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Understanding the contribution of race to factors associated with cigarette smoking and nicotine metabolism is essential for the characterization of patterns of tobacco use, nicotine dependence and incidence of tobacco-related diseases. This paper reports an investigation of cotinine levels among Southeast Asian smokers in two separate studies. Study 1 included 327 male and female smokers who participated in community-based interviews where smoking history information was obtained and a saliva continine sample was collected. Results indicated that subjects smoked an average of 11.2 cigarettes/day, with men reporting significantly higher consumption rates as compared to women (p < 0.0001). Subjects' mean cotinine level was 65 ng/ml with an average cotinine/cigarette ratio of 8.2. In Study 2, plasma and saliva cotinine in six Southeast Asian adult smokers were measured during 2 days of smoking followed by 6 days of abstinence. On day 1, mean plasma and saliva continine levels were 268 and 235 ng/ml, respectively. After 6 days of abstinence, mean levels had dropped to 12 ng/ml for plasma and 8 ng/ml in saliva. On average, it required at least 4.7 days for saliva continine levels to reach < 14 ng/ml. Mean cotinine concentrations during smoking differed in these two separate studies. Implications of these findings are discussed and future research recommendations are presented.

Appalachians remain at high risk for cancer, heart and lung disease, in part because of their high prevalence of tobacco use; yet, information about their tobacco consumption patterns is limited. The purpose of this study was to describe tobacco consumption variables among rural adult Appalachian tobacco users. Subjects, aged 18 and older (N = 249), participated in a face-to-face interview about tobacco consumption variables and knowledge regarding the health effects of tobacco at fairs in two rural Ohio Appalachian counties. The majority of participants were categorized as precontemplators, although 21 percent were classified in preparation stage of change. Mean age of initiation was 16.6 years and number of cigarettes smoked per day (cpd) was significantly higher for men, as compared to women. One-third of males reported the use of smokeless tobacco. The majority had not tried to quit for more than a year and the average number of previous quit attempts was low. One-half of the sample had been advised in the past to quit by their physician. Few had used nicotine replacement with past quit attempts but greater than half would consider this approach with future attempts. Knowledge about the health effects of smoking indicated that most were aware of the relationship between smoking and cancer but less than one-half recognized its association with heart disease. Those with less education were less informed about the health effects to self and non-smokers. While a sizeable portion expressed interest in quitting, knowledge about the health effects of smoking is lacking, especially with regard to heart disease and among those with less education.

A total of 1,403 Southeast Asian adult immigrant males (n = 783) and females (n = 620) from Cambodia, Laos, and Vietnam who currently resided in Central Ohio were interviewed to determine the self-reported smoking prevalence among them, and underwent biochemical confirmation of their smoking status. Variables having to do with the subjects' sociodemography, acculturation, and smoking history that were related to the misclassification of smoking status were also investigated. Self-reported current smoking rates were 40.9% and 5.6% for males and females, respectively. After verification of the subjects' smoking status by saliva cotinine assay (smoker status > or = 14 ng/ml), the rates of smoking were found to be greater, at 43.7% for males and 14.8% for females. Years of education, self-reported smoking status, country of origin, and method of healthcare payment were significant predictors of misclassification. These findings suggest that the prevalence of smoking is higher among Southeast Asian adult females than has been previously reported. Variables that predict misclassification with regard to smoking status are presented, and their implications for clinicians and researchers are discussed.

We present data on the effects of a heart health education intervention targeted at adult Southeast Asians. Within each of the Cambodian, Laotian, and Vietnamese groups who received the intervention, we obtained random samples approximately three to 18 months postintervention. Comparisons were made between preintervention and postintervention knowledge of blood pressure and awareness of behaviors to prevent heart disease. Within all three ethnic samples, we found significant increases in the pre-to-post percentages of individuals who could define blood pressure and identify ways to prevent heart diseases. [Am J Prev Med 1994;10:205–8]

This article describes the setting for the first Office of Minority Health funded Minority Community Health Demonstration Grant Project targeted toward the Southeast Asian minorities of Cambodians, Laotians, and Vietnamese, explains how the theoretical basis of the Indigenous Model was implemented, and offers lessons learned and suggestions for future minority health programs. Three examples of how the Indigenous Model was applied, in some instances, in unanticipated ways are discussed. Lessons related to implementing the Indigenous Model for minorities are suggested

Identifying factors associated with successful tobacco quit attempts may help in the development and targeting of effective cessation strategies. This paper aims to describe factors associated with smokeless tobacco (ST) cessation and compares the results to findings in the smoking cessation literature. Prospective data on 116 men aged 19 to 70 and participating in a ST cessation program were used to examine correlates of successful ST cessation at 1 year post-intervention. Controlling for age, level of education (p =0.002) and daily coffee consumption (p =0.005) had significant independent associations with successful cessation. No ST use variables were significant predictors of cessation success. In a multivariable logistic regression model three factors were significantly associated with cessation: education (p = 0.010), coffee consumption (p =0.019), and age (p =0.029). Factors associated with successful ST cessation in this sample are consistent with predictors of smoking cessation reported in the literature. Based on its widespread use and the strength of its association with successful quitting, the role of caffeine consumption in ST cessation merits further study.

Higher risks of tobacco-related morbidity and mortality in Appalachians provided the impetus for this qualitative study. The purpose was to describe beliefs about tobacco use and cessation among current and former tobacco users in rural Appalachia using focus groups. Findings included themes of nicotine addiction and pros and cons of tobacco use. The importance of family and personal independence in relation to tobacco were evident. Participants identified helpful tobacco treatment strategies. Similarities to treatment needs of tobacco users in general underscore the point that rural Appalachians require best practice tobacco treatment integrating unique cultural aspects of family and personal independence.

PURPOSES OF THE PAPER: The purposes of this paper are as follows: (1) discuss seven design considerations and their respective lessons learned or resolutions in initiating the National Institutes of Health's only funded smoking cessation grant targeting Asian Americans; (2) present empirical findings that resulted from the design considerations alluded to previously; and (3) delineate unresolved challenges on conducting smoking cessation research particularly for adult Southeast Asians. SUMMARY OF METHODS UTILIZED: The authors base this paper on their empirical data collected as part of the "Lay-led Smoking Cessation Approach for S.E. Asian men" study. Data collected include baseline data from 1553 adult Southeast Asianslpar;721 women and 832 menrpar; in Ohio as well as subsequent data collected on selected individuals. The investigators faced seven major, conceptual issues in initiating smoking cessation research focusing on Southeast Asian adults. These seven considerations related to: language, culture, nicotine addiction characteristics, verification of smoking exposure and smoking status, knowledge of the health consequences of smoking, social environmental factors, and criteria for evaluating effectiveness of the proposed intervention. Smoking cessation interventions must be conducted in the appropriate Asian language because current smokers are the least likely to understand spoken English. Culturally speaking, Cambodian and Laotian male smokers are significantly more likely to have traditional Southeast Asian values than their never smoker counterparts. As a measure of addiction to nicotine, the median time until the first cigarette was 30 minutes for both Cambodians and Vietnamese suggesting that these men are highly addicted. Cotinine levels were negatively correlated with time to the first cigarette and positively correlated with numbers of cigarettes. Knowledge of the health consequences of smoking is lower than mainstream populations. Almost 100 per cent of Southeast Asian male smokers have at least one "best" friend who smokes. Verification of smoking status through saliva cotinine testing suggest that actual smoking rates among Southeast Asians are higher than selfshy;report rates. The largest proportion of Cambodian and Vietnamese smokers are in the precontemplation stage while Laotian smokers are proportionally more likely to be in the contemplation stage. CONCLUSIONS: Design considerations discussed represent considerations beyond those that are normally considered in communityshy;based research for majority populations. The quality and quantity of empirical data collected with due attention to these conceptual considerations appear to substantiate the validity of these considerations. Authors delineated challenges for initiating smoking cessation research among Southeast Asians. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: This paper is particularly relevant for increasing the data base on adult Cambodians, Laotians, and Vietnamese. KEY WORDS: Asian Americans, Cambodians, Laotians, Vietnamese, culture, language, tobacco, smoking cessation, nicotine