Using pod based e-cigarettes and nicotine pouches to reduce harm for adults with low socioeconomic status who smoke: A pilot randomized controlled trial

INTRODUCTION

Alternative Nicotine Delivery Systems (ANDS) such as e-cigarettes (EC) and oral nicotine pouches (ONP) may facilitate the substitution of smoking for those unwilling to quit. This pilot study assesses the harm reduction potential of EC and ONP among smokers with low socioeconomic status (SES).

METHODS

Adults who smoked daily in the past 6 months, had a household income < 250% federal poverty level and had no intention of quitting smoking in the next 30 days were randomized 2:2:1 to 8 Weeks of 5% nicotine EC; 4mg ONP or assessment-only control (CC). The primary outcome was a within-group change in cigarettes per day (CPD) from Baseline to Week 8.

RESULTS

45 individuals were randomized (EC: N=18; ONP: N=18; CC: N=9). Analyses included 33 participants who completed the Week 8 visit. Mean age was 50.2 years (SD:10.7) and average CPD at baseline was 13.9 (SD: 10.1). For those randomized to EC, average CPD decreased from 14.7 (95%CI: 10.3; 19.1) at Baseline to 2.9 (95%CI: 0.09; 5.79) at Week 8 (p-value <0.001). For those randomized to ONP, average CPD decreased from 15.0 (95%CI: 5.02; 24.93) to 8.3 (95%CI: 1.34; 15.18) by Week 8 (p-value =0.01). In the EC and ONP groups, respectively, 4 (28.6%) and 1 (8.3%) participant fully switched from smoking to the ANDS product by Week 8.

CONCLUSIONS

Individuals with low SES who smoke had lower CPD after switching to EC or ONP. These findings show the potential of ANDS in helping smokers switch to less harmful devices.

IMPLICATIONS

This study provides novel evidence that e-cigarettes and nicotine pouches can be a harm reduction tool for individuals with lower SES who smoke and are not willing to quit smoking, contributing to reducing tobacco-related disparities in this population.

Recency of Cannabis Vaping in Sexual Minorities in Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study

BACKGROUND

Cannabis vaping is increasing in the United States. Among populations at-risk are sexual minorities (SM) who are more likely to vape cannabis compared to their heterosexual counterparts. Cannabis vaping has been associated with negative health outcomes and concomitant use of other substances with increased risk with more recent use.

OBJECTIVES

This study examined the association between SM identification and recency of cannabis vaping (the last occasion that a participant used their vape device with cannabis) and number of puffs (the count of puffs that the participant took during their most recent use of their vape device with cannabis) using Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study.

RESULTS

In a weighted sample of participants who reported ever vaping cannabis (N = 5,331), 15% identified as SM, about 60% vaped cannabis in the past 3 or more days, and the mean number of puffs was 2 (SE = 0.17). Using multinomial logistic regression and zero-inflated negative binomial regression, the results showed that compared to heterosexual adults who reported not recently vaping cannabis, SM had higher probabilities of vaping cannabis in the past 3 or more days, 1-2 days, and the day of interview.

CONCLUSION

SM individuals were more likely to recently vape cannabis, placing them at higher risk for respiratory diseases and use of other substances. Public health researchers and practitioners need to identify reasons for cannabis vaping in this population and implement targeted public health messaging to inform SM communities of the potential health effects of cannabis vaping.

A qualitative exploration of the continuum of help-seeking among Asian American breast cancer survivors

Breast cancer rates among Asian American women are increasing. Despite this, there are limited studies on help-seeking among this population. Through a qualitative exploration, this paper examines the help-seeking experiences of Asian American breast cancer survivors. Asian American women (n = 52) with early-stage breast cancer were interviewed. Findings illustrate a continuum of experiences including: keeping diagnosis personal and not asking for help, keeping diagnosis personal but asking for limited help, and sharing diagnosis and seeking support. Results indicate that seeking support is a complex process for Asian Americans with breast cancer, with implications for survivorship and quality of life.

Correlates of smoking during COVID-19 in the LGBTQI + cancer survivor population

PURPOSE

Stressors brought on by the pandemic may have further encouraged lesbian, gay, bisexual, transgender, queer, and intersex plus (LGBTQI +) cancer survivors to smoke. The purpose of this study is to examine factors associated with smoking among LGBTQI + cancer survivors during the pandemic.

METHODS

We used a secondary data analysis of OUT: The National Cancer Survey. We conducted logistic regression analysis to examine the associations between psychological distress, binge drinking, and socio-demographic factors with ever use and current use of cigarettes, other tobacco, and nicotine products.

RESULTS

Of the 1629 participants in our sample, 53% used in their lifetime and 13% reported current use. Correlates of increased ever use included being of older age (AOR = 1.02; 95% CI: 1.01, 1.03) and binge drinking (AOR = 2.47; 95% CI: 1.17, 5.20) while correlates of decreased ever use were among those with a graduate or professional degree (AOR = 0.40; 95% CI: 0.23, 0.71). Correlates of increased current use included being of Latine descent (AOR = 1.89; 95% CI: 1.07, 3.36), binge drinking (AOR = 3.18; 95% CI: 1.56, 6.48), without health insurance (AOR = 2.37; 95% CI: 1.10, 5.10), and being disabled (AOR = 1.64; 95% CI: 1.19, 2.26) while correlates of decreased current use were among cisgender women (AOR = 0.30; 95% CI: 0.12, 0.77), being of younger age (AOR = 0.98; 95% CI: 0.96, 0.99), and having a graduate or professional degree (AOR = 0.33; 95% CI: 0.15, 0.70).

CONCLUSIONS

Our findings demonstrate that a proportion of LGBTQI + cancer survivors continue to smoke during the pandemic despite the increased risk involved with smoking. Furthermore, individuals with intersecting marginalized identities experience additional stressors that may have been further exacerbated by the conditions of the pandemic that encourage them to smoke.

IMPLICATIONS FOR CANCER SURVIVORS

Quitting smoking after a cancer diagnosis can decrease the chances of recurrence and a new primary malignancy. In addition, practitioners and researchers should advocate towards examining and addressing systemic forms of oppression in institutions that LGBTQI + cancer survivors navigate during the pandemic.

Change in E-cigarette risk perception and smoking behavior of Black and Latinx individuals who smoke

INTRODUCTION

Trends in knowledge and beliefs about e-cigarette (EC) harm have been changing. Our study examined whether change in risk perception of ECs predicts cigarettes smoked per week (CPW) among Black and Latinx individuals who smoke enrolled in an EC switching randomized clinical trial (RCT).

METHODS

We analyzed data from one arm of a 6-week EC RCT of individuals who smoke attempting to switch to nicotine salt pod system ECs (n = 110; Black, n = 57; Latinx, n = 53). Our explanatory variable was change in risk perception of ECs compared to combustible cigarettes (CC) from baseline to week 6. Our outcome was CPW measured by a 7-day timeline follow-back interview. A negative binomial GEE model was conducted to examine the association between risk perception and CPW at baseline and week 6.

RESULTS

The mean CPW decreased from 82.8 (SD=49.8) at baseline to 15.8 (SD=29.8) at week 6. A one-level increase in EC risk perception (i.e., EC perceived as riskier than CC from baseline to week 6) was associated with an increase in CPW (IRR: 1.83, 95% CI: 1.03; 3.24). Latinx participants were more likely to have higher CPW as EC risk perception increased compared to Black participants (IRR=1.89, 95% CI: 1.09; 3.26).

CONCLUSION

We found that CPW at week 6 was significantly higher as change in risk perception of EC relative to CC increased. Given the influence of risk perception on smoking behavior, people who smoke should be educated on the benefits and harms of ECs.

Social Influence of E-cigarette Use among Asian Americans in California

Objectives: The use of e-cigarettes is on the rise in the United States (US). An understudied facet of e-cigarette use is the influence of social groups. The purpose of the present article is to examine the role of social groups in the use of e-cigarettes among Asian Americans. Methods: We conducted 12 semi-structured interviews of Asian Americans who use e-cigarettes living in California. Interviews were transcribed and analyzed using thematic analysis. Results: Findings showed that e-cigarette use is normalized and encouraged among peer groups and social gatherings, anecdotal success stories of their peers who were able to quit or reduce their use of combustible cigarettes using e-cigarettes were motivating, and vape shops provided a space for socialization and belonging. Conclusions: The findings illuminate that e-cigarette use is a mediator in Asian American social groups as an activity for collectivity and connection. Public health researchers and practitioners can address nicotine use or addiction among Asian Americans through group or peer targeted prevention and intervention strategies.

Socioeconomic status across the life course and smoking cessation among older adult smokers in the U.S

INTRODUCTION

Socioeconomic status (SES) at different stages of the life course impacts late-life health. However, whether SES across the life course impacts smoking cessation in late-life is not known.

PURPOSE

Assess how life course SES impacts smoking cessation among older smokers.

METHODS

We identified 5,124 smokers, 50 years and older, from the 1998 to 2018 waves of the Health and Retirement Study. The outcome was self-reported smoking cessation. The main exposure was life course SES, defined as: low child and low adult SES (persistent low); low child, high adult SES (upward mobility); high child, low adult SES (downward mobility); and high child, high adult SES (persistent high). A multilevel mixed-effect logistic model was used to examine how life course SES predicts smoking cessation at age 65 and over time, adjusted for covariates.

RESULTS

Compared to those with persistent high SES, those with persistent low SES, upward and downward SES were more likely to be Hispanic or non-Hispanic Black. The adjusted results showed that at age 65, compared to those with persistent high SES, those with persistent low SES (OR= 0.69, 95 % CI = [0.51-0.92]), upward SES (OR= 0.49, [0.32-0.75]), and downward SES (OR= 0.55, [0.40-0.76]) were less likely to quit. However, as age increased, only those with downward or persistent low SES were significantly less likely to quit compared to those with persistent high SES.

DISCUSSION

Social mobility of SES from childhood to adulthood significantly impacts smoking cessation. Both stages of the life course should be considered to understand smoking behaviors.

The Role of Financial Strain and Educational Attainment on Smoking Abstinence of African Americans and Whites Who Smoke

Objective

To examine if reduced financial strain and higher educational attainment would confer less advantage for successful cessation among African Americans than for White individuals.

Design

A secondary data analysis of the Quit2Live study, a smoking cessation intervention for individuals who smoke.

Setting

Recruited participants from a metropolitan city in the Midwest.

Participants

The sample included 224 African American and 225 White individuals who smoke.

Main Outcome Measures

Our outcome variable was cotinine-verified smoking abstinence at the end-of-treatment (week 12). Our explanatory variables were a combination of financial strain (high, low) and educational attainment (high, low).

Methods

We implemented a logistic regression analysis and a two-way interaction of the combined financial strain and educational attainment variable and race on smoking abstinence.

Results

About 25% of the study participants were low financial strain and high education, 41% high financial strain and high education, 23% high financial strain and low education, and 11% low financial strain and low education. A greater proportion of African Americans vs Whites were in the high financial strain/low educational attainment category (28% vs 18%, P = .01). Participants with high financial strain and low educational attainment had substantially lower odds of abstinence (OR = .29 [95% CI: .12, .68]) compared to participants with low financial strain and high educational attainment. Contrary to our hypothesis, race did not moderate this association.

Conclusion

Findings highlight the constraining role of high financial strain and low educational attainment, irrespective of race, on smoking abstinence among smokers actively engaged in a quit attempt.

Perceived discrimination and cognitive function among older Puerto Ricans in Boston: The mediating role of depression

OBJECTIVES

To examine (1) the association between perceived discrimination, including everyday perceived discrimination and major lifetime perceived discrimination, and cognitive function and (2) the mediating role of depression between discrimination and cognitive function among older Puerto Ricans.

METHODS

Data came from the Boston Puerto Rican Health Study, collected from 562 Puerto Ricans aged 60+. Structural Equation Modelling was used to examine the association between discrimination and cognitive function and the mediating effect of depression.

RESULTS

Everyday perceived discrimination was negatively associated with cognitive function, which was fully mediated by depression. Major Lifetime perceived discrimination was not associated with cognitive function.

CONCLUSIONS

The findings contribute new information regarding the impact of perceived discrimination on cognitive function among older Puerto Ricans and underscore the importance of assessing experiences of discrimination to prevent depression and cognitive decline in this population.

Socioeconomic status across the life course and smoking trajectories of older adult smokers in the U.S

The objective of this study is to assess how SES over the life course impacts smoking cessation among older adult smokers in the U.S. 6,058 current smokers 50 years and older were identified from the 1998-2018 Waves of the Health and Retirement Study (HRS). The outcome of interest was smoking cessation. The main independent predictor was lifetime SES, categorized as low child and low adult SES (persistent low); low child, high adult SES; high child, low adult SES; and high child, high adult SES (persistent high). Multilevel mixed-effect logistic model was used to examine how lifetime SES predicts smoking cessation at age 65 and over time, adjusted by health and smoking covariates. The majority of older smokers had persistent high lifetime SES (60.3%), followed by high child/low adult SES (18.7%), persistent low SES (15.5%) and low child/high adult SES (5.6%). Compared to those with persistent high SES, those with persistent low SES were more likely to be Hispanic (25.9% vs. 3.0%, p&lt;0.001) or non-Hispanic Black (22.7% vs. 8.7%, p&lt;0.001), respectively. The adjusted results showed that at age 65, compared to those with persistent high SES, those with persistent low SES, low child/high adult SES, and low adult/high child SES were less likely to quit (OR: 0.42, 95%CI:0[.31-0.56]; OR:0.37, [0.24-0.55]; OR:0.53, [0.40-0.70], respectively). Similar results were observed over time for those with persistent low SES and low adult/high child SES. However, there was no significant difference for those with low child/high adult SES.

Workplace Discrimination and Short Sleep Among Healthcare Workers: The Buffering Effect of People-Oriented Culture

OBJECTIVE

Examine the association of discrimination and short sleep and the buffering effect of people-oriented culture in the workplace among nurses and patient care associates.

METHODS

Used a mixed-methods design from the 2018 Boston Hospital Workers Health Study (N = 845) and semi-structured interviews among nurse directors (N = 16).

RESULTS

We found that people-oriented culture reduced the odds of short sleep and slightly attenuated the association of discrimination and short sleep. People-oriented culture did not buffer the effects of discrimination on short sleep. Qualitative findings showed that discrimination occurred between co-workers in relation to their job titles and existing support in the workplace does not address discrimination.

CONCLUSIONS

Healthcare industries need to implement specific programs and services aimed at addressing discrimination which can potentially improve health outcomes among workers.

A randomized controlled trial of a therapeutic relational agent for reducing substance misuse during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic disrupted access to treatment for substance use disorders (SUDs), while alcohol and cannabis retail sales increased. During the pandemic, we tested a tailored digital health solution, Woebot-SUDs (W-SUDs), for reducing substance misuse.

METHODS

In a randomized controlled trial, we compared W-SUDs for 8 weeks to a waitlist control. U.S. adults (N = 180) who screened positive for substance misuse (CAGE-AID>1) were enrolled June-August 2020. The primary outcome was the change in past-month substance use occasions from baseline to end-of-treatment (EOT). Study retention was 84%. General linear models tested group differences in baseline-to-EOT change scores, adjusting for baseline differences and attrition.

RESULTS

At baseline, the sample (age M = 40, SD = 12, 65% female, 68% non-Hispanic white) averaged 30.2 (SD = 18.6) substance occasions in the past month. Most (77%) reported alcohol problems, 28% cannabis, and 45% multiple substances; 46% reported moderate-to-severe depressive symptoms. Treatment participants averaged 920 in-app text messages (SD = 892, Median = 701); 96% of completed lessons were rated positively; and 88% would recommend W-SUDs. Relative to waitlist, W-SUDs participants significantly reduced past-month substance use occasions (M = -9.1, SE = 2.0 vs. M = -3.3, SE = 1.8; p = .039). Secondary substance use and mood outcomes did not change significantly by group; however, reductions in substance use occasions correlated significantly with increased confidence and fewer substance use problems, cravings, depression and anxiety symptoms, and pandemic-related mental health effects (p-value<.05).

CONCLUSIONS

W-SUDs was associated with significant reductions in substance use occasions. Reduction in substance use occasions was associated with better outcomes, including improved mental health. W-SUDs satisfaction was high.

Centering Ethnic Studies in Health Education: Lessons From Teaching an Asian American Community Health Course

Anti-Asian racism and violence dramatically increased during the COVID-19 pandemic. As a result, recent studies and reports are showing that the health and well-being of Asian Americans are negatively affected. To address this urgent problem, the field of health education and public health must be equipped with the critical frameworks and concepts to analyze racism and White supremacy and how it affects the health and well-being of Asian Americans. We argue that using an ethnic studies lens in health education can help educators, researchers, and practitioners teach and train health educators to address racism experienced by Asian Americans during COVID-19 in relation to their health. We will discuss the elements of ethnic studies and demonstrate how to use it as a lens in understanding health disparities in the Asian American population influenced and exacerbated by the COVID-19 pandemic.

Perceived Discrimination and Psychological Distress: A Survey of Filipinx Americans in Massachusetts during the COVID-19 Pandemic

The onset of the COVID-19 pandemic has led to an upsurge of discrimination against Asian American populations, and Filipinx Americans (FA) have reported high cases of perceived discrimination. Prior studies have shown a relationship between experiences of discrimination and poor mental health. The purpose of this study was to examine the association of perceived discrimination and psychological distress among FA living in Massachusetts from a survey collected during the COVID-19 pandemic (N = 133). Multiple regression analysis revealed that experiences of perceived discrimination were associated with psychological distress. Older participants were less likely to report psychological distress. Compared to men, womxn were more likely to report psychological distress. Our findings highlight the potential mental health consequences of perceived discrimination experienced by FA, which may have been exacerbated during the COVID-19 pandemic.

Race and Ethnicity in the Social Work Grand Challenges

Race, ethnicity, and racism (RER) are interconnected with the critical problems tackled in the Grand Challenges for Social Work (GCSW). Yet, the extent to which the GCSW discuss the central role of RER is less clear. This article investigates how the GCSW integrate RER in their discourse. Using content analysis, authors examined all 21 concept papers that comprise the 12 initial GCSW to determine their attention to RER. Authors assessed whether each paper made any reference to race or ethnicity, whether race or ethnicity was considered as a primary theme, and whether racism was mentioned. Nine GCSW had at least one paper that mentioned race or ethnicity; seven had at least one paper that treated race and ethnicity as a major construct. Five GCSW contained at least one paper that discussed racism's impacts on their topical interests. None of the papers analyzed in the study defined or specified their conceptualization of racism. The GCSW are strategically positioned to widen and deepen social work's focus on RER, and the recent adoption of the 13th GCSW to "Eliminate racism" is an important first step. Authors encourage the social work field to embrace a more explicit, renewed, and continued commitment to eradicating systemic racism.

Racial discrimination, ethnic-racial socialization, and cultural identities among Asian American youths

OBJECTIVES

This study investigates whether and how racial discrimination is associated with ethnic-racial socialization in the family and how distinct aspects of ethnic-racial socialization influence children's ethnic and American identity among Filipino American and Korean American families.

METHOD

The data are obtained from the Midwest Longitudinal Study of Asian American Families Project (N = 1,580; 379 Filipino American youths and 377 parents, and 410 Korean American youths and 414 parents; M_age of youths = 15.01). Using the bootstrapping and maximum likelihood with missing values approaches, we conducted path analyses to test the hypothesized associations concurrently and longitudinally for each ethnic group.

RESULTS

Youth-reported racial discrimination was directly associated with weaker American identity, both concurrently and longitudinally. In concurrent models, racial discrimination experienced by both youth and parents was positively associated with youth-reported preparation for bias, which in turn was linked with stronger ethnic identity among Filipinos, whereas no indirect pathways reached statistical significance among Koreans. In longitudinal models, parent-reported discrimination was linked with higher levels of promotion of mistrust among both groups, which predicted weaker ethnic identity among Filipino youth but stronger American identity among Korean youth.

CONCLUSIONS

The present study highlights how exposure to racial discrimination may have a lasting influence in cultural identity development among Asian Americans and possibly through ethnic-racial socialization in the family, which might have been shaped by such experiences. Our results also underscore the importance of considering the experiences of both children and parents in studies of discrimination and ethnic-racial socialization. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Associations of Sociodemographic Factors With Health-Related Social Networks Among Premigration Filipinos

Social networks provide health information that is useful to prevent illness, promote health, and facilitate treatment for health problems. One understudied facet is which people in social networks provide health information. The present article fills a critical gap in the empirical literature by identifying which social networks are reported based on a premigrant's sociodemographic status that operate as their source of health information. Data were analyzed from the Health of the Philippine Emigrants Study (HoPES) (n = 829) migrant sample. Findings indicated having high English proficiency and educational attainment reduces the likelihood of reporting no one in their network as a source of health information. Those who reported family/relatives are less likely to be younger, and those who reported friends are also less likely to be living-in with a partner. This article informs social work researchers and practitioners in implementing interventions among premigration immigrants to help increase and broaden their social networks.

Personal Motivations of Asian Americans Who Use ENDS: A Qualitative Study

Objectives: The purpose of this study is to explore the motivations that encourage Asian Americans to use ENDS. In addition, it seeks to evaluate the underlying implications of Asian cultural beliefs and values that influence the use of ENDS. Methods: We conducted 12 semi-structured in-depth interviews among Asian Americans. Data were analyzed using thematic analysis. Results: Participants were influenced by Asian cultural values of filial piety and saving face which allowed them to either de-stigmatize or conceal the use of ENDS among their family members and peers. They also reported preferences for e-juice flavors reflective of food and products prominent in the Asian culture. Moreover, respondents also believed that ENDS use is less harmful than combustible cigarettes and reported experiencing perceived health benefits. Conclusion: Asian Americans who use ENDS are encouraged by the perception of their family members and value a sense of comfortability and familiarity when choosing their e-juice flavors. These results can help inform public health educators and researchers create culturally-specific health campaigns and interventions targeting the Asian-American population.

Older Chinese Americans' Perspectives on Physical Activity: A Mixed Methods Study

The benefits of physical activity for successful aging are well established. Few interventions however, target older Asian Americans who may have distinct needs for cultural and linguistic tailoring. The heterogeneity among Asian Americans underscores the need to elucidate specific physical activity preferences by ethnic subgroup. To better understand older Chinese Americans' perceptions about physical activity, we conducted a community-engaged, mixed methods study with 60 participants. Through survey and focus groups, four emerging themes characterized perceptions of physical activity: (a) physical activities benefit the body and mind, (b) traditional Chinese culture influences perceptions and preferences for physical activity, (c) physical activity presents opportunities for social engagement, and (d) physical activity facilitates family harmony. Design recommendations includes encouraging mind-body approaches, incorporating culturally specific practices, highlighting opportunities for social engagement, and emphasizing the potential for improved harmony.

Cultural Perspectives on Tobacco Use and Cessation Among Chinese American Immigrants: A Community-Engaged Qualitative Study

INTRODUCTION

Tobacco use is a preventable cause of death among ethnic minorities. Chinese Americans have high smoking rates and underutilize evidence-based cessation therapies. Community members' perspectives on tobacco use and cessation may help bridge treatment gaps and ensure that cessation approaches are aligned with cultural values.

METHODS

Focus group methods were used to explore cultural factors influencing tobacco use and cessation among 50 Chinese immigrants. Emerging themes were identified using thematic analysis.

RESULTS

The three emerging themes are (a) tobacco use is influenced by Chinese American immigrants' socioecological environment, (b) self-discipline determines the ability to quit, and (c) complex family dynamics influence quitting.

DISCUSSION

Cessation approaches framed within cultural perspectives may help bridge treatment gaps. Innovations such as leveraging soft technologies that are widely used in the community may extend the reach of health promotion campaigns and treatments.

Unmet Needs of Asian American and Pacific Islander Cancer Survivors

In the USA, cancer is the leading cause of death for Asian Americans and Pacific Islanders (AAPIs), but little is known about the unmet needs of AAPI cancer survivors, especially from a national perspective. Using a community-based participatory research approach, we partnered with the Asian and Pacific Islander National Cancer Survivors Network and the Asian American Cancer Support Network to design and conduct a cross-sectional survey to understand the unmet needs of a national sample of AAPI cancer survivors. We assessed unmet needs in 10 domains: day-to-day activities, financial expenses, emotional concerns, medical treatment, cancer information, home care, nutrition, physical concerns, family relationships, and spirituality. We also assessed self-reported measures related to quality of life. This national sample of AAPI cancer survivors included people from 14 states and two territories who had been diagnosed with a broad range of cancers, including cancer of the breast, ovary/uterus/cervix, prostate, blood, and other sites. Over 80 % reported at least one unmet need. Participants reported an average of 8.4 unmet needs, spanning an average of 3.9 domains. Most commonly reported were unmet needs pertaining to physical concerns (66 %), day-to-day activities (52 %), and emotional concerns (52 %). This is the first report of unmet needs in a national sample of AAPI cancer survivors with a range of different cancer types. It describes the areas of greatest need and points to the importance of devoting more resources to identifying and addressing unmet needs for the underserved population of AAPI cancer survivors.

"I don't have to explain, people understand": Acceptability and Cultural Relevance of a Mobile Health Lifestyle Intervention for Filipinos with Type 2 Diabetes

BACKGROUND

Filipino Americans have the highest risk for obesity-related type 2 diabetes and related complications compared with all major Asian American subgroups. Identifying effective interventions to improve Filipino health outcomes are needed to reduce this health disparity.

OBJECTIVE

To assess the acceptability and cultural relevance of the PilAm Go4Health program - a culturally adapted mobile health weight-loss lifestyle intervention including virtual social networking for Filipino Americans with type 2 diabetes.

DESIGN SETTING PARTICIPANTS

Qualitative semi-structured post-program interviews explored perceptions of 45 Filipino Americans with type 2 diabetes in Northern California regarding their perceptions of the acceptability and cultural relevance of PilAm Go4Health. Participants' mean age was 57.6 years. Sixty-seven interviews were recorded, transcribed, and thematically analyzed by four independent coders.

RESULTS

Over half (n=26, 57.8%) of the respondents found that a culturally tailored intervention program enhanced their engagement. All (n=45) of the respondents felt that mobile health technology promoted their self-efficacy. A majority of the respondents (n=29, 64.4%) expressed that they progressed from despair to self-efficacy as a result of their participation in the intervention. More than one-fourth of the participants (n=13, 28.8%) discussed that the intervention needed further cultural tailoring.

CONCLUSIONS

Overall, PilAm Go4Health - a mobile health weight-loss lifestyle intervention - was acceptable and culturally relevant for Filipino Americans with type 2 diabetes. Findings may help inform clinician and researchers on effective intervention strategies for diabetes self-management when designing interventions for diverse populations.

Associations with E-cigarette use among Asian American and Pacific Islander young adults in California

With attention to the rapidly growing market of electronic nicotine delivery systems (ENDS/e-cigarettes) and the fastest growing US ethnic minority group, the current study explored associations between awareness, perceived risks, and use of ENDS among Asian American and Pacific Islander (AAPI) young adults.

AAPI young adults (ages 18–25) in California were recruited via social media, college classes, listservs for AAPI-serving non-profits, and snowball sampling to complete an anonymous survey between 2014 and 2015.

The sample (N = 501) was 57% women, 15% LGBTQIA; with a mean age of 21; 26% foreign-born; identifying as Filipino (29%), Chinese (24%), Vietnamese (14%), mixed-AAPI heritage (13%), or 21% other. Nearly half the sample (44%) reported ever ENDS use; 11% were current users. Current ENDS use was twofold greater for: Filipino and Vietnamese compared to Chinese respondents; men versus women; LGBTQIA-identified respondents; those vocationally trained; and employed. Awareness of ENDS from peers/friends was most common and was associated with ever though not current ENDS use. Most respondents perceived ENDS as harmful (62%); low compared to high risk perception was associated with a three-fold greater likelihood of ever use and six-fold greater likelihood of current use. Popular flavors were fruit (49%, e.g., lychee, taro) and candy/sweets (26%). Current users viewed ENDS as a healthier alternative or quit aid for conventional cigarettes (42%); recreation/social use (33%) also was common.

Findings indicate ENDS visibility among AAPI young adults in California with affinity for flavors and many engaging in trial and current use for harm reduction and recreational/social aims.

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In a convenience sample of Asian–American and Pacific Islander (AAPI) young adults, most perceived e-cigarettes as harmful.

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Lower risk perception of e-cigarettes was associated with ever and current use.

•

Popular e-cigarette flavors were fruit (e.g., lychee, taro) and candy/sweets.

•

AAPI young adult current users viewed e-cigarettes as cessation aids or healthier alternatives to combustible cigarettes.

Changing Attitudes towards Hepatitis B among Asian Americans

Background: Asian Americans have the highest prevalence of hepatitis B virus (HBV) in the US. The San Francisco Hep B Free (SFHBF) campaign aimed to increase awareness and access to HBV education and services among Asian Americans in San Francisco. Purpose: We sought to examine attitudes and knowledge among Asian Americans regarding HBV at baseline (2009) and benefits of the SFHBF outreach campaign four years later (2013). Methods: Four focus groups were conducted (n=45) in 2009, followed by in-depth interviews (n=40) in 2013. Results: In 2009, many participants were misinformed about HBV symptoms and transmission. They also reported stigma associated with HBV, which hindered Asian Americans from discussing the disease and seeking services. The 2013 interviews revealed that SFHBF had contributed towards awareness of HBV screenings and vaccinations, and also instilled acute seriousness that HBV could affect them directly. Conclusion: The in-depth interviews conducted in 2013 illustrated that there was less concern about “saving face,” but a shift to a level of seriousness associated with HBV. Future efforts among Asian Americans should continue to focus on self-efficacy regarding HBV prevention, including screening and vaccination.