Using Community-Based Prevention Marketing to Reduce Smoking-Related Health Disparities In a Disadvantaged Ethnic Enclave

Background: Numerous risk factors present among the Chinese immigrant population makes this racial/ethnic minority group exceptionally vulnerable to tobacco-related health disparities. Almost two-thirds of men in China smoke, and more than 600,000 deaths each year are attributable to smoking. Exposure to socio-cultural norms, beliefs, and attitudes toward smoking in their countries of origin are likely to have affected Asian immigrants and their families, especially for those most recently settled in the United States. Furthermore, immigrants face acculturative stress, economic insecurity and many lack health insurance, all further contributing to the significant problem of health inequities. Data gathered from 2006-2008 revealed that 31% of the adult males smoke in Chicago’s Chinatown, which is above the city’s current rate of 24% and the national smoking rate of 21%.

Program background: A novel framework for program planning, Community-Based Prevention Marketing (CBPM), was used to: (1) engage and empower community members; (2) plan, implement, and evaluate a comprehensive multi-level public health intervention; (3) tailor the intervention to be culturally and linguistically appropriate for the community; and (4) disseminate smoking-related health information to a hard-to-reach and disadvantaged ethnic enclave. The Coalition for Asian Substance Abuse Prevention (CASAP) represented by different sectors of the community used the processes of CBPM to develop and implement a multi-level public health approach to address smoking. CASAP selected two different audiences to target, adults and youth between the ages of 12-18 years old, for smoking cessation and prevention respectively. At the environmental-level, a culturally tailored media campaign was implemented community-wide. Central to CBPM is the implementation of individual-level strategies to complement the media messages delivered. Thus, a first-ever smoking cessation program was offered in Chinese to adult members in the Chinatown community. Secondly, a community-based participatory action research methodology called photovoice was implemented among vulnerable Chinese American adolescents at a youth-serving organization in this ethnic enclave with the aim of smoking prevention.

Evaluation Methods and Results: This intervention will use a mixed methods design to collect both qualitative and quantitative data for process and outcome evaluation. Through key informant interviews with youth, data will be gathered to determine the effectiveness of photovoice to prevent adolescents from smoking. Data from a pilot study of the smoking cessation program that has been translated into Chinese with scientific rigor will be collected to determine its effectiveness, feasibility, and acceptability among participants. Anticipated results will reveal the utility of the Community-Based Prevention Marketing framework to plan, implement, and evaluate an effective multi-level and strategic public health approach that is culturally appropriate for the target community.

Conclusions: The Community-Based Prevention Marketing framework engages and empowers community members in planning, implementing, and evaluating a comprehensive multi-level public health intervention. It also proves to be an effective approach to culturally tailoring health promotion programming, and distributing culturally and linguistically appropriate messaging to hard-to-reach and vulnerable populations.

Implications for research and/or practice: Implications of this project are the lessons learned to apply the CBPM framework in racial/ethnic minority populations and/or immigrant populations living in socially isolated ethnic enclaves to reduce health disparities.