Latinos and Tobacco Annotated Bibliography: 1991 to 2006* Draft

Robert Durán, Ph.D.
Robert Muñoz, Ph.D.
Estevan Flores, Ph.D.

Latino/a Research and Policy Center
University of Colorado at Denver and Health Sciences Center

June 27, 2006

* This bibliography is work conducted as part of a contract from the Colorado Department of Public Health and Environment’s State Tobacco Education and Prevention Partnership (STEPP) program. The project is called the Latino Statewide Tobacco Prevention and Education Network (LSTPEN) and is directed by Estevan Flores, Ph.D.; the project manager is Robert Muñoz, Ph.D.

THE LATINO/A RESEARCH AND POLICY CENTER 
(LRPC)
LSTPEN Project

The Latino/a Research & Policy Center (LRPC) is an organized research unit of the University of Colorado at Denver and Health Sciences Center. The LRPC is a "think tank" that uses community based participation in its work. The LRPC is creating a “Latino Statewide Tobacco Prevention and Education Network? (LSTPEN), in 5 regions of the state covering 26 counties, where 95% of Colorado Latinos reside. This work is part of a contract from the Colorado Department of Public Health and Environment’s State Tobacco Education and Prevention Partnership (STEPP) program.

THIS ANNOTATED BIBLIOGRAPHY
This bibliography is part of the LSTPEN project and includes 134 references to research articles on Latinos and tobacco from 1991 to 2006. The references are listed in alphabetical chronological order. Articles were gathered using Medline (FirstSearch) using the following search categories “Hispanic/Latino/Mexican? and a variety of tobacco topics relating to cessation, community organizations, and promotoras. This annotated bibliography is not an exhaustive list of research articles relating to Latinos and tobacco. There were several research articles that could not be obtained using Medline due to the University of Colorado at Denver not subscribing to a number of journals or the electronic download version being unavailable.

LSTPEN AND THE COLORADO FRONT RANGE COMMUNITY NETWORKThe LSTPEN will interface and in some cases, meet and work with the newly established “Colorado Front Range Latino Community Network,? an NCI funded 5 year LRPC project (2005-10) in 11 Front Range counties. The LSTPEN provides the infrastructure for establishing the fight against big tobacco in Colorado counties where most Latinos live.

THE SURVEY
The LRPC will conduct a statewide survey of adult Hispanic and Anglo smokers to develop more effective, tailored smoking cessation interventions. We will conduct a survey in the five designated Colorado Network areas (26 counties), targeting census units with high proportions of Latinos for an N of 1,000 Hispanics and a comparison group of 500 adult white non-Hispanics. Our survey instrument will address: 1) smoking history and relevant sociodemography, 2) experience of prior cessation-related interventions by health care providers, 3) experience with the most effective cessation interventions, and 4) culturally-specific attitudes and beliefs relevant to nicotine addiction and its treatment.

LSTPEN NETWORKThe Network will consist of some 25 community based organizations. A Steering Committee (SC) of 12 members will guide the work of the Network. We are currently 1) establishing the Network as a functioning and stable organization and 2) developing an email list serve and a Network “resource guide.?

Balcazar, Hector, Matilde Alvarado, Mary Luna Hollen, Yanira Gonzalez-Cruz,
Odelinda Hughes, Esperanza Vasquez, and Kristine Lykens. 2006. “Salud Para Su Corazon-NCLR: A Comprehensive Promotora Outreach Program to Promote Heat-Healthy Behaviors Among Hispanics.? Health Promotion Practice 7:68-77.

This article describes results of year-1 implementation of the Salud Para Su Corazon promotora health program. There were 29 trained promotoras who served 188 families in Escondido, CA; Chicago, IL; and Ojo Caliente, NM. Promotoras had at least high school education and preferred speaking Spanish. A lead promotora trained others and involved a 32 hour training at NCLR headquarters, 18 hours of training by lead promotoras to local teams of promotoras with the “Your Heart, Your Life? curriculum, a 2-day training to promotoras at the National Promotoras Conference conducted by lead promotoras, participation in promotora training activities and continuing education at NCLR National Conference, and participation in monthly telephone calls. Total hours of training in three sites: 186; Family program delivery hours in three sites: 2,311; Community event hours in three sites: 136; Total promotora hours: 3,064. Communities grant: $33,000. Program cost per promotora hour: $10.77.

Findings: Promotora approach worked based on evidence obtained from the following indicators: changes in promotora’s pre-post knowledge and performance skills, progress toward their pledge goals following training, recruiting and teaching families, providing follow-up, and organizing or participating in community events. Trained promotoras can engage Latino families in a health education program and identify CVD risk factors for participating families. Researchers evaluated the extent to which pledges were fulfilled by the end of year-1 of the project implementation phase. The pledge to conduct follow-up activities yielded very good results in two communities (Chicago 79 families) and Espanola (60 families)-achieving a 100 percent follow-up success rate (41 out of 49 families). Pretest-and post test were obtained for one site that showed 74 percent score on pre-test and 100 percent score on post-test therefore they significantly improved their performance their performance after 1 year. The promotoras pledged to teach 50% of seven session of the “Your Health, Your Life? curriculum. Chicago reported implementation rates of 50 percent, Escondido reported 100 percent, New Mexico reported 100 percent implementation of all seven sessions. An assessment of CVD risk factors was conducted by promotoras and recorded for each of the 188 participating families. Participants praised the promotoras from the Salud Para Su Corazon program for their teaching and for showing them how to incorporate health education into their daily lives.

Caraballo, Ralph S., Sue Lin Yee, Joseph C. Gfroerer, Terry F. Pechacek, and Rosemarie Henson. 2006. “Tobacco Use Among Racial and Ethnic Population Subgroups of Adolescents in the United States.?  Preventing Chronic Disease. Public Health Research, Practice, and Policy. Center for Disease Control and Prevention 3:1-12.

“The objective of this study was to evaluate cigarette smoking among U.S. youths by racial and ethnic subgroups. The study used a nationally representative sample of youths aged 12 to 17 years who participated in the National Survey on Drug Use and Health in 1999, 2000, or 2001. Outcomes measured include prevalence of cigarette smoking, mean age of smoking initiation, and susceptibility to start smoking (p. 1).?  There was a total sample size of 74,207 whom were equally divided by gender. There were 10,275 Latinos in the sample.

Findings: The percentage of current smokers between the ages of 12 to 17 went in this order: American Indian (27.9 percent), White (16.0 percent), Latino (10.8 percent), Asian (8.1 percent), and Black (7.0 percent). The overall mean age to begin smoking for all racial and ethnic groups was 12.3 years of age and for Latinos specifically it was 12.5 years of age with boys starting a little younger than girls (12.3 vs. 12.6). The rate of previous smoking went in this order: American Indian (29.4 percent), White (22.2 percent), Hispanic (21.3 percent), Black (18.3 percent), and Asian (15.6 percent).

Caraballo, R S, LL Pederson, and N Gupta. 2006. “New Tobacco Products: do Smokers Like Them??  Tobacco Control 15:39-44.

The objective of this study was to determine what people thought about products such as Eclipse, Omini, Advance Lights, Accord, or Ariva. In October of 2002, the researchers developed 16 focus group sessions with current smokers aged 30-50 years of age in Chattanooga, Tennessee, and Dallas, Texas. Specific focus groups were determined by gender and race and ethnicity.  Groups were conducted by trained female moderators who were similar in age and race.  

Findings: “The majority of participants learned about PREPs (Potentially Reduced Exposure Products) through advertising or promotion, family, friends, and co-workers; major reasons given for first trying PREP’s were that the products were free or inexpensive, they wanted to stop smoking, they believed the product claims of fewer health risks, or they were curious; most of them tried Eclipse probably because the focus groups were conducted in the cities where Eclipse was introduced; most participants did not like PREPs; most discontinued the use of PREPS, some who continued to use them did so infrequently and also kept smoking their regular brands of cigarettes; and most would not recommend PREPs, although a few might recommend them to specific groups (for example, new smokers, the young, women, curious or health conscious people)? (p. 39). Some people said the PREPS were so bad that they wanted to smoke more than they had before.    

Conway, T L., S I Woodruff, CC Edwards, M F Hovell, and J Klein. 2006. “Intervention to Reduce Environmental Tobacco Smoke Exposure in Latino Children: Null Effects on Hair Biomarkers and Parent Reports.? Tobacco Control 13:90-92

The purpose of this study was to evaluate the effectiveness of a lay delivered intervention to reduce Latino children’s exposure to environmental tobacco smoke. Efforts were directed to an adult member of the household who had a child between the ages of 1-9 years of age and reported exposing their child to at least six cigarettes a week. Eligible participants were randomly assigned either to an intervention group or to the measurement only control group. Six home and telephone sessions were delivered by promotoras over a four month period.

Findings: Participants were 143 Spanish speaking Latino adults and their children. The random assignment resulted in 71 participants in the intervention group and 72 in the control group. Most adults were mothers and averaged 33 years of age who had low incomes and had obtained their education in Mexico. Applying a lay promotora model to deliver the behavioral problem solving intervention was not effective. The researchers think this occurred because the promotoras were not trained in behavior change theory and research methods. The researchers believe that the four week, 20 hour, training course was not enough. They also thought that it may be because the research protocol may have constrained promotoras interactions with participants.

Daza, Patricia, Ludmila Cofta-Woerpel, Carlos Mazas, Rachel T. Fouladi, Paul M. Cinciripini, Ellen R. Gritz, and David W. Wetter. 2006. “Racial and Ethnic Differences in Predictors of Smoking Cessation.? Substance Use and Misuse 41:317-339.

The current study examined racial/ethnic differences in smoking cessation, prospective predictors of cessation, and whether the predictive ability of these factors differed by race/ethnicity. Participants were 709 employed adults recruited though the National Rural Electric Co-op Association or through natural gas pipeline corporation. Data was collected in 1990 and 1994.

Findings: Race/ethnicity was not predictive of abstinence but rather for differential tobacco and work related variables. These finding were thought to be due to lower socioeconomic status and blue-collar occupations. Latinos smoked fewer cigarettes per day and waited longer for their fist cigarette. Latinos and African Americans are more likely to abstain from smoking, but not as likely to successfully quit smoking. However, there were only 34 Latinos in this study. 

Hu, Mei-Chen, Mark Davies, and Denise B. Kandel. 2006. “Epidemiology and Correlates of Daily Smoking and Nicotine Dependence Among Young Adults in the United States.?  American Journal of Public Health 96:299-308.

The authors describe “the epidemiology of smoking behaviors in a national young adults sample and identify common and unique demographic, social, and psychological correlates of daily smoking and lifetime and current nicotine dependence by race/ethnicity (p. 299). Data was obtained by the National Longitudinal Survey of Adolescent Health that was conducted in 1994-1995 on a nationally representative sample of 90,118 adolescents in grades 7-12. The authors analyzed a total of 14,202 cases.

Findings: African Americans were the least likely to initiate smoking or to smoke a whole cigarette whereas American Indians and Whites were most likely. Latinos were the least likely to be daily smokers and be dependent on nicotine. African Americans and American Indians had the highest rate of current dependence. Education had a strong negative association with daily smoking. Latinos with a high school degree were more likely to smoke as were both parents smoking and friends smoking. Pleasant sensations were the reasons given for smoking.

Larkey, Linda. 2006. “Las Mujeres Saludables: Reaching Latinas for Breast, Cervical and Colorectal Cancer Prevention and Screening.? Journal of Community Health 31:69-77.

Researchers implemented 12-week program that educated 366 Latinas in breast, cervical and colorectal cancer prevention and screening and emphasized social support among class members. Three month community based intervention was implemented using a standard Promotora-led community classroom format. Three Latina community health advisors, or Promotoras de Salud, assisted in developing curricula for five cancer prevention and screening objects. Promotoras utilized networks of contacts in churches and community centers to promote the program and recruit women from underserved areas of the greater Phoenix metropolitan area. 457 women started in the program and 366 completed the class and completed full post-intervention survey. 

Findings: For evaluation of the outcomes of the intervention, baseline information was gathered on each woman as she entered the program and follow-up assessments were conducted at the end of the sessions. Chi-square tests were run for each screening to examine potential effects of health insurance coverage. Pre-and post-intervention assessments demonstrated significant increases for fruit and vegetable consumption (3.05 to 3.60 servings/day) and physical activity (65.15 to 122.40 minutes/week). Forty-two percent of the women in the study who were over age 40 had never received mammography screening. By the end of the program 30.6 percent of these women were screened.

Leslie, Jennie C., Sandra J. Diehl, and Shelley L. Galvin. 2006. “A Comparison of Birth Outcomes Among US-Born and non-US-Born Hispanic Women in North Carolina.?  Maternal and Child Health Journal 10:33-38.

The goal was to compare birth outcomes between non-US born and US-born Latina women in North Carolina by using birth/death certificate data from 1993 to 1997. This data conducted included 22,234 births identified as “Hispanic? by mother’s place of birth. “The majority, 58%, were born in Mexico, 21% in the US and District of Columbia, 3% in Puerto Rico, 0.7% in Cuba, and 17% in other, unidentified countries? (p. 34). The US born women more likely came from Texas (24%), New York (18%), California (14%), North Carolina (9%), and Florida (6%).  

Findings: “Mexico-born Hispanic women (58%) had significantly fewer medical risks, tobacco or alcohol use during pregnancy; however, they also had significantly less education and prenatal care than US-born Hispanic women (21%)? (p. 33). US born women were 10-times greater for daily tobacco use and 7-times greater for weekly alcohol use. US born women are more likely to lose children to Sudden Infant Death Syndrome than foreign born women.   

Madan, Ashima, Latha Palaniappan, Guido Urizar, Yun Wang, Stephen P. Fortmann, Jeffrey B. Gould. 2006. “Socicultural Factors that Affect Pregnancy Outcomes in Two Dissimilar Immigrant Groups in the United States.? Journal of Pediatrics 148:341-6.

The authors’ objective was “to compare perinatal risks and outcomes in foreign- and U.S. born Asian-Indian and Mexican women? (p. 341). The researchers evaluated 6.4 million U.S. vital records for births during 1995-2000.

Findings:  21.9 percent of the 6.4 million births were to foreign born Mexican and 14.5 percent to U.S. born Mexicans. Alcohol and tobacco use was higher for U.S. born Mexican women than foreign born Mexican women (odds ratio 2.08 vs. 1.65). U.S. born Mexican women did however have a better sociodemographic risk profile, greater number of college graduates, and access to prenatal care. Foreign born women have good perinatal outcomes (compared to white women), but this decreases with subsequent generations in the U.S.

Martinez-Bristow, Zuzanne Sias, J. Jeri. 2006. “Tobacco Cessation Services through Community Health Workers for Spanish-Speaking Populations.? American Journal of Public Health 96:211-213.

Partnership established between University of Arizona to train promotores as tobacco cessation counselors. The project certified 89 participants of whom 95 percent were promotores: 88 percent were Latino, 67 percent were women, and 62 percent spoke Spanish as their primary language.

Findings: Participants understood training material. The training courses were easily accessible and free of change, which helped, and the program accommodated different schedules. [This research article provided little additional information].

Tong, Elisa K. Michael K. Ong, Eric Vittinghoff, Eliseo J. Pérez-Stable. 2006. “Nondaily Smokers Should Be Asked and Advised to Quit.? American Journal of Preventive Medicine 30:23-30.

Researchers analyzed the 2000 National Health Interview Survey in 2004 with multivariate logistic regression. The sample included interviews with 32,374 adults aged over 18 years with a 72 percent response rate. Data included 1,422 nondaily smokers, 5,999 daily smokers, and 17,567 people who never smoked.

Findings: About one in five current smokers was a nondaily smoker. The number of cigarettes smoked averaged 80 cigarettes (four packs) per month or less. Compared to daily and never smokers, nondaily smokers were more likely to be aged <45 years, ethnic minorities, and single. Nondaily smokers drink alcohol more frequently than both daily and never smokers, but report better health than daily smokers. Latino nondaily smokers and higher educated smokers were less likely than whites to want to quit within six months.

Zhu S-H, Q B Nguyen, S Cummins, S Wong and V Wightman. 2006. “Non-smokers Seeking Help for Smokers: a Preliminary Study.?  Tobacco Control 15:107-13.

The researchers’ goal was to examine how non smokers take action to seek help for smokers by language and ethnic groups. The people selected were callers to California’s tobacco quit line between August 1992 and September 2005 who identified themselves as either white, black, Hispanic, American Indian, or Asian (n=349,110) and acting as a proxy (calling for someone else). Only 3.9 percent of the total did not identify as a racial/ethnic group and they were excluded from the study. 

Findings: Over 22,000 non-smoking proxies called the California tobacco quit line between August 1992 and September 2005. “Proportions differed dramatically across language/ethnic groups, from mean 2.7 (0.3%) among English-speaking American Indians through 9.3 (0.3 %) among English-speaking Hispanics to 35.3 (0.7 %) among Asian-speaking Asians? (p. 107). The lowest numbers of proxies were English Speaking American Indians (3 percent) to a high of Asian speaking Asians (35 percent). “Proxies were primarily women (79.2%), living in the same household as the smokers (65.0%), and having either explicit or implicit understandings with the smokers that calling on their behalf was acceptable (90.0%)? (p. 107). The majority of Hispanic proxies were female (English Speaking Hispanics (ESH) 77.6 percent and Spanish Speaking Hispanics (SSH) (81.8 percent), between the ages of 25-44 (ESH 42.3 percent and SSH 62.4 percent), spouse (ESH 48 percent and SSH 53.8 percent), living in the same household (ESH 70.4 percent and 74.6 percent SSH), and previously never smoking (ESH 78.7 percent and SSH 84.1 percent). The authors believe that the more collectivist the culture the more likely a proxy will be used. They also propose that the higher percentage of women non-smokers increases the chance of seeking help for someone else. Limitations include self-report. Policy should focus on the role woman play in promoting the non use of tobacco.

Balcazar, Hector, Matilde Alvarado, Mary Luna Hollen, Yanira Gonzalez-Cruz, and Veronica Pedregon. 2005. “Evaluation of Salud Para Su Corazón (Health for Your Heart) – National Council of La Raza Promotora Outreach Program.? Preventing Chronic Disease 2:AO9:1-9.

National Heart, Lung, and Blood Institute partnered with the National Council of La Raza to conduct a pilot test of its community based outreach program. The evaluation consisted of analyzing data collected from 33 promotores and 223 families for a total of 320 individuals across seven Latino communities. Most promotoras were women and between the ages of 20 to 67 with the average age being 41. Most promotores were bilingual and had worked as lay health educators before. 

Findings: The community outreach model worked well in the seven pilot programs because of the success of the promotores and the support of the community based organizations. The ability of promotores to effect behavioral change is evident among the families they served. Families showed an improvement of 18 percent on self-reported heart healthy behaviors. Ninety-six percent of the 223 families were satisfied with the program 

Behrendt, Carolyn E. 2005. “Mild and Moderate-to-severe COPD in Nonsmokers: Distinct Demographic Profiles.?  Chest 128:1239-1245.

This study examined people who were white, black, or Mexican American between the ages of 18 to 80 years who were never-smokers or former smokers with a <5 pack-year smoking history who did not smoke cigars or pipes. The authors were interested in analyzing COPD which refers to chronic bronchitis, emphysema, and the subset of asthma characterized by irreversible or partly reversible airflow obstruction. The data was obtained from the Third National Health and Nutrition Examination Survey that was conducted from 1988 to 1994 by using a case-control study and logistic regression analysis.

Findings:  “According to the current study, nonsmokers account for one fourth (24.9 [+ or -} 1.4%) of COPD cases in the United States? (p. 5). Exposure to smoke occurred at home or workplace.

Bock, Beth C., Raymond S. Niaura, Charles J. Neighbors, Rosa Carmona-Barros, Munawar Azam. 2005. “Differences between Latino and non-Latino White Smokers in Cognitive and Behavioral Characteristics Relevant to Smoking Cessation.? Addictive Behaviors 30:711-724.

Adult smokers were recruited during routine health care visits at primary care clinics located in three urban hospitals and were given a brief intervention and nicotine replacement therapy. Analyses compared bicultural (BC: n=60) or less acculturated (LA: n=138) Latinos and non-Latino White (NL: n=417) participants. Language fluency is well correlated with more extensive measures of acculturation. 

Findings: Both Latino groups were more similar to each other and significantly different from non-Latino White (NL) subjects in smoking rate and nicotine dependence. Bicultural (BC) and less acculturated (LA) subjects differed significantly from NL subjected in perceived benefits of quitting, perceived risk from smoking, and negative affect smoking. LA subjects had higher cessation rates than either BC or NL groups. LA were less likely than BC to report smoking in response to negative moods despite having slightly higher depression symptoms. “That is, characteristics that have been shown to be predictive of successful cessation in primarily White, non-Latino populations may not be predictive of cessation among Latinos, or may be differentially predictive between Latino subgroups based on acculturation, gender, country of origin, or other factors (p. 721).? Familism and Simpatia are cultural values that need to be incorporated when planning intervention. In this study, motivation to quit smoking was associated with having more children at home.    

Brook, Judith S., Elinor B. Balka, Zohn Rosen, David W. Brook, and Richard Adams. 2005. “Tobacco Use in Adolescence: Longitudinal Links to Later Problem Behavior Among African American and Puerto Rican Urban Young Adults.?  The Journal of Genetic Psychology 166:133-151.

The authors in the study assessed the relationship between adolescent tobacco smoking and measures of inner control, deviant behavior, and associating with deviant peers. The adolescents completed questionnaires in their classrooms in 1990 (n=1,332) and later in 1995 (n=1,190) and then again later in 2000 (n=662). Eighty percent of the students who initially volunteered to participate completed the questionnaires. The time two interviews were conducted in the homes and the time three were conducted by phone and home. Only 662 people could be interviewed in time three due to budgetary reasons. The time three sampled include 333 African Americans (169 females, 164 males) and 329 Puerto Ricans (167 females, 162 males).    

Findings: Fifty-six percent of the 662 respondents never smoked during adolescence (nonsmokers), 18.3 percent smoked at time one and not at time two. 16.5 percent smoked at time two but not at time one and 9.2 percent smoked continuously between time one to time two. Experimental tobacco smokers demonstrated more problem behaviors than did nonsmokers, and late and continuous smokers demonstrated more problem behaviors as young adults than did experimental smokers and nonusers. Non smokers exhibited less anti-social behavior. Experimental smokers had greater inner control. Peer smoking was associated the respondents smoking behavior. All information was obtained by self-report.  

Daza, Patricia, Carlos Mazas, Lynne Nguyen, and David Wetter. 2005. “Categorizing Race among Hispanic Smokers.? Cancer Control 12 Suppl 2:91-92.

Study examined self-categorization into racial categories among Hispanics of low socioeconomic status who reenrolled in a population-based smoking cessation study. Of 355 callers, 306 agreed to participate of which 55 percent were men, 92 percent were immigrants, 60 percent spoke only Spanish in the home, and the mean age was 41 years. The participants were low socioeconomic status since 50 percent had a total annual household income of less than $20,000, and the mean education was 11 years.

Findings: Ninety-nine percent of the sample indicated they were of Hispanic origin. Fifty percent classified themselves as White, 2 percent Black, 9 percent Mixed race, and 39 percent as Other. The current study suggests that attempts to categorize race may be difficult for Hispanics who have traditionally been categorized by their ethnicity.

Dell, Jade L., Steven Whitman, Ami Shah, Abigail Silva, and David Ansell. 2005. “Smoking in 6 Diverse Chicago Communities—A Population Study.? American Journal of Public Health 95:1036-1042.

Researchers analyzed smoking survey data across communities in Chicago, Ill to explore community-level variations in smoking behavior. 300 completed interviews were met in 5 of the 6 communities. The community that did not meet the required interviews (190 of 300) had the highest median income. No representative study.

Findings: South Lawndale was the one predominantly Mexican neighborhood in this study. Education was positively associated with smoking. Ninety-two percent of residents started smoking when they were teenagers. The prevalence of smoking was less than current US prevalence. Demographic groups that were more likely to be current smokers included men, people living in households with lower incomes (<30,000 per year) or without working telephones, and people without a high school diploma.

Dierker, Lisa C., Rafael R. Ramirez, Ligia M. Chavez, and Glorisa Canino. 2005. “Association between Psychiatric Disorders and Smoking Stages among Latino Adolescents.? Drug and Alcohol Dependence 80:361-368.

Authors examined the prevalence of smoking behaviors and their association with psychiatric disorders within a representative sample of youth from Puerto Rico. Nine-hundred-and-eleven adolescents between the ages of 11-17 years old were selected from an island wide probability household sample of children. 1990 Census block groups were the primary sampling units, stratified by urban/rural and health reform regions. Two waves of assessment were conducted.

Findings: Major depression and oppositional defiant disorder were significantly associated with nicotine dependence, rather than with lower levels of use. Conduct disorder was generally associated with lower levels of use rather than with nicotine dependence. Smoking rates were lower among Puerto Rican youth than U.S. national samples. 

Elder, John P. , Guadalupe X. Ayala, Nadia R. Campbell, Donald Slymen, and Eva T. Lopez-Madurga, Moshe Engelberg, and Barbara Baquero. 2005. “Interpersonal and Print Nutrition Communication for a Spanish-Dominant Latino Population: Secretos de la Buena Vida.? Health Psychology 24:49-57.

The researchers studied 357 people who were randomly assigned to one of three conditions: promotora plus print material, tailored print material, or off-the-shelf print material (control). Measurement: select two dietary intake measures that represented modifiable dietary risk behaviors associated the acculturation process. They used 24-hour dietary recall interview, acculturation measured by the Acculturation Rating Scale for Mexican Americans. Researchers also measured height, weight, and BMI by using the Health-o-Meter standard scale. The then checked waist, hip, and waist-hip ratio.

Findings:  Self-report and physiological stats were collected at baseline and post intervention. Prior to random assignment, all participants were visited in their homes for the baseline interview. All three conditions were somewhat helpful, especially in the areas of total calorie and dietary fat reduction. Response to the promotora condition was generally superior and may derive from the personal touch achieved by face-to-face interactions without our participants in providing both informational and emotional support to women trying to achieve dietary change.

Elder, John P. , Shelia L. Broyles, Jesse J. Brennan, Maria Luisa Zuñiga de Nuncio, and Philip R. Nader. 2005. “Acculturation, Parent-Child Acculturation Differential, and Chronic Disease Risk Factors in a Mexican-American Population.?  Journal of Immigrant Health 7:1-9.

Authors examined different levels of acculturation among family members. They looked at alcohol and tobacco use and behavioral risks. The data was collected for the San Diego Study of Children’s Activity and Nutrition that involved 351 families of which 149 were Anglo and 202 were Mexican American. Measurement waves were conducted at six month intervals by self-report in the homes of the families.

Findings:  “Only 46.2% of the mothers reported earning a high school education or higher. Forty-one percent of the mothers reported being employed full-time, with an additional 20.8% reporting part-time employment. Sixty percent of the mothers reported a family income of less than $25,000 per year, while 50.9% reported 5 or more people living in the household? (p. 4-5). “Fifty two percent of the children were at “high risk? for tobacco susceptibility, but 94.2% had not smoked any cigarettes during the last 30 days. Twenty-seven percent reported having tried tobacco in their lifetime (once or twice), while 64.7% reported never trying tobacco? (p. 5). “The Anglo differential score was found to be a significant predictor of lifetime alcohol prevalence, and the Mexican differential score was found to be a significant predictor of tobacco susceptibility? (p. 7). Depression was found to increase alcohol and tobacco use and also less physical activity. The authors conclude that Mexican children oriented more toward Anglo culture were somewhat more likely to develop risk factors for alcohol and tobacco use. 

Hansen, Lisa K., Polly Feigl, Manuel R. Modiano, Jose A. Lopez, Sylvia Escobedo Sluder, Carol M. Moinpour, Donna K. Pauler, and Frank L. Meyskens. 2005. “An Educational Program to Increase Cervical and Breast Cancer Screening in Hispanic Women.? Cancer Nursing 28:47-53

Study included training promotoras and then encouraging their social contacts to obtain breast and cervical cancer screenings. A sociologist with experience in developing promotora programs conducted 2-day workshop with the project staff prior to developing the training course curriculum. Two Latina health educators were hired to conduct the Promotora Training Course. Both educators were fluent in Spanish and English. The curriculum consisted of 11 classes. They were aged 40-57.

Findings: Five promotoras completed the 12 week course. The five promotoras contacted 141 women. Fifty women (35.5 percent) obtained a screening mammogram and/or Papanicolaou smear during the study period. Most common reasons for not being screened: too busy or already screened in the year. Twenty two eligible female patients were invited to attend an orientation night designed to introduce the study purpose and the role of the promotora. Six of the women consented to participate. All promotoras used the contact logs to document activities. Promotoras knew most of their contacts previously (88.7 percent) and the majority of contacts were made in the home of the woman or the promotora (46.8 percent). Unfortunately, promotoras did not consistently document the frequency at which appointment lag times created barriers to screening. Tracking a small number of patients throughout the course of a year was problematic.
The average numbers of contacts and of screenings per promotora were higher than projected (20 contacts projected vs. 28.2 actual contacts).

Honda, Keiko. 2005. “Psychosocial Correlates of Smoking Cessation among Elderly Ever-Smokers in the United States.?  Addictive Behaviors 30:375-381.

“This study was conducted to identify the psychosocial factors associates with successful smoking cessation among ever-smokers aged 60 and older in the United States. Descriptive and multivariate analyses of the 2000 National Health Interview Survey (NHIS) were conducted? (p. 375). The total number of participants was 32,374 of which 3,170 of the respondents were 60 years old and ever smokers.  
  
Findings: “Controlling for sociodemographics and medical history of smoking-associated diseases, former smokers were less likely to have psychological distress (adjusted OR=0.71, 95% CI=0.58-0.88) and more likely to believe in the danger of second-hand smoke (adjusted OR=3.01, 95% CI=0.37-0.78) and the appropriateness of a smoking ban in indoor public places (adjusted OR=2.62, 95% CI=2.11-3.26). Having no regular source for care (adjusted OR=0.54, 95% CI=0.37-0.78) was an independent barrier to cessation, as were younger age, female, Hispanic race, being nonmarried and employed, and having lower income and education? (p. 375). The prevalence of smoking for people older than 60 years was 13.9 percent for males and 12.4 percent for females. “Smoking may be a way of coping with psychological distress among older persons? (p. 380).

Hyland, Andrew, Hamed Rezaishiraz, Joseph Bauer, Gary A. Giovino, K. Michael Cummings. 2005. “Characteristics of Low-level Smokers.?  Nicotine and Tobacco Research 7:461-468.

This study compares low level smokers with heavier smokers by using cross-sectional and longitudinal data. The authors define low-level smoking as people who reported smoking an average of five or fewer cigarettes per day. Telephone surveys were conducted in 22 North American communities in 1988 and 1993. This was a randomized sample. A cohort of 6,603 smokers were identified in 1988 and interviewed again in 1993 and 2001.

Findings: In 1988, 7.6 percent of all smokers were low-level smokers and in 1993 10.7 percent met these criteria. Low level smokers were more likely to be female, older, not married, Black or Hispanic and to have a college degree, to have no other adult smokers in the household; and to wait longer in the day to have their first cigarette. Fifty-six percent of the low-level smokers in 1988 (n=443) had quit smoking in 1993. Thirty-eight percent of low-level smokers in both 1988 and 1993 had quit smoking by 2001. Bad breath or wanting to set a good example was given as reasons for not smoking. Overall, 77 percent of persons who were low-level smokers in 1988 or 1993 were able to maintain this rate of smoking or quit altogether when reassessed in 2001.       

Hymowitz, Norman, Joseph Schwab, Christopher Keith Haddock, Sara Pyle, Glenisha Moore, and Sara Meshberg. 2005. “The Pediatric Resident Training on Tobacco Project: Baseline Findings from the Parent/Guardian Tobacco Survey. Preventive Medicine 41:334-341.

“The Pediatric Residency Training on Tobacco Project is a 4-year randomized prospective study of the effectiveness of training pediatric residents to intervene on tobacco in patients and parents? (p. 334). The study included 15 pediatric residency training programs to which people were randomly assigned to special and standard training conditions. These training programs were located in New Jersey and New York. A total of 1,770 parents/guardians completed the 15 to 20 minute tobacco survey.  

Findings: The majority of the parent/guardians were primarily low-income African American and Hispanic females who were low-income, single, and high school graduates. The parents/guardians began smoking when they were 16 years of age and most smoke menthol. Twenty percent reported that they smoked cigarettes and 37 percent had smoked cigarettes in the past. Whites were more likely to report that they smoked cigarettes (54.3 percent) than African Americans (37.8 percent), Hispanics (34.5 percent) or Asians (23.1 percent). Latinos were significantly more likely to report that they had quit smoking during the past year. Sixty percent prohibited smoking in their homes. Only about 10 percent of the respondents reported that doctors offered to help them stop smoking. Those who had tried to quit reported cigarette cravings (86.5 percent), risibility (53.8 percent), weight gain (37.4 percent), depression (24.4 percent), and inability to concentrate (20.2 percent). The reasons for returning to smoking were stress, cravings, others smoking, lack of will power, withdrawal, and weight gain.

Nezami, Elahe, Jennifer Unger, Sylvia Tan, Caitlin Mahaffey, Anamara Ritt-Olson, Steve Sussman, Selena Nguyen-Michel, Lourdes Baezconde-Garbanati, Stan Azen, and C. Anderson Johnson. 2005. “The Influence of Depressive Symptoms on Experimental Smoking and Intention to Smoke in a Diverse Youth Sample.? Nicotine and Tobacco Research 7:243-248.

The present study assessed the association between depression and smoking intention and experimentation among adolescents from four ethnic groups in the Los Angeles area. Over 800 7th graders in the Los Angeles area completed measures of depressive symptoms, experimentation with smoking, intention to smoke, and sociodemographic covariates.

Findings: From the entire sample 15.2 percent of respondents had ever tried smoking. Chinese American students had the lowest levels of depressive symptoms, whereas Latinos had the highest levels. Latinos also were more likely to intend to smoke in the next year and were the most likely to have started experimenting with cigarette smoking.

Nichols, Donna C. Cecilia Berrios, and Haroon Samar. 2005. “Texas’ Community Health Workforce: From State Health Promotion Policy to Community-level Practice.? Preventing Chronic Disease 2:1-7

These researchers studied a state health promotion policy that culminated in a training and certification program for promotores to determine the impact it had on the lay health education workforce. By the end of December 2005 an estimated 700 certified promotores will be in Texas. In 1999 Texas will be the first statewide voluntary promotora training and certification program.

Findings: Texas was pursuing a certification of promotoras. However, there was some fear that professionalizing will result in a loss of indigenous qualities
Overall great interest. Time and cost were not issues for creating and utilizing a promotora program. [Little additional information is provided in this research article].

Peters, Ronald J., Steven H. Kelder, Alexander Prokhorov, Charles Amos, George S. Yacoubian, Carolyn A. Agurcia, Nancy Murray, and Ross Shegog. 2005. “The Relationship Between Perceived Youth Exposure to Anti-Smoking Advertisements: How Perceptions Differ by Race.?  Journal of Drug Education 35:47-58.

The authors conducted secondary analysis of self-reported data from 1,608 high school students in Houston, Texas to determine perceived exposure to anti-smoking messages. The data was collected between October 2002 and March 2003.

Findings: Latinos comprised 50.4 percent of the sample, Blacks 39.8 percent and Whites 5.8 percent. “Logistic regression identified that African American perceived significantly less exposure to anti-smoking advertisements via television and posters than Whites… Hispanic youth perceived significantly less exposure to anti-smoking posters and significantly higher exposure to anti-smoking messages at sporting events and school programs compared to white youth? (p. 47-48).   

Peterson, Andrew N., John B. Lowe, and Robert J. Reid. 2005. “Tobacco Outlet Density, Cigarette Smoking Prevalence, and Demographics at the County Level of Analysis.? Substance Use and Misuse 40:1627-1635.

The authors examined the geographic associations between tobacco outlet density, cigarette smoking prevalence, and demographic variables at the county unit of analysis. The study was conducted in Iowa and included a random sample of 3,622 residents from January through December of 2002. There were a total of 4,745 licensed tobacco selling retail outlets at the end of 2002.

Findings:  Counties with a greater number of tobacco outlet density were more likely African American and higher median household income. This may be due to Iowa being considered a low-inequality state when compared to other U.S. states. The percent of Latino residents were low according to the discriminant Coefficient of .20 compared to African American residents of .55 and median household income .78. Tobacco outlet density was defined as an indicator of the physical availability of tobacco in a community.  These findings were computed as the number of tobacco outlets divided by kilometers of roadway. The figure was multiplied by 50 to yield a measure of tobacco outlet density per 50 kilometers of roadway.

Ramirez, Amelie G., Kipling J. Gallion, Lucina Suarez, Aida L. Giachello, Jose R. Marti, Martha A. Medrano, Eliseo J. Perez-Stable, Gregory A. Talavera, and Edward J. Trapido. 2005. “A National Agenda for Latino Cancer Prevention and Control.? Cancer 103:2209-15.

Survey of 624 key opinion leaders from around the country. Sixty-four percent were Latinos of Mexican, Puerto Rican, South American, Cuban, and Central American descent.  

Findings: Primary recommendations: 1. access to cancer screening and care. 2. Tobacco use was determined to be the number two priority cancer issue and they discussed several groups that provide outreach for this problem. Tobacco use should be primarily focused on adolescent smoking patterns. 3. Improve communication between patient-doctor. 4. More research is needed on dietary factors that affect cancer. 5. Finding the most effective means of communicating cancer risk to patients should be the major research emphasis.

Reynolds, Jennifer H., Robin L. Hobart, Patricia Ayala, Monica H. Eischen. 2005. “Clean Indoor Air in El Paso, Texas: A Case Study.?  Preventing Chronic Disease. Public Health Research, Practice, and Policy. Centers for Disease Control and Prevention 2:1-7.

This study looks at how a coalition was formed in El Paso in April of 200 to conduct a four-year campaign to initiate an ordinance to protect nonsmoking persons from the health effects of secondhand smoked in public places. An actual ordinance was introduced in April 2001 and was passed in June of 2001. “With a population of more than 550,000, El Paso is the fifth largest city in Texas and the largest border city in the United States? (p. 2). El Paso is the 10th poorest city in the United States.

Findings: One of the first steps taken by the coalition involved a public awareness campaign that involved meeting with members of the local newspaper editorial board. They began gathering research on various clean indoor air ordinances, opposition to ordinances, and the harmful effects of secondhand smoke. The coalition then formed a task force active in the faith community and collected 7000 signatures that were hand delivered to city representatives and the mayor. The coalition initiated television media ads. They gave out buttons saying “I support Clean Indoor Air? and involved members of the community. This paper outlines the six part plan that was used in passing this ordinance. These included protecting all workers, receiving training on policy and media advocacy, diverse coalition, benefited from youth leaders, cultivated a strong champion on city council, and was proactive with the media.   

Shavers, Vickie L., Deirdre Lawrence, Pebbles Fagan, and James T. Gibson. 2005. “Racial/Ethnic Variation in Cigarette Smoking among the Civilian US Population by Occupation and Industry, TUS-CPS 1998-1999. Preventive Medicine 41:597-606.

“This study examined racial/ethnic variation in the prevalence of current smoking and cigarette consumption patterns by occupation, industry and workplace smoking policy? (p. 597). Data was examined from the 1998-1999 Tobacco Use Supplement to the Current Population Survey that included 9,095 African Americans, 1,025 American Indians, 3,463 Asian/Pacific Islanders, 8,428 Latinos, and 86,676 White participants.
    
Findings: The smoking prevalence ranged from a high of 35.1 percent for American Indians, 24.7 percent for Whites, 22.2 percent for African Americans, 17.9 percent for Latinos, and 15.2 percent for Asian Americans. People who were employed in agriculture, forest, farming, and fishing industries (31.7 percent) had the highest prevalence of current smoking and people who worked in professional occupations had the lowest (15.6 percent). The lowest rate of smoking was found in workplaces in which smoking was banned. There was a lack of consistency in the association of specific occupations and industries with smoking prevalence among racial and ethnic groups that were not entirely clear to the researchers. The prevalence of occasional smoking was highest among Latinos (36.3 percent), Asian Americans (25.1 percent), African Americans (24 percent), American Indians (21 percent), and non-Hispanic Whites (16.3 percent). Non-Hispanic Whites were more likely to report heavy smoking (54.1 percent) than American Indians (43.7 percent), African Americans (29.7 percent), Asian Americans (25.5 percent) or Latinos (21.5 percent).  

Sherrill, Windsor W., Linda Crew, Rachel M. Mayo, William F. Mayo, Brooke L. Rogers, and Donna F. Haynes. 2005. “Educational and Health Services Innovation to Improve Care for Rural Hispanic Communities in the US.? Education for Health 18:356-67.

This research reports the challenges and success in the development and implementation of the Accessible and Culturally Competent Health Care Project (ACCHCP). Program is designed to provide care for underserved populations in Oconee Country, South Carolina. Variety of people from community and university played a role. Women in the community also serve as promotoras. The clinic effectively utilized lay helpers of “promotoras? from the community. Promotoras were recruited through contacts at local churches, agencies, and the mobile clinic. Twenty five women were invited to serve as promotoras and ten accepted.

Findings: Between January 31, 2003 and June 30, 2004, the Joseph Sullivan Center held 63 mobile clinic sessions and provided services to 1,076 patients. The majority of patients were Latino, female, and 19-39 years old. A patient satisfactory survey reported that a majority (68 percent) used the clinic as their primary source of care and significant portion reported that without the clinic their only option for health care would be the emergency room. ACCHCP was successful in meeting its program goals of increasing access to primary and preventive health services among the medically underserved population of Oconee County. The collaborative program was a success. Patients reported that they liked the regular presence of trained interpreters and Spanish speaking staff.

Soto, Mas, Francisco G., Richard L. Papenfuss, Holly E. Jacobson, Chiehwen Ed Hsu, Ximena Urrutia-Rojas, and William M. Kane. 2005. “Hispanic Physicians’ Tobacco Intervention Practices: A Cross-Sectional Survey Study.?  BMC Public Health 5:120-128.

“The purpose of this study was to assess the tobacco intervention practices and training needs of Hispanic physicians? (p. 1). The authors conducted a cross-sectional sample of self-reported Hispanic physicians in the state of New Mexico. They first conducted taped interviews and then completed a draft survey.

Findings:  Forty-five surveys were entered into the data set. The majority of respondents were male, in the 36-45 age range, and born in the U.S. The physicians reported a low prevalence of smoking and also low levels of smoking intervention. The physicians estimate that about 25 percent of patients that they see are smokers. However, less than half of the physicians routinely asked about smoking status, generally because it is listed in medical chart. Less than one-fourth of physicians routinely talk with patients about the health risks from smoking. The sample size was small and only represents 15 percent of the Latino physician population. Latino physicians may be in greater need of training and resources.

Teufel-Shone, Nicolette I., Rebecca Drummond, and Ulrike Rawiel. 2005. “Developing and Adapting a Family-based Diabetes Program at the U.S. Mexico Border.? Preventing Chronic Disease 2:1-9.

The University of Arizona and two community health agencies on the Arizona border collaborated to design, pilot, and assess the feasibility of a lay health-outreach worker (promotora-) program for families. Investigators met with promotoras in a day-long work session to discuss local strengths, challenges, and educational needs. After the initial meeting the investigators met separately with promotoras from each site over an eight-month period. In Yuma County, two promotoras delivered the five sessions through a series of weekly home visits. In Santa Cruz County, two promotoras delivered the modules in weekly evening classes to five to 10 families in a group format.

Findings: Impact of the intervention was assessed using the following: 1) a written preintervention and posterintervention Knowledge, Attitudes, Beliefs, and Behaviors questionnaire with 15 close-ended items and 2) post graduation interviews. Adult daughters and wives were the predominant participating supporters. This community case study supports the use of family based approach to diabetes prevention and control. The promotoras had previous experience and training. Generalizing unknown due to small sample size (72 families), but results are promising and warrant continued implementation of program in these communities and piloting in similar communities.

Vidrine, Jennifer Irvin, Cheryl B. Anderson, Kathryn I. Pollak, and David Wetter. 2005. “Race/Ethnicity, Smoking Status, and Self-Generated Expected Outcomes from Smoking among Adolescents.? Cancer Control 12 Suppl 2:51-7.

Paper reports secondary analyses of data collected from students attending one all girls’ and one all-boys’ urban Catholic high school. The purpose is to examine relations among race/ethnicity, self-generated smoking outcome expectancies, and smoking status with in a sample of high school students. Total participants include 332 girls and 283 boys.

Findings: In their sample Hispanics had the most current smokers (42 percent) than Whites (34 percent), Asians (24 percent), or African Americans (4 percent). This has thought to indicate that higher acculturation increases smoking among Hispanic adolescents. Hispanic student who had never smoked were the least susceptible to smoking. However, total Hispanics interviewed was 81.  

Welsh, Adrienne L., Angela Sauaia, Jillian Jacobellis, Sung-joon Min, and Tim Byers. 2005. “The Effect of Two Church-based Interventions on Breast Cancer Screening Rates among Medicaid-Insured Latinas.? Preventing Chronic Disease 2:1-11.

Objective of this study was to compare the effect of two Tepeyac Project interventions on the mammogram rates of Latinas and non-Latina whites enrolled in the Medicaid fee-for-service program. Two intervention groups were compared: 209 churches in Colorado that received educational printed materials in Spanish and English and four churches in the Denver area that received personalized education from promotoras.

Findings: Small, nonsignificant increases in screening were observed among Latinas exposed to the promotora intervention (25 to 30 percent). Screening among non-Latina whites increased from 32 to 38 percent. No significant disparities in breast cancer screening were detected by Latinas and non-Latina whites. Yet greater impact than has been predicted for promotora intervention than the printed statewide intervention in increasing mammogram use among Latinas.

Wilkinson, Anna V., Margaret R. Spitz, Sara S. Strom, Alexander V. Prokhorov, Carlos H. Barcenas, Yumei Cao, Katherine C. Saunders, and Melissa L. Bondy. 2005. “Effects of Nativity, Age at Migration, and Acculturation on Smoking Among Adult Houston Residents of Mexican Descent.?  American Journal of Public Health 95:1043-1049.

The authors “investigated differences in smoking behaviors between US- and Mexican-born ever smokers and examined the influence of US culture on smoking initiation? (p. 1043). The study included 5,030 adults of Mexican descent who were enrolled in an on-going population based cohort in Houston, Texas that was initiated in July of 2001 by the Department of Epidemiology at The University of Texas M.D. Cancer Center. The participants resided in predominantly Mexican American neighborhoods in Houston, Texas and were recruited by random-digit dialing, block walking, and recruitment and various local and community centers. Of the participants 1,392 were men and 3,638 were women and 70 percent had been born in Mexico. The US born population was older and more educated than Mexican born participants.  

Findings: Men reported current smoking (28.7 percent) more than women (9.5 percent) as did US born women than Mexican born women. US born Latinos had smoking rates greater than Whites and similar to African Americans. Male gender, older age, and higher level of acculturation predicted history of smoking more than high school education and living in an older aged census tract for US-born participants. The authors conclude that “Smoking interventions for people of Mexican descent should be tailored according to gender, nativity, and acculturation level and should target all ages, not just young people? (p. 1043). 

Artinian, Nancy T., Stephanie Myers Schim, Jillon S. Vander Wal, Mary A. Nies. 2004. “Eating Patterns and Cardiovascular Disease Risk in a Detroit Mexican American Population.?  Public Health Nursing 21:425-434.

“The purpose of this study was to examine dietary patterns and cardiovascular risk factors in Hispanic adults living in Southwest Detroit. A descriptive design was used. Self-report baseline data were collected using The Rate Your Plate and Personal Health Risk Assessment questionnaires. A nonrandom sample of 32 Mexican American adults was recruited from a large Roman Catholic Church in Southwest Detroit. Participants were selected if they were enrolled in the larger parent research study to test the effects of a lay health educator intervention and planned to participate in the nutrition education portion of the intervention? (p. 425).

Findings: “Unhealthy eating patterns outnumbered heart healthy eating practices. The majority used higher fat salad dressings; ate fried foods, sweets, and high fat snacks; consumed greater than the desired amounts of regular cheese; drank whole milk; and ate few fruits and vegetables. Lack of physical activity, being overweight, and exposure to second-hand smoke were the most prevalent cardiovascular risk factors. