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Abstract

One of the greatest public health success stories of the past 50 years has been the reduction in cigarette smoking in the United States. Smoking prevalence has decreased by 50% or more in the United States since the 1960s, and although recent reports indicate a plateau in this decline, the long-term downward trend has resulted in an overall smoking prevalence rate of 20.6% in 2009.1 Despite this success, the Healthy People 2010 objective of reducing the prevalence of cigarette smoking among adults to 12% or less has not been realized. This is, in large part, due to the fact that tobacco control efforts have not impacted population subgroups equally. In general, racial/ethnic minority groups and persons of lower socioeconomic status (SES) have not benefited as much as whites and those of higher SES from smoking prevention and cessation programs. If we are to meet the goal of 12% or less smoking prevalence among the overall adult population, more effort is needed to influence tobacco use behaviors among racial/ethnic and low SES populations
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... To enhance the effectiveness of tobacco interventions among minorities, researchers have called for cultural adaptation and tailored tobacco interventions [15]. 'Targeted' interventions focus on expanding the generalizability of an intervention (developed in other populations) to minority groups, and while these interventions may have embedded dominant cultural values, they do not take the values and experiences of a minority group into consideration [15,28]. In contrast, 'tailored' interventions focus on ensuring that the intervention meets the unique needs of the minority group by including ethnic/cultural experiences, norms, and values [29][30][31][32][33]. ...
... Indeed, the end-of-treatment smoking cessation rate was 43.1% after six months, which is substantially better than the quit rates among African American (range 11.2%-27.5%), and Alaska Native smokers (30%) [15,28] who have completed smoking cessation programs. A possible contributor to this difference may be a genetic disposition in these populations, a variance in study design and conduction, or specific social factors attributed to the cultures of these populations [57][58][59][60]. ...
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To date, no smoking cessation programs are available for Arab American (ARA) men, who are a vulnerable population with high rates of smoking. Thus, the primary aim of this one group pre-test/post-test study was to assess the effectiveness of Sehatack—a culturally and linguistically tailored smoking cessation program for ARA men. The study sample was 79 ARA men with a mean age of 43 years who smoked between 5 and 40 cigarettes (mean = 19.75, SD = 9.1) per day (98.7%). All of the participants reported more interest in smoking cessation post-intervention and many of the participants in the baseline (38.5%) and post-intervention phases (47.7%) wanted to quit smoking " very much ". For daily smokers who completed the smoking cessation program, the median number of cigarettes smoked daily was significantly lower than those in the post-intervention phase (Z = −6.915, p < 0.001). Results of this preliminary study indicate that: (a) Sehatack may be a promising way for ARA men to quit smoking, and (b) culturally relevant smoking cessation counselors can be trained to recruit and retain ARA smokers in an intensive group smoking cessation program. Strengths of this study were community engagement and rapport between three faith organizations and the University of Florida College of Nursing. However, a larger trial is needed to address study limitations and to confirm benefits in this population.
... To enhance the effectiveness of tobacco interventions among minorities, researchers have called for cultural adaptation and tailored tobacco interventions [15]. 'Targeted' interventions focus on expanding the generalizability of an intervention (developed in other populations) to minority groups, and while these interventions may have embedded dominant cultural values, they do not take the values and experiences of a minority group into consideration [15,28]. In contrast, 'tailored' interventions focus on ensuring that the intervention meets the unique needs of the minority group by including ethnic/cultural experiences, norms, and values [29][30][31][32][33]. ...
... Indeed, the end-of-treatment smoking cessation rate was 43.1% after six months, which is substantially better than the quit rates among African American (range 11.2%-27.5%), and Alaska Native smokers (30%) [15,28] who have completed smoking cessation programs. A possible contributor to this difference may be a genetic disposition in these populations, a variance in study design and conduction, or specific social factors attributed to the cultures of these populations [57][58][59][60]. ...
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Full-text available
Abstract: To date, no smoking cessation programs are available for Arab American (ARA) men, who are a vulnerable population with high rates of smoking. Thus, the primary aim of this one group pre-test/post-test study was to assess the effectiveness of Sehatack—a culturally and linguistically tailored smoking cessation program for ARA men. The study sample was 79 ARA men with a mean age of 43 years who smoked between 5 and 40 cigarettes (mean = 19.75, SD = 9.1) per day (98.7%). All of the participants reported more interest in smoking cessation post-intervention and many of the participants in the baseline (38.5%) and post-intervention phases (47.7%) wanted to quit smoking ”very much”. For daily smokers who completed the smoking cessation program, the median number of cigarettes smoked daily was significantly lower than those in the post-intervention phase (Z = −6.915, p < 0.001). Results of this preliminary study indicate that: (a) Sehatack may be a promising way for ARA men to quit smoking, and (b) culturally relevant smoking cessation counselors can be trained to recruit and retain ARA smokers in an intensive group smoking cessation program. Strengths of this study were community engagement and rapport between three faith organizations and the University of Florida College of Nursing. However, a larger trial is needed to address study limitations and to confirm benefits in this population. Keywords: smoking cessation; NRT; Arab American; cultural; linguistic; tailoring
... To enhance the effectiveness of tobacco interventions among minorities, researchers have called for cultural adaptation and tailored tobacco interventions [15]. 'Targeted' interventions focus on expanding the generalizability of an intervention (developed in other populations) to minority groups, and while these interventions may have embedded dominant cultural values, they do not take the values and experiences of a minority group into consideration [15,28]. In contrast, 'tailored' interventions focus on ensuring that the intervention meets the unique needs of the minority group by including ethnic/cultural experiences, norms, and values [29][30][31][32][33]. ...
... Indeed, the end-of-treatment smoking cessation rate was 43.1% after six months, which is substantially better than the quit rates among African American (range 11.2%-27.5%), and Alaska Native smokers (30%) [15,28] who have completed smoking cessation programs. A possible contributor to this difference may be a genetic disposition in these populations, a variance in study design and conduction, or specific social factors attributed to the cultures of these populations [57][58][59][60]. ...
Article
Full-text available
Abstract To date, no smoking cessation programs are available for Arab American (ARA) men, who are a vulnerable population with high rates of smoking. Thus, the primary aim of this one group pre-test/post-test study was to assess the effectiveness of Sehatack—a culturally and linguistically tailored smoking cessation program for ARA men. The study sample was 79 ARA men with a mean age of 43 years who smoked between 5 and 40 cigarettes (mean = 19.75, SD = 9.1) per day (98.7%). All of the participants reported more interest in smoking cessation post-intervention and many of the participants in the baseline (38.5%) and post-intervention phases (47.7%) wanted to quit smoking ”very much”. For daily smokers who completed the smoking cessation program, the median number of cigarettes smoked daily was significantly lower than those in the post-intervention phase (Z = −6.915, p < 0.001). Results of this preliminary study indicate that: (a) Sehatack may be a promising way for ARA men to quit smoking, and (b) culturally relevant smoking cessation counselors can be trained to recruit and retain ARA smokers in an intensive group smoking cessation program. Strengths of this study were community engagement and rapport between three faith organizations and the University of Florida College of Nursing. However, a larger trial is needed to address study limitations and to confirm benefits in this population. View Full-Text Keywords: smoking cessation; NRT; Arab American; cultural; linguistic; tailoring
... Also, smokingcessation rates among African-American (range, 11.2-27.5%), and Alaska Native smokers (30%) who had completed smoking-cessation programs [18,19]. A possible contributor to this difference may be a variance in study design and conduction, a genetic predisposition in these populations, or specific social factors attributed to the cultures of these populations [20]. ...
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Background Most of the studies about the efficacy of smoking-cessation medication and its side effects were conducted in developed countries on participants who differ from Arab population in sociocultural and genetic factors. Patients and methods A randomized controlled trial was conducted on a convenient sample of 100 smokers at the smoking-cessation clinic. The participants were allocated into four groups: nicotine-replacement therapy (NRT), bupropion (BPP), combination of NRT+BPP, and placebo. Counseling was offered to all participants. Outcomes: self-reported smoking status with biochemical verification (success to stop smoking, lapse, relapse, or failure to stop smoking) at 3 and 6 months from starting treatment. Results The total success rate in four studied groups was 14% at 3 months and 8% at 6 months. There was no evidence of any statistically significant difference between any of the interventional groups (NRT, BPP, or their combination) and placebo group at 3 and 6 months as regards success rate (8, 12, 8, and 28%, respectively, at 3 months and 8, 12, 0, and 12%, respectively, at 6 months). There were no serious adverse events in the studied groups. Headache was more significantly reported by placebo group compared with all other groups (P=0.01), and urgency was more significantly reported by placebo group compared with NRT group (P=0.001). Conclusion The study found no evidence of the superior effect of NRT, BPP, or their combination over placebo in helping smokers quit smoking at 3 and 6 months. However, more withdrawal symptoms were reported by the placebo group.
... [10][11][12][13][14][15][16][17][18] Success is hampered by additional factors in low SES populations: [19][20][21] they have lower quit rates than the general population, even when utilizing evidence-based programs. [22][23][24][25][26][27] Determinants of these disparities are greater life stress, depression, lack of skills training and support, and access barriers. [28][29][30][31][32] Women are more likely than men to encounter cessation barriers due to elevated levels of stress, negative affect, and sex hormones, which may interfere with skills to manage smoking urges -and they are less successful at quitting. ...
Article
Background: Tobacco use is the leading preventable cause of disease and death in the US and smoking rates are high in low-income populations (28% vs. 17% of those living above the poverty line).1,2 Consequently, low-income groups have elevated tobacco-related disease risk exacerbating health disparities.3,4 Mindfulness has been associated with positive effects on psychosocial, physical and mental health outcomes, which has increased interest in using mindfulness as an adjunctive treatment for smoking cessation and relapse prevention.5,6 However, research on mindfulness in relation to such factors in underserved populations is lacking. Purpose/Hypothesis: The purpose of this research is to investigate the psychometric qualities and correlates of the Cognitive and Affective Mindfulness Scale (CAMS-R)7 in a sample of low-income, mostly minority women who smoke cigarettes. It is hypothesized that the CAMS-R will be reliable, and mindfulness will be associated with known barriers to cessation. Methods: Secondary analysis of self-report data from 12-month follow-up in a large, randomized smoking cessation trial, Babies Living Safe and Smokefree,8 was used to explore mindfulness and its relationship to known cessation barriers and facilitators. Temple University IRB approval was received before data collection. CAMS-R items were summed to create a composite score. Results: The sample of women (N=187) was mostly (72%) African American, average age was 30 years old, ~28% had less than a high school degree/GED and on average smoked ~9 cigarettes/day. The CAMS-R was reliable (α=.74). Zero-order correlations showed higher mindfulness was significantly correlated with greater social support (p < .01). Higher mindfulness was significantly correlated with lower depressive symptoms, social constraints, household chaos, sleep disturbances, childhood trauma, life stressors, and chronic mental, and physical health conditions (p's < .01 except physical health p < .05). Conclusions/Relevance: The sample had higher CAMS-R scores compared to central tendency scores in broader populations. The high scores may indicate an amenable characteristic of mindfulness that could be trained for interventions. Yet, more research is needed on feasibility/acceptability in this population. Higher mindfulness is inversely related to many negative health and psychosocial factors which are known barriers to cessation, as well as positively related to social support, an important facilitator of cessation. The interplay between social support and mindfulness should be explored, as each is theorized as a “stress buffer.” research should investigate psychosocial factors as potential mediators in mindfulness interventions for smoking cessation targeting vulnerable female smokers.
... 17,18 Most adult smokers are motivated to quit. 19 However, low-income and racial minority smokers who initiate cessation demonstrate lower quit rates [19][20][21] than the overall population because they face more barriers to access and uptake of evidencebased treatments and confront more challenges to quitting. 22 -24 Because such challenges exist, underserved families could benefit from harm-reduction approaches that immediately address child TSE while continuing to encourage smoking cessation rather than focusing entirely on smoking cessation. ...
