Chinese immigrant smokers’ access barriers to tobacco cessation services and experience using social media and text messaging
More details
Hide details
Department of Population Health, Grossman School of Medicine, New York University, New York, United States
School of Global Public Health, New York University, New York, United States
Nan Jiang   

Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Ave, New York, NY 10016, United States
Submission date: 2020-05-29
Final revision date: 2020-07-18
Acceptance date: 2020-08-02
Publication date: 2020-09-11
Tob. Prev. Cessation 2020;6(September):52
Smoking rates remain disproportionately high among Chinese immigrants in the US, particularly in males. Community-based smoking cessation services and quitlines have low engagement rates. Social media and text messaging programs can be effective in promoting quit rates and improving treatment engagement. This study examined Chinese immigrant smokers’ barriers to accessing available smoking cessation services and patterns of using social media platforms and mobile phone text messaging.

We conducted in-depth interviews (n=30) and a brief survey (n=49) with adult Chinese immigrant smokers leaving in New York City in 2018. Qualitative interviews explored smokers’ challenges with smoking cessation, barriers to accessing and using smoking cessation services, and experience using social media and text messaging. The quantitative survey assessed smoking and quitting behaviors, and social media and text messaging use patterns.

Qualitative data revealed that participants faced various barriers to accessing cessation services, including the lack of awareness about services, skepticism about treatment effects, reliance on willpower for cessation, and time constraints. WeChat was mainly used to maintain social networking and acquire information. Participants rarely used text messaging or other social media platforms. Quantitative data showed that 55% of participants had no plan to quit smoking. Among those who reported past-year quit attempts (45%), 55% used cessation assistance. WeChat was the most frequently used platform with 94% users.

WeChat has potential to serve as an easily accessible platform for delivering smoking cessation treatment among Chinese immigrant populations. Research is warranted to explore the feasibility and efficacy of employing WeChat in smoking cessation treatment.

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
This study was supported by the New York University Center for the Study of Asian American Health under the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health (U54MD000538-15). NIMHD played no role in study design, data collection and analysis, manuscript writing, or the decision to submit the paper for publication.
Not commissioned; externally peer reviewed.
New York City Department of City Planning. Population - New York City population: Population facts. Accessed May 4, 2018.
United States Census Bureau. Selected population profile in the United States: 2016 American community survey 1-year estimates. https://centropr.hunter.cuny.e.... Published September 14, 2017. Accessed May 4, 2018.
New York City Department of Health and Mental Hygiene. Epi Data Brief Published June, 2018. Accessed March 2, 2019.
Haines-Saah RJ, Kelly MT, Oliffe JL, Bottorff JL. Picture Me Smokefree: a qualitative study using social media and digital photography to engage young adults in tobacco reduction and cessation. J Med Internet Res. 2015;17(1):e27. doi:10.2196/jmir.4061
Shelley D, Fahs M, Scheinmann R, Swain S, Qu J, Burton D. Acculturation and tobacco use among Chinese Americans. Am J Public Health. 2004;94(2):300-307. doi:10.2105/ajph.94.2.300
Tsang IK, Tsoh JY, Wong C, et al. Understanding and use of nicotine replacement therapy and nonpharmacologic smoking cessation strategies among Chinese and Vietnamese smokers and their families. Prev Chronic Dis. 2014;11:E26. doi:10.5888/pcd11.130299
Ma GX, Tan Y, Toubbeh J, Su X. Differences in stages of change of smoking behavior among current smokers of four Asian American subgroups. Addict Behav. 2003;28(8):1431-1439. doi:10.1016/s0306-4603(03)00071-6
Fu SS, Ma GX, Tu XM, Siu PT, Metlay JP. Cigarette smoking among Chinese Americans and the influence of linguistic acculturation. Nicotine Tob Res. 2003;5(6):803-811. doi:10.1080/14622200310001614566
Spigner C, Yip M-P, Huang B, Shigaki A, Tu SP. Chinese and Vietnamese adult male smokers' perspectives regarding facilitators of tobacco cessation behavior. Asian Pac J Cancer Prev. 2007;8(3):429-435. PMID:18159982.
Yu ESH, Chen EH, Kim KK, Abdulrahim S. Smoking among Chinese Americans: Behavior, knowledge, and beliefs. Am J Public Health. 2002;92(6):1007-1013. doi:10.2105/ajph.92.6.1007
Zhang JY, Chan SSC, Fong DYT, Malone RE, Lam TH. The social context of smoking cessation in China: an exploratory interview study. Tob Control. 2012;21(1):57-58. doi:10.1136/tc.2010.040691
Spence W, Zhu L. Perceptions of smoking cessation among Glasgow's Chinese community. Tobacco Prevention & Cessation. 2017;3(October):1-9. doi:10.18332/tpc/77942
Chen MS, Tang H. Review of smoking cessation research among Asian Americans: The state of the research. Nicotine Tob Res. 2007;9(3):S485-S493. doi:10.1080/14622200701587052
Hsia FN, Spruijt-Metz D. The meanings of smoking among Chinese American and Taiwanese American college students. Nicotine Tob Res. 2003;5(6):837-849. doi:10.1080/14622200310001615259
Tu SP, Walsh M, Tseng B, Thompson B. Tobacco use by Chinese American men: An exploratory study of the factors associated with cigarette use and smoking cessation. Asian Am Pac Isl J Health. 2000;8(1):46-57. PMID:11567512.
Katigbak C, Maglalang DD, Chao YY, Au H, Liang W, Zuo S. Cultural perspectives on tobacco use and cessation among Chinese American immigrants: A community-engaged qualitative study. J Transcult Nurs. 2019;30(4):350-358. doi:10.1177/1043659618817583
Kuiper N, Zhang L, Lee J, et al. A national Asian-language smokers' quitline — United States, 2012-2014. Prev Chronic Dis. 2015;12:1-10. doi:10.5888/pcd12.140584
Kong G, Ells DM, Camenga DR, Krishnan-Sarin S. Text messaging-based smoking cessation intervention: A narrative review. Addict Behav. 2014;39(5):907-917. doi:10.1016/j.addbeh.2013.11.024
Naslund JA, Kim SJ, Aschbrenner KA, et al. Systematic review of social media interventions for smoking cessation. Addict Behav. 2017;73:81-93. doi:10.1016/j.addbeh.2017.05.002
Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2016;4(4):CD006611. doi:10.1002/14651858.CD006611.pub4
Scott-Sheldon LA, Lantini R, Jennings EG, et al. Text messaging-based interventions for smoking cessation: A systematic review and meta-analysis. JMIR Mhealth Uhealth. 2016;4(2):e49. doi:10.2196/mhealth.5436
Statista. Most popular global mobile messenger apps as of July 2019, based on number of monthly active users (in millions). Published July, 2019. Updated July, 2020. Accessed November 19, 2019.
Hollander R. WeChat has hit 1 billion monthly active users. Business Insider. Published March 6, 2018. Accessed July 18, 2020.
QSR International Pty Ltd. NVivo qualitative data analysis software. Version 12. Doncaster, Australia: QSR International Pty Ltd; 2018. https://www.qsrinternational.c.... Accessed July 18, 2020.
Lewins A, Silver C. Using Software in Qualitative Research: A Step-by-Step Guide. London, UK: SAGE Publications; 2007.
Saldaña J. The Coding Manual for Qualitative Researchers. 1st ed. London, UK: SAGE Publications; 2009. Accessed July 18, 2020.
StataCorp. Stata Statistical Software. Version 16. College Station, TX: StataCorp; 2019.
Centers for Disease Control and Prevention. Tips From Former Smokers®: About the campaign. Published April 23, 2018. Accessed June 16, 2018.
Li WHC, Ho KY, Lam KKW, et al. A study protocol for a randomised controlled trial evaluating the use of information communication technology (WhatsApp/WeChat) to deliver brief motivational interviewing (i-BMI) in promoting smoking cessation among smokers with chronic diseases. BMC Public Health. 2019;19(1):1083. doi:10.1186/s12889-019-7417-6
Semple K. In Chinatown, sound of the future is Mandarin. The New York Times. Published October 21, 2009. Accessed July 18, 2020.
Patanavanich R, Glantz SA. Smoking is associated with COVID-19 progression: A meta-analysis. Nicotine Tob Res. 2020;22(9):1653-1656. doi:10.1093/ntr/ntaa082