Filling the Void: A Multi-Component, Culturally Adapted Smoking Cessation Program Integrating Western and Non-Western Therapies
Beckham, Sheila, Washburn, Anuenue, Ka'aha'aina, Darlene, Bradley, Stephen, American Journal of Health Education
Background: Smoking is especially prevalent among Native Hawaiians. The 2002 Behavioral Risk Factor Surveillance System revealed that 33.8% of Hawaiians were current smokers. Native Hawaiians have the highest age-adjusted lung cancer incidence and mortality rates and the highest prevalence of asthma among all ethnicities. Purpose: This study describes the outcomes of a culturally appropriate, integrated smoking cessation program. Methods: Each participant (n=209) was exposed to multiple treatment options--Hawaiian therapies, Western pharmacotherapy, acupuncture, and fitness training--and was permitted to opt for the program of personal preference. Pre-post program evaluation, with three-, six-, and twelve-month follow-up, was performed. Results: Of the 177 participants who attended two or more sessions, 59% (n=105) quit or reduced smoking by one half, and 23% (n=41) quit. The three-, six-, and twelve-month quit rates were 23% (n=40), 15% (n=27), and 15% (n=27), respectively. Discussion: There is limited data available on quit rates for culturally specific, multi-component smoking cessation programs. A variety of methods and treatments, including pharmacological, lifestyle, alternative, and behavioral therapies, have enhanced smoking cessation program outcomes. Translation to Health Education Practice: Through the development of a multi-component program that integrated Western methodologies with traditional healing practices, a void was filled. Similar culturally informed methods may enhance future efforts in designing ethnic-specific smoking cessation programs.
Cigarette smoking has been identified as the leading preventable killer in the United States, with an annual national death toll of more than 440,000 individuals. (1) In 2003, an estimated 22.1% of adults in America smoked cigarettes. (2) When figures due to lost productivity and excess medical expenditures are combined, the annual economic burden caused by smoking exceeds $150 billion, or $7.18 for each pack of cigarettes sold in the United States. (3)
Smoking is especially prevalent among Native Hawaiians. The 2002 Behavioral Risk Factor Surveillance System (BRFSS) revealed that 33.8% of Hawaiians surveyed were current smokers (up from 26.5% in 1999). (4) Native Hawaiians have the highest age-adjusted lung cancer incidence and mortality rates and the highest prevalence of asthma among all ethnicities. (5,6) In a study of a small Native Hawaiian population (n=257) on the island of Moloka'i, 42% of the males smoked cigarettes regularly. (7) In a separate survey, more than 25% of the female Hawaiian/Pacific Islander youths interviewed reported having smoked in the past month. (8)
According to a 1990 survey conducted by the State of Hawai'i Alcohol and Drug Abuse Division among 2,157 students attending high school on the Wai'anae Coast, over half of the Hawaiian/part-Hawaiian students reported that one or both of their parents smoked. Likewise, in a pediatric asthma management program funded by the Hawai'i Medical Service Association Foundation and conducted by the Wai'anae Coast Comprehensive Health Center (WCCHC) in 1999-2001, smoking was observed in 75% of the homes visited. (9) Among WCCHC patients, smoking prevalence reflected that of the community. A chart review of the 4,082 active adult records containing documentation regarding smoking status revealed that 2,193 (54%) of the individuals were current smokers. It should also be noted that an additional 2,206 records contained no documentation, so smoking prevalence may be higher.
A uniting factor among those who smoke seems to be the desire to quit. A 2002 nationwide survey found that 52% of smokers had attempted to quit in 2001, compared with 45% in 1996. (10) Another survey indicated that even though 70% of smokers possessed a strong desire to quit, only 5.7% maintained nonsmoker status 12 months after quitting. (11) According to the 2000 Native Hawaiian Smokers Study, 71% of the respondents desired to quit or smoke less, and 70% had tried to quit smoking at some point in their lives. …