Article
Background: Provider adherence to best practice guidelines (ask, advise, refer [AAR]) for addressing child tobacco smoke exposure (TSE) motivates parents to reduce TSE. However, high-risk, vulnerable populations of smokers may require more intensive treatment. We hypothesized that a pragmatic, multilevel treatment model including AAR coupled with individualized, telephone-based behavioral counseling promoting child TSE reduction would demonstrate greater child TSE reduction than would standard AAR. Methods: In this 2-arm randomized controlled trial, we trained pediatric providers in systems serving low-income communities to improve AAR adherence by using decision aid prompts embedded in routine electronic health record assessments. Providers faxed referrals to the study and received ongoing AAR adherence feedback. Referred participants were eligible if they were daily smokers, >17 years old, and spoke English. Participants were randomly assigned to telephone-based behavioral counseling (AAR and counseling) or nutrition education (AAR and attention control). Participants completed prerandomization and 3-month follow-up assessments. Results: Of providers, >80% (n = 334) adhered to AAR procedures and faxed 2949 referrals. Participants (n = 327) were 83% women, 83% African American, and 79% low income (below poverty level). Intention-to-treat logistic regression showed robust, positive treatment effects: more parents in AAR and counseling than in AAR and attention control eliminated all sources of TSE (45.8% vs 29.9%; odds ratio 1.99 [95% confidence interval 1.44-2.74]) and quit smoking (28.2% vs 8.2%; odds ratio 3.78 [95% confidence interval 1.51-9.52]). Conclusions: The results indicate that the integration of clinic- and individual-level smoking interventions produces improved TSE and cessation outcomes relative to standalone clinic AAR intervention. Moreover, this study was among the first in which researchers demonstrated success in embedding AAR decision aids into electronic health records and seamlessly facilitated TSE intervention into routine clinic practice.
... Our encouraging results and similar between-group attrition rates suggests that our approach was acceptable, feasible, and potentially efficacious in promoting physical activity in a low-income, underserved population known to have low intervention uptake and less successful response to physical activity and smoking interventions than the general population-major contributors to health disparities [57][58][59][60][61]. A review of counseling treatments in low-income populations underscored the need to establish enhanced interventions for this high-risk group, including more effective telephone-based counseling services (e.g., quitlines) [62]. ...
Article
Smoking and physical inactivity contribute to disproportionate disease burden among underserved adults. Telephone-based interventions (quitlines) are becoming the standard care for addressing smoking. There is increasing interest to determine whether quitlines can be utilized to administer interventions for other unhealthy behaviors. This study aims to examine the proof-ofconcept and potential efficacy of a telephone-based behavioral counseling intervention to boost daily low-tomoderate physical activity among low-income, physically inactive smokers. Participants (N = 101) were randomized to receive 4 weeks of counseling prior to their smoking quit day that included either standard smoking cessation counseling (control) or the Step-up to Quit (SUTQ) intervention. SUTQ promoted daily walking to foster physical activity as a primary smoking urge management strategy and facilitate incremental increases in daily steps with the goal of achieving 7500 steps/day by the quit day in week 4. Exploratory structural equation modeling tested SUTQ effects on six measures of low-tomoderate physical activity (primary outcome) and smoking cue reactivity (secondary outcome) simultaneously in a single multivariate model with controlling variables. The sample was 51%female and 77%African- American, with a mean age of 42.1 years (SD = 10.9). Compared to the control condition, SUTQ intervention was associated with greater physical activity at week 4 (b = 0.51, z = 1.71, p = 0.08), with between-group differences sustained at follow-up. At week 4, the SUTQ group had higher 7-day mean steps/day (M = 7,207.25, SD = 4,276.03) than controls (M = 3,947.03, SD = 3,655.03) (t = 3.35; p < .01); and had more participants reach the >7500 steps/day goal (49% vs. 11 %, c2 = 10.78; p < .01), a difference that was sustained at 1-month follow-up (X2 = 9.04, p < .01) Effects of SUTQ treatment on cue reactivity were in the hypothesized direction but not significant (b = −0.29; z = −1.09, p = 0.27). To our knowledge, this is the first study to promote physical activity using telephone counseling in an underserved population of smokers known to have greater challenges with physical activity adoption and smoking cessation. The SUTQ approach suggests that integration of physical activity advice and support within the context of smoking cessation treatment has the potential to promote physical activity among smokers intending to quit
... Our encouraging results and similar between-group attrition rates suggests that our approach was acceptable, feasible, and potentially efficacious in promoting physical activity in a low-income, underserved population known to have low intervention uptake and less successful response to physical activity and smoking interventions than the general population-major contributors to health disparities [57][58][59][60][61]. A review of counseling treatments in low-income populations underscored the need to establish enhanced interventions for this high-risk group, including more effective telephone-based counseling services (e.g., quitlines) [62]. ...
Article
Smoking and physical inactivity contribute to disproportionate disease burden among underserved adults. Telephone-based interventions (quitlines) are becoming the standard care for addressing smoking. There is increasing interest to determine whether quitlines can be utilized to administer interventions for other unhealthy behaviors. This study aims to examine the proof-of-concept and potential efficacy of a telephone-based behavioral counseling intervention to boost daily low-to-moderate physical activity among low-income, physically inactive smokers. Participants (N = 101) were randomized to receive 4 weeks of counseling prior to their smoking quit day that included either standard smoking cessation counseling (control) or the Step-up to Quit (SUTQ) intervention. SUTQ promoted daily walking to foster physical activity as a primary smoking urge management strategy and facilitate incremental increases in daily steps with the goal of achieving 7500 steps/day by the quit day in week 4. Exploratory structural equation modeling tested SUTQ effects on six measures of low-to-moderate physical activity (primary outcome) and smoking cue reactivity (secondary outcome) simultaneously in a single multivariate model with controlling variables. The sample was 51 % female and 77 % African-American, with a mean age of 42.1 years (SD = 10.9). Compared to the control condition, SUTQ intervention was associated with greater physical activity at week 4 (b = 0.51, z = 1.71, p = 0.08), with between-group differences sustained at follow-up. At week 4, the SUTQ group had higher 7-day mean steps/day (M = 7,207.25, SD = 4,276.03) than controls (M = 3,947.03, SD = 3,655.03) (t = 3.35; p < .01); and had more participants reach the >7500 steps/day goal (49% vs. 11 %, c2 = 10.78; p < .01), a difference that was sustained at 1-month follow-up (X2 = 9.04, p < .01) Effects of SUTQ treatment on cue reactivity were in the hypothesized direction but not significant (b = −0.29; z = −1.09, p = 0.27). To our knowledge, this is the first study to promote physical activity using telephone counseling in an underserved population of smokers known to have greater challenges with physical activity adoption and smoking cessation. The SUTQ approach suggests that integration of physical activity advice and support within the context of smoking cessation treatment has the potential to promote physical activity among smokers intending to quit.
Article
The current study examined the impact of health versus economic content, as well as gain versus loss frame, in smoking cessation intervention messages on intention, motivation, and planning to quit smoking. Gender, race, Socioeconomic Status (SES), nicotine dependence, and smoker identity variables were investigated as moderators of the relationship between message content and outcomes. Self-identified smokers were randomly assigned to read a gain or loss framed message with economic or health content. Intention, motivation, and planning to quit smoking were measured before and after message exposure. Results showed average gains in intention, motivation, and planning to quit smoking, regardless of message received. However, change in motivation and intention was greater for participants exposed to the economic message. There were no effects of message frame. Years of smoking and race moderated the effects of message content on intention and motivation. Implications for developing tailored messages for smoking cessation in young adults are discussed.
Article
As countries implement Article 11 of the World Health Organization (WHO) Framework Convention on Tobacco Control, graphic warning labels that use images of people and their body parts to illustrate the consequences of smoking are being added to cigarette packs. According to exemplification theory, these case examples-exemplars-can shape perceptions about risk and may resonate differently among demographic subpopulations. Drawing on data from eight focus groups (N = 63) with smokers and nonsmokers from vulnerable populations, this qualitative study explores whether people considered exemplars in their reactions to and evaluations of U.S. graphic health warning labels initially proposed by the Food and Drug Administration. Participants made reference to prior and concurrent mass media messages and exemplars during the focus groups and used demographic cues in making sense of the images on the warning labels. Participants were particularly sensitive to age of the exemplars and how it might affect label effectiveness and beliefs about smoking. Race and socioeconomic status also were salient for some participants. We recommend that exemplars and exemplification be considered when selecting and evaluating graphic health warnings for tobacco labels and associated media campaigns.
Article
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The rationale for targeted and tailored substance use prevention programs derives from essentially three observations: 1) differences in substance use prevalence rates across racial/ethnic groups; 2) differences in the prevalence of the risk factors for substance use across racial/ethnic groups; and 3) differences in the predictors of substance use across groups. This article provides a model for understanding cultural sensitivity as it pertains to substance use prevention. Cultural sensitivity is defined by two dimensions, surface and deep structure. Surface structure involves matching intervention materials and messages to observable, “superficial” characteristics of a target population. This may involve using people, places, language, product brands, music, food, locations, and clothing familiar to, and preferred by, the target audience. Surface structure refers to how well interventions fit within a specific culture. Deep structure involves incorporating the cultural, social, historical, environmental, and psychologic forces that influence the target health behavior in the proposed target population. For example, peer influences may exert a greater influence on substance use initiation among White and Hispanic than among African American youth, while parental influences may be stronger among African Americans. Whereas surface structure generally increases the "receptivity" or "acceptance" of messages, deep structure conveys salience. Techniques for developing culturally sensitive interventions, borrowed from social marketing and health communication theory, are described. © 2000 John Wiley & Sons, Inc.
Article
Cigarette smoking remains the leading cause of preventable morbidity and mortality in the United States. Despite overall declines in cigarette smoking, a high prevalence of smoking persists among certain subpopulations, including persons with mental illness. Combined data from the 2009-2011 National Survey on Drug Use and Health (NSDUH) were used to calculate national and state estimates of cigarette smoking among adults aged ≥18 years who had any mental illness (AMI), defined as having a mental, behavioral, or emotional disorder, excluding developmental and substance use disorders, in the past 12 months. During 2009-2011, an annual average of 19.9% of adults aged ≥18 years had AMI; among these persons, 36.1% were current smokers, compared with 21.4 % among adults with no mental illness. Smoking prevalence among those with AMI was highest among men, adults aged <45 years, and those living below the poverty level; smoking prevalence was lowest among college graduates. During 2009-2011, adults with AMI smoked 30.9% of all cigarettes smoked by adults. By U.S. region, smoking prevalence among those with AMI was lowest in the West (31.5%) and Northeast (34.7%) and highest in the Midwest (39.1%) and South (37.8%), with state prevalence ranging from 18.2% (Utah) to 48.7% (West Virginia). The prevalence of cigarette smoking is high among adults with AMI, especially for younger adults, those with low levels of education, and those living below the poverty level; the prevalence varies by U.S. region. Increased awareness about the high prevalence of cigarette smoking among persons with mental illness is needed to enhance efforts to reduce smoking in this population. Proven population-based prevention strategies should be extended to persons with mental illness, including implementing tobacco-free campus policies in mental health facilities. Primary care and mental health-care providers should routinely screen patients for tobacco use and offer evidence-based cessation treatments. Given that persons with mental illness are at risk for multiple adverse behavioral and health outcomes, tobacco cessation will have substantial benefits, including a reduction in excess morbidity and mortality attributed to tobacco use.
Article
The 1998 Surgeon General's report, Tobacco Use Among U.S. Racial/Ethnic Minority Groups, addressed diverse tobacco-control needs of the four primary U.S. racial/ethnic minority populations: non-Hispanic blacks, American Indians/Alaska Natives (AI/ANs), Asians/Pacific Islanders, and Hispanics. However, data on these populations do not describe differences in tobacco-use prevalence among subsets of these populations. To assess the prevalence of cigarette smoking among persons aged > or =12 years among 14 racial/ethnic populations in the United States, CDC analyzed self-reported data collected during 1999-2001 from the National Survey on Drug Use and Health (NSDUH) (formerly the National Household Survey on Drug Abuse). This report summarizes the results of that analysis, which indicated that the prevalence of cigarette smoking among adults aged > or =18 years ranged from 40.4% for AI/ANs to 12.3% for the Chinese population, and the prevalence among youths aged 12-17 years ranged from 27.9% for AI/ANs to 5.2% for the Japanese population. Implementing tobacco-control programs that include culturally appropriate interventions can help reduce tobacco use among racial/ethnic populations.
Article
OBJECTIVE: To determine if hypothesized differences in attitudes and beliefs about cigarette smoking between Latino and non-Latino white smokers are independent of years of formal education and number of cigarettes smoked per day. DESIGN: Cross-sectional survey using a random digit dial telephone method. SETTING: San Francisco census tracts with at least 10% Latinos in the 1990 Census. PARTICIPANTS: Three hundred twelve Latinos (198 men and 114 women) and 354 non-Latino whites (186 men and 168 women), 18 to 65 years of age, who were current cigarette smokers participated. MEASUREMENTS AND MAIN RESULTS: Self-reports of cigarette smoking behavior, antecedents to smoking, reasons to quit smoking, and reasons to continue smoking were the measures. Latino smokers were younger (36.6 vs 39.6 years, p<.01), had fewer years of education (11.0 vs 14.3 years, p<.001), and smoked on average fewer cigarettes per day (9.7 vs 20.1, p<.001). Compared with whites, Latino smokers were less likely to report smoking “almost always or often” after 13 of 17 antecedents (each p<.001), and more likely to consider it important to quit for 12 of 15 reasons (each p<.001). In multivariate analyses after adjusting for gender, age, education, income, and number of cigarettes smoked per day, Latino ethnicity was a significant predictor of being less likely to smoke while talking on the telephone (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.26, 0.64), drinking alcoholic beverages (OR 0.66; 95% CI 0.44, 0.99), after eating (OR 0.55, 95% CI 0.37, 0.81), or at a bar (OR 0.62, 95% CI 0.41, 0.94), and a significant predictor of being more likely to smoke at a party (OR 1.72; 95% CI 1.14, 2.60). Latino ethnicity was a significant predictor of considering quitting important because of being criticized by family (OR 1.93; 95% CI 1.26, 2.98), burning clothes (OR 1.57; 95% CI 1.02, 2.42), damaging children’s health (OR 1.67; 95% CI 1.08, 2.57), bad breath (OR 2.07; 95% CI 1.40, 3.06), family pressure (OR 1.67; 95% CI 1.10, 2.60), and being a good example to children (OR 1.83; 95% CI 1.21, 2.76). CONCLUSIONS: Differences in attitudes and beliefs about cigarette smoking between Latinos and whites are independent of education and number of cigarettes smoked. We recommend that these ethnic differences be incorporated into smoking cessation interventions for Latino smokers.
Article
OBJECTIVE: We conducted this study to determine if a smoking status stamp would prompt physicians to increase the number of times they ask, advise, assist, and arrange follow-up for African-American patients about smoking-related issues. DESIGN: An intervention study with a posttest assessment (after the physician visit) conducted over four 1-month blocks. The control period was the first 2 weeks of each month, while the following 2 weeks served as the intervention period. SETTING: An adult walk-in clinic in a large inner-city hospital. PARTICIPANTS: We consecutively enrolled into the study 2,595 African-American patients (1,229 intervention and 1,366 control subjects) seen by a housestaff physician. INTERVENTIONS: A smoking status stamp placed on clinic charts during the intervention period. MAIN RESULTS: Forty-five housestaff rotated through the clinic in 1-month blocks. In univariate analyses, patients were significantly more likely to be asked by their physicians if they smoke cigarettes during the intervention compared with the control period, 78.4% versus 45.6% (odds ratio [OR] 4.28; 95% confidence interval [CI] 3.58, 5.10). Patients were also more likely to be told by their physician to quit, 39.9% versus 26.9% (OR 1.81; 95% CI 1.36, 2.40), and have follow-up arranged, 12.3% versus 6.2% (OR 2.16; 95% CI 1.30, 3.38). CONCLUSIONS: The stamp had a significant effect on increasing rates of asking about cigarette smoking, telling patients to quit, and arranging follow-up for smoking cessation. However, the stamp did not improve the low rate at which physicians offered patients specific advice on how to quit or in setting a quit date.
Article
Tested a 7-month, media-based, community intervention among Hispanics in San Francisco designed to change levels of information on the damaging effects of cigarette smoking and on the availability of culturally appropriate cessation services. Three community-wide surveys of Hispanics were conducted with independent random samples, two as baselines (n = 1,660 and 2,053) and one postintervention (n = 1,965). Results showed that changes in the level of awareness of cessation services had taken place after implementation of the intervention. Furthermore, those changes took place primarily among the less acculturated Spanish-speaking Hispanics who were the target of the intervention. The changes in information reported here demonstrate that a culturally appropriate information dissemination campaign that utilizes multiple channels can produce changes in a community's level of information even when the campaign is implemented for a relatively short period.
Article
This article provides an overview of the contribution of sociologists to the study of racial and ethnic inequalities in health in the United States. It argues that sociologists have made four principal contributions. First, they have challenged and problematized the biological understanding of race. Second, they have emphasized the primacy of social structure and context as determinants of racial differences in disease. Third, they have contributed to our understanding of the multiple ways in which racism affects health. Finally, sociologists have enhanced our understanding of the ways in which migration history and status can affect health. Sociological insights on racial disparities in health have important implications for the development of effective approaches to improve health and reduce health inequities.