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Pilot Project I: Advancing A Research Agenda for Tobacco Prevention and Control On Guam
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| This project will establish university-community partnerships to increase the capacity in Guam’s network of health service professionals and practitioners to design conduct and apply tobacco control research clarifying evidence based interventions for improving cancer prevention programs. The following action objectives will be implemented over the three-year period: 1. What do community stakeholders, with diverse interests, perceive are the most important issues/questions that need to be addressed in order to control tobacco on Guam? (e.g., stakeholders include community leaders, health professionals, youth organizations, teachers, etc.) 2. Can community stakeholders, who participate in the Participatory Action Research process, reach a consensus for how they will support research on tobacco control? (e.g., can they identify and prioritize the most important questions that need to be investigated in order to reduce tobacco use on Guam). 3. Building on a community consensus, can a research agenda to control a specific tobacco- control need on Guam be launched, with support from community stakeholders? (e.g., design a pilot research study that targets information needed to advance tobacco cessation in adults living on Guam). This project has important implications for the advancement of tobacco control research because it focuses on several needs confronting Pacific Islander communities attempting to reduce cancer related disparities that exist (see Asian Pacific Partners for Empowerment and Leadership, 2001). It will help fill data gaps on Pacific Islander and Asian American tobacco use for underrepresented, underserved populations. It will increase utilization of ongoing community-based surveillance systems that measure tobacco use and patterns in the U.S. associated Pacific Island jurisdictions. It will add to studies on tobacco use and factors of prevention and cessation to better understand what is effective for Asian American and Pacific Islander ethnic-specific populations. PREVALENCE OF SMOKING ON GUAM A recent study using Guam’s surveillance data sets documented the high prevalence of smoking among Pacific Islanders in their home islands and the suggestion that their tobacco use may have increased over the past five years while that of other groups has stayed the same or decreased (Workman, 2001a). The Guam data indicate current smoking prevalence (38%) among Pacific Islander adults on Guam to be similar if not higher than that among Native Hawaiians ( Kaholokul, et, al.,1999). Half of Guam’s adult Pacific Islander population have been smokers (100+ cigarettes in lifetime), and in both 1995 and 1999 most of them reported being current smokers, more so than other ethnic communities on island. The residual group of Non-APIs on Guam had a comparable level of smoking to that of the U. S. general population. There is a need for more controlled statistical analyses of these data to clarify underlying determinants of the noted ethnic differences. The interplay of educational attainment, age, occupation and other factors, such as marital status or years-on-island, must be sorted out. For example, Workman (2001a) found that among those who had “ever tried” smoking, API subjects were more likely than non-API to report being current smokers and less likely to be “former” smokers. Anti-smoking education campaigns, to the extent they occurred, were not effective in the Pacific Islands. Under half of current smokers on Guam reported attempting to quit smoking in the year before the surveys, regardless of ethnicity. If anything, these data hint that in contrast to other areas of the United States showing declines in smoking behavior (CDC, 2002a,b), smoking behavior may have increased over the years from 1995 to 1999 among Pacific Islanders on Guam. This same study found Pacific Islander youth displayed patterns similar to those among Guam’s adult APIs. Pacific Islander youth were more likely than other ethnicities to report being current smokers and, similar to the island’s adult Asian community, Asian youth on Guam were the least likely to report current smoking. A more recent study comparing Guam’ s 1999 and 2001 YRBS (Workman 2001b) again revealed that, in contrast to the declines in smoking behavior found in the mainland U.S., smoking behavior has remained high and unchanged among Pacific Islander youth on Guam Data indicated fewer youth are experimenting with tobacco (i.e., “ever tried in lifetime” declined), a trend also found in the national data (CDC, 2002). Yet, the incidence of current smoking (i.e., smoking 1+ days in past month) has remained unchanged, with one-fifth (20%) of middle school youth, and over one-third (38%) of high school youth being current smokers in 2001. This is well above national levels, where reported current smoking has steadily declined among high school students from 36.4% in 1997 to 28.5% in 2001 (CDC 2002b). From 1999-2001, there appears to be an increase in Guam students having tried chewing tobacco, and in those who have tried cigars, cigarillos, or little cigars, in particular, middle school girls (more than boys). More alarming, is the decrease in current teenage smokers reporting that they tried to quit during the past year (down from 83.5% of smokers to 78.5%). Studies have found smoking behavior was most prominent among Guam’s Pacific Islander girls. A high prevalence of smoking among Hawaiian/Pacific Islander girls was also found by Appleyard, Messeri and Haviland (2001), using National Youth Tobacco survey data. Again, in other applications of Guam surveillance data, analyses revealed that “being overweight” was a factor increasing risk-behaviors, such as unsafe dieting practices, smoking and other substance abuse, as well as related to depression (Workman, Pinhey, Perez, and Taitano, 1999). More research is needed to understand these associations, and the contributions of body image, diet and genetics to ethnic cultural differences in the social purposes and motivations for smoking. |
SPECIFIC AIMS:
| Dr. Michael Ehlert, Co-Leader Assistant Professor of Psychology College of Liberal Arts and Social Sciences University of Guam B.S. , M.S., Brigham Young University Ph.D., University of New Hampshire E-mail: mbehlert@uog9.uog.edu |
| Dr. Cheryl Albright, Co-Leader Associate Professor (Researcher) Cancer Research Center of Hawaii; Clinical Faculty John A. Burns School of Medicine, University of Hawaii Ph.D. (Social Psychology and Behavioral Medicine), University of Houston M.P.H. (Epidemiology), University of California at Berkeley E-mail: calbright@crch.hawaii.edu |