs. Semi-structured interviews were conducted with five health educators (nurses) who administered CTHS with 62 patients to evaluate the acceptability of the program. Thematic analyses were conducted with interview transcripts.ResultsCHC health educators viewed CTHS has enhanced patient-centered communication, was able to identify patients' needs beyond tobacco use, and individualize action planning to integrate social and behavioral health needs.ConclusionCTHS received enthusiasm from CHC health educators as a helpful tool to address tobacco use among their patients. Comprehensive on-site smoking cessation programs at CHCs that provide a structured evidence-based approach informed by an understanding of each patient's coexisting social and behavioral health needs may play an important role in reducing tobacco use disparities in the United States.InnovationCTHS offers a new promising framework to comprehensively integrate the 5A's within the context of social and behavioral determinants of health for smoking cessation.

The coronavirus disease 2019 (COVID-19) pandemic has underscored the structural inequities facing communities of color and its consequences in lives lost. However, little is known about the COVID-related disparities facing Asian Americans amidst the heightened racism and violence against this community. We analyze the mortality toll of COVID-19 on Asian Americans using multiple measures. In 2020, one in seven Asian American deaths was attributable to COVID-19. We find that while Asian Americans make up a small proportion of COVID-19 deaths in the USA, they experience significantly higher excess all-cause mortality (3.1 times higher), case fatality rate (as high as 53% higher), and percentage of deaths attributed to COVID-19 (2.1 times higher) compared to non-Hispanic Whites. Mounting evidence suggest that disproportionately low testing rates, greater disease severity at care presentation, socioeconomic factors, and racial discrimination contribute to the observed disparities. Improving data reporting and uniformly confronting racism are key components to addressing health inequities facing communities of color.

Author(s): Ta Park, Van; Grill, Joshua D; Zhu, Jeanette; Nguyen, Khue; Nam, Bora; Tsoh, Janice; Kanaya, Alka; Vuong, Quyen; Bang, Joon; Nguyen, Nhi Cristina Y; Cho, In Hyang; Gallagher-Thompson, Dolores; Hinton, Ladson; Meyer, Oanh L | Abstract: IntroductionThis study elicited Asian Americans and Pacific Islanders' (AAPI) perspectives about recruitment strategies/messaging for participation in an aging, Alzheimer's disease and related dementias (ADRD), and caregiving research recruitment registry.MethodsUsing a mixed methods design, CARE (Collaborative Approach for AAPI Research and Education) conducted 14 focus groups (Nn=n123) with AAPI cultural groups (Asian Indian, Chinese, Filipino, Japanese, Korean, Samoan, Vietnamese) in different languages. Descriptive statistics and thematic qualitative analyses were conducted.ResultsMean age of participants was 54 years (median: 61; range 18-80), 66% were female, and 81% were foreign-born. Themes of consideration for recruitment emerged: (1) culturally/linguistically appropriate outreach in culturally specific spaces, (2) motivations for research participation, and (3) approaches to outreach and recruitment methods. Within each of these themes, there were ethnic differences in specific strategies/approaches reflected as subthemes.DiscussionRecruitment and messaging strategies should be tailored uniquely for each targeted AAPI group, with a thorough understanding of the cultural/linguistic factors that facilitate research participation to increase AAPI participation in ADRD, aging, and caregiver-related research. .

Home smoking bans can reduce tobacco smoke exposure, but little is known about the impact for Chinese American household pairs. In this study of 202 household pairs with low acculturation, 53.9% reported a home smoking ban, 31.7% had inconsistent reports, and 14.4% reported no ban. With decreasing home smoking ban enforcement, more nonsmokers had tobacco smoke exposure (66.1%–86.2%) as measured by the tobacco-specific nitrosamine biomarker urine NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol). Despite reported bans, about one-quarter of nonsmokers still reported tobacco smoke exposure at home (23.6%–30%) within the past 2 months and three-quarters reported outdoor exposure. In adjusted regression analyses of geometric mean NNAL ratios, nonsmokers in households with no ban had over two times higher levels than nonsmokers in households with a ban: adjusted log NNAL ratio = 2.70 (95% CI 1.21, 6.03). Higher smoker NNAL level and nonsmoker English fluency were also significantly associated with nonsmoker NNAL levels. Nonsmoker levels in households with an inconsistent ban were not significantly different compared to those with a ban. Although home smoking bans were generally associated with lower NNAL levels, tobacco smoke exposure in this immigrant population with low English proficiency was higher than that of the general population. From a health equity standpoint, there is a need for broader implementation and enforcement of comprehensive smoke-free policies.

Vietnamese American males have high smoking rates. This study explored social support mechanisms provided by lay health workers (LHWs) and family members through a smoking cessation intervention. Eight focus groups (N = 54) were conducted in Vietnamese stratified by intervention arms (Tobacco [experimental] and healthy living [control]) with 18 smokers, 18 family members, and 18 LHWs. Smokers reported feeling more accountable for their health behaviors, and smoking changes were reinforced by family members, peers, and LHWs through conversations facilitated during and outside the program. Culturally appropriate interventions with multiple social support mechanisms may reduce smoking in minority populations.

Introduction. Smoking prevalence is disproportionately high among Asian American immigrant men with limited English proficiency. Understanding the role of family support may provide insights into culturally acceptable strategies to promote smoking cessation. Aims. This study examined how family support was associated with readiness to consider smoking cessation among Chinese and Vietnamese American male daily smokers. Methods. We analyzed baseline data ( N = 340 ) from a cluster randomized trial of a family-based healthy lifestyle intervention. We assessed the frequency of receiving family support in various forms (encouraging use of cessation resources, praising efforts, checking in, and reminding of familial role). Multiple regression analysis was used to determine associations between family support areas and readiness to consider smoking cessation, controlling for covariates. Results/Findings. Reporting a higher frequency of receiving praise and encouragement for one’s efforts to quit was positively associated with readiness to consider cessation. Other areas of family support were not significant. Conclusions. These findings provide evidence to explore specific areas of family support in enhancing Asian American smokers’ readiness to consider cessation. As there is high interest from Asian American family members to support their smokers for quitting, culturally specific and acceptable strategies are needed to promote smoking cessation among Asian Americans.

Author(s): Chou, Chia-Ying; Tsoh, Janice Y; Shumway, Martha; Smith, Lauren C; Chan, Joanne; Delucchi, Kevin; Tirch, Dennis; Gilbert, Paul; Mathews, Carol A | Abstract: OBJECTIVES:Hoarding disorder (HD) was recognized as a psychiatric disorder in 2013. Existing literature suggests room for improvement in its treatment. The current pilot study aimed to provide an initial evaluation on the potential of compassion-focused therapy (CFT) as an intervention for HD, with the primary aim being assessing its feasibility and acceptability, and the secondary being evaluating its effects. DESIGN:Both CFT and a second round of the current standard of treatment and cognitive behavioural therapy (CBT) were investigated in the current study as follow-up treatment options for individuals who had completed CBT but were still significantly symptomatic. METHODS:Forty eligible individuals were enrolled (20 in each treatment). Treatment feasibility and acceptability were assessed by quantitative and qualitative measures. To explore treatment effects, HD symptom severity, HD-related dysfunctions, and their underlying mechanisms were assessed pre-treatment and post-treatment. RESULTS:Retention rates were 72% for CFT and 37% for CBT. All participants and 79% of the participants rated CFT and CBT, respectively, as good or excellent. After receiving CFT as a follow-up treatment, HD symptom severity dropped below the cut-off point for clinically significant HD forn77% of the treatment completers, and 62% achieved clinically significant reduction in symptom severity. In contrast, after completing a second course of CBT, 23% had HD symptom severity dropped below the cut-off threshold, and 29% achieved clinically significant symptom reduction. CONCLUSIONS:The current study showed satisfactory feasibility and acceptability of CFT. Moreover, it also found promising effects of CFT in addressing hoarding-related mechanisms that may not have been sufficiently addressed by CBT. The results suggest promising potential of CFT as a treatment for HD. Further investigation on this intervention is needed. PRACTITIONER POINTS:CFT may be a promising treatment option, particularly for those who do not respond well to CBT. Improving emotion regulation and negative self-perception by applying CFT interventions may help relieve hoarding symptoms. Generalization of the findings should be applied with caution given the small convenience sample of the current study. Statistical comparison on treatment effect measures between CFT and CBT as follow-up treatments was not available due to small sample size. Therefore, the comparative conclusions based on this pilot study should be made with caution.

Author(s): Ta Park, Van M; Goyal, Deepika; Suen, Joyce; Win, Nolee; Tsoh, Janice Y | Abstract: PurposeThe objective of this study was to explore the perspectives of postpartum depression (PPD) and mental health help-seeking behaviors among Chinese American women.Study design and methodsUsing a qualitative design, Chinese American women, who had given birth in the past year, participated in a semistructured interview (English or Mandarin). Depressive symptoms and mental health services questionnaires were also conducted.ResultsAll 15 participants were married and between 29 and 39 years of age. Content analysis revealed two main themes including culture-specific postpartum traditions and mental health help-seeking. Nine reported sadness or PPD symptoms, including three who scored above the cutoff of the Edinburgh Postnatal Depression Scale (EPDS score ≥9) for risk of PPD and others who disclosed such information during the interview. Many women shared that they experienced postpartum depressive symptoms, but some did not believe depression was applicable to Chinese women.Clinical implicationsHealthcare professionals working with Chinese American women must be aware of culture-specific childbearing traditions to promote maternal-infant well-being outcomes.

e13542 Background: Individuals from the family and social support network of cancer patients can have a pivotal role in reinforcing patients’ efforts to become and remain tobacco-free. This support is critical along the entire continuum of cancer care. While NCI-designated cancer centers across the US are increasingly offering tobacco cessation services, as a result of the NCI Cancer Center Cessation initiative, engaging patients’ family and other support network in tobacco treatment is not yet routine practice and has not been well described. We present findings from NCI designated cancer centers on the practice of assessing and offering tobacco treatment to support persons as part of care. Methods: A 24-item survey was administered (July-August 2021) across 50 cancer centers participating in C3I. Questions focused on the practice of routine assessment, offering information on quitting, referral to tobacco treatment, involving the family and social support person in tobacco treatment, provide tobacco treatment and document treatment for support persons of cancer patients. Responses assessed frequency of these practices, which included “never,” “rarely,” “sometimes,” “always (routine),” and “don’t know”. Additionally, strength of support from leadership for these practices and program access to linguistic and culturally appropriate resources were assessed using responses “not at all,” “some,” “great,” “full extent” and “don’t know”. Descriptive statistics were performed using SPSS (V. 28). Results: Representatives from 45 centers (90%) completed the survey. Less than half of centers (44%) indicated they always identified and 29% always offered resources to patients’ support persons or family members who used tobacco. Fewer clinics (18%), always provided treatment to patients’ support persons or family members and only one reported billing for tobacco use treatment encounters with support persons. For patient’s secondhand smoke exposure, less than half of the clinics report routinely (always) assessing (44%), documenting (49%) and providing intervention (29%). Importantly, 60% of centers reported having access to linguistically and culturally appropriate, population-specific resources to address support persons tobacco use to a great or full extent. Leadership support to address family and support persons’ tobacco use was indicated by 56% of clinics. Conclusions: While some NCI designated cancer centers report routine practices for patients’ support persons, including family members who use tobacco, there is substantial room for improvement. The importance of routine practices to assess and treat support persons who use tobacco can dramatically improve tobacco cessation and ultimately overall outcomes for cancer patients. Similarly, addressing secondhand smoke exposure for cancer patients and their support person(s) who smoke, is critical along the entire continuum of cancer care.

This study compares the effectiveness of approaches used to recruit a diverse sample for a randomized clinical trial for Hoarding Disorder (HD) in the San Francisco Bay Area. Of the 632 individuals who inquired about the study, 313 were randomized and 231 completed treatment. Most participants heard about the study via flyering (N = 161), followed by advocacy groups (N = 113), word of mouth (N = 84), health care professionals (N = 78), online (N = 68), and media (N = 11). However, those that heard about the study via advertising methods, such as flyers, were less likely to complete the study, p = .01, while those recruited via advocacy groups were most likely to be randomized, p = .03. No source proved more effective in recruiting underrepresented groups such as men, p = .60; non-whites, p = .49; or Hispanics, p = .97. Advertising recruited the youngest individuals, p

Background Tobacco use is common in people who experience homelessness. However, despite biological differences in use by sex and lower quit rates in women, research in homeless and unstably housed (HUH) women is sparse. We identified correlates of use specific to this population, with the goal of informing tobacco cessation programs tailored for HUH women. Methods We conducted a prospective study among HUH women recruited from San Francisco homeless shelters, street encampments, free meal programs and low-income hotels. Between June 2016 and January 2019, study participants completed six monthly interviews to examine factors associated with tobacco use, defined as urinary cotinine >10 pg/mL or self-reported prior 30-day use. Results Among 245 participants, 40% were Black, the median age was 53, 75% currently used tobacco and 89% had ≥one 24-hour quit attempt in the prior year. Tobacco use was more common in women with PTSD (66% vs. 48%) and depression (54% vs. 35%) compared to women without these conditions. Adjusted odds of tobacco use decreased significantly with increasing age (OR/5 yrs: 0.81; 95% CI:0.68, 0.96) and increased with an increasing number of additional substances used (OR: 2.52; 95% CI: 1.88, 3.39). Conclusion Outside of a treatment setting and within a community-recruited sample population composed of HUH women, the number of additional substances used is a primary correlate of ongoing tobacco use. Tailored cessation interventions that prioritize the issue of multiple substance use, and public health policies that allocate funding to address it, may increase tobacco cessation in this population.

Physical inactivity is prevalent among ethnic minority women including Korean American (KA) women. We explored the barriers to and facilitators of physical activity (PA) and strategies to promote continued engagement in a PA program with a component of an online community. We conducted a qualitative descriptive study of 37 KA middle-aged women who used to be physically inactive and participated in an exit interview following postintervention visit. Using a thematic analysis approach to analyze the data, we found the individual, interpersonal, and neighborhood/community-level barriers to and facilitators of PA; social influence and social support-related themes were evident. Participants expressed benefit and interest in lifestyle modification using social media. Such program that reduces the barriers and reinforces the facilitators may be able to help motivate KA women to increase their PA.

In the U.S., cigarette smoking is increasingly concentrated in disadvantaged and vulnerable populations, such as populations with lower income and with mental health needs. Food insecurity is linked with psychological distress and is an independent risk factor for smoking. We prospectively examined how cigarette smoking, food insecurity, and psychological distress operate as risk factors for one another in a 2-year longitudinal analysis of U.S. adults from the 2015 and 2017 Panel Study of Income Dynamics, a nationally representative household survey (N=7946). Using cross-lagged panel analysis, cross-lagged regression coefficients were estimated simultaneously with direct-effect paths, controlling for covariates. Results showed significant bidirectional associations between smoking and food insecurity: 2015 smoking predicted 2017 food insecurity, and 2015 food insecurity predicted 2017 smoking. Food insecurity and psychological distress also had significant bidirectional associations. However, the association between smoking and psychological distress was unidirectional: 2015 psychological distress predicted 2017 smoking, but not vice versa. The findings suggest a cyclical possibility that smoking exacerbates food insecurity, food insecurity exacerbates psychological distress, and psychological distress exacerbates smoking. There is a need to replicate with more timepoints, but our results highlight the importance of examining the overlapping health burdens of smoking, food insecurity, and psychological distress.

BACKGROUND: Immigrants tend to live in areas with higher co-ethnic density, and the effect of neighborhood ethnic composition could be particularly salient for health. This study explored associations between neighborhood ethnic composition and self-rated health among Asian immigrants. METHODS: We analyzed data collected at baseline from 670 Chinese and Vietnamese immigrants enrolled in a lifestyle intervention trial. Residential addresses were geocoded and combined with neighborhood socio-demographic profiles based on census data. We used generalized linear mixed models to examine neighborhood ethnic composition and self-rated health. RESULTS: Independent of individual-level factors, living in neighborhoods more densely populated by whites was associated with poor/fair self-rated health. Neighborhood household income and density of participants’ own ethnic group were not associated with poor/fair self-rated health. DISCUSSION: More research is warranted to disentangle reasons why Asian immigrants living in white-concentrated neighborhoods reported poorer self-rated health, including investigating effects of discrimination, relative deprivation, and availability of social resources.

Numerous studies have assessed individual-level factors associated with intention to quit smoking. However, fewer studies have assessed how neighborhood and built environment also contribute towards individual-level behavior. We used baseline data of 340 Chinese and Vietnamese male daily smokers from August 2015 to November 2017 living in the San Francisco Bay Area, who enrolled in a lifestyle intervention trial. The outcome variable was intention to quit in 30days. To understand the role of contextual factors participants' residential addresses were geocoded, and neighborhood median income, ethnic composition, and tobacco retail density were computed. Individual level analysis suggested that Vietnamese American men had greater intention to quit smoking (OR=2.90 CI=1.59, 5.26) in comparison to Chinese Americans. However, after adding neighborhood level factors to the model, no ethnic group difference was observed. Neighborhood household median income (OR=0.74, CI=0.64, 0.86) and tobacco retail counts (OR=0.79, CI=0.67, 0.94) were negatively associated with intention to quit. Years lived in the U.S. was the only individual level factor associated with intention to quit. By comparing two Asian American groups that live in heterogeneous neighborhoods, we identify key environmental and policy drivers that are associated with quit intention. Future studies aimed at influencing individual-level behavior should take into consideration the neighborhood context and built environment characteristics.