Description of tobacco use and cessation among Bhutanese refugees participating in a tobacco cessation program

ABSTRACT

Objectives. To compare the tobacco use, exposure, and cessation differences between Bhutanese refugee and non-Hispanic Caucasian tobacco users in a US federally qualified health center tobacco cessation program.

Design. A retrospective cohort study reviewing data from 374 patients counseled on tobacco cessation was performed. Demographic information, tobacco use history, exposure to tobacco, and type of tobacco used characterized baseline assessments. The patient record was followed forward in time to evaluate tobacco cessation outcomes as the dependent variable. Data were analyzed using odds ratios and the Mann–Whitney U-test.

Results. Data analysis included 318 patients (211 non-Hispanic Caucasian patients and 107 Bhutanese refugee patients). Bhutanese refugees demonstrated a higher likelihood of smokeless tobacco product use than the non-Hispanic Caucasian population (67.3% vs 1%, OR = 214.971, 95% CI 50.429, 916.383), and a greater odds of having household tobacco users (OR = 2.533, 95% CI 1.532, 4.186). Likewise, the non-Hispanic Caucasian population exhibited larger odds of smoking cigarettes vs the Bhutanese population (97.2% vs 26.2%, OR = 96.399, 95% CI 38.449, 241.687), had a higher odds of passive smoke exposure (OR = 12.765, 95% CI 5.36, 30.393), and higher likelihood of a past quit attempt (OR = 9.037, 95% CI 5.180, 15.765). Significant gender differences with regard to type of tobacco used were noted among Bhutanese refugees. Bhutanese refugees demonstrated significantly higher likelihood of tobacco cessation, compared with the non-Hispanic Caucasian population, at all length cutpoints, while showing no difference in number of follow-up visits or median time followed.

Conclusion. These culture-specific findings, showing unique tobacco use characteristics and increased cessation among the Bhutanese refugee population, provide novel information helpful to professionals identifying and treating these individuals for tobacco cessation. More research is needed to confirm our results and findings.

KEYWORDS:

• Tobacco
• Bhutanese
• refugee
• Nepal
• cessation
• retrospective cohort
• pharmacist
• rural health
• community health center

Acknowledgements

The authors would like to express gratitude for the assistance of Dr Megan Orr (North Dakota State University) for her expertise in statistical analysis, and Dr Mark Strand (North Dakota State University) for mentorship of study design.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCiD

Brody Maack http://orcid.org/0000-0002-9181-221X

Robert Willborn http://orcid.org/0000-0002-4634-8235

Additional information

Funding

Assistance from Family HealthCare in Fargo, ND (practice site) and Fargo Cass Public Health (grant funding to support the tobacco cessation program) are appreciated. This work was supported by the Tobacco Prevention and Control Local Grant Contract Program for Fargo Cass Public Health.