The effects of a multilingual telephone quitline for Asian smokers: a randomized controlled trial

Abstract

Background: Although telephone counseling services (quitlines) have become a popular behavioral intervention for smoking cessation in the United States, such services are scarce for Asian immigrants with limited English proficiency. In this study, we tested the effects of telephone counseling for smoking cessation in Chinese-, Korean-, and Vietnamese-speaking smokers.

Methods: A culturally tailored counseling protocol was developed in English and translated into Chinese, Korean, and Vietnamese. We conducted a single randomized trial embedded in the California quitline service. Smokers who called the quitline's Chinese, Korean, and Vietnamese telephone lines between August 2, 2004, and April 4, 2008, were recruited to the trial. Subjects (N = 2277) were stratified by language and randomly assigned to telephone counseling (self-help materials and up to six counseling sessions; n = 1124 subjects) or self-help (self-help materials only; n = 1153 subjects) groups: 729 Chinese subjects (counseling = 359, self-help = 370), 848 Korean subjects (counseling = 422, self-help = 426), and 700 Vietnamese subjects (counseling = 343, self-help = 357). The primary outcome was 6-month prolonged abstinence. Intention-to-treat analysis was used to estimate prolonged abstinence rates for all subjects and for each language group. All statistical tests were two-sided.

Results: In the intention-to-treat analysis, counseling increased the 6-month prolonged abstinence rate among all smokers compared with self-help (counseling vs self-help, 16.4% vs 8.0%, difference = 8.4%, 95% confidence interval [CI] = 5.7% to 11.1%, P < .001). Counseling also increased the 6-month prolonged abstinence rate for each language group compared with self-help (counseling vs self-help, Chinese, 14.8% vs 6.0%, difference = 8.8%, 95% CI = 4.4% to 13.2%, P < .001; Korean, 14.9% vs 5.2%, difference = 9.7%, 95% CI = 5.8% to 13.8%, P < .001; Vietnamese, 19.8% vs 13.5%, difference = 6.3%, 95% CI = 0.9% to 11.9%, P = .023).

Conclusions: Telephone counseling was effective for Chinese-, Korean-, and Vietnamese-speaking smokers. This protocol should be incorporated into existing quitlines, with possible extension to other Asian languages.

Figure 1

CONSORT diagram showing the flow of subjects in the trial. A randomized trial was conducted to test the effects of a culturally tailored smoking cessation protocol, which was developed in English, and translated into Chinese, Korean, and Vietnamese for telephone counseling of Asian language speakers. Smokers who called the Asian language lines of the California quitline between August 2, 2004, and April 4, 2008, were recruited, stratified by language and sex, and randomly assigned to telephone counseling or self-help (self-help materials only) groups. Subjects were evaluated for smoking cessation at 4 and 7 months after random assignment.

Figure 2

Relapse curves for counseling and self-help groups in a randomized trial to test a telephone counseling protocol for smoking cessation in Asian language speakers. The culturally tailored smoking cessation protocol was developed in English and translated into Chinese, Korean, and Vietnamese. Smokers who called the Asian language lines of the California quitline between August 2, 2004, and April 4, 2008, were recruited, stratified by language and sex, and randomly assigned to group. Subjects were evaluated at 4 and 7 months after random assignment. Kaplan–Meier curves were generated for subjects who made a quit attempt of 24 hours or more within the first 90 days of recruitment. This figure excludes the 205 subjects who were not evaluated at either 4 or 7 months. AB = percent abstinent; CI = confidence interval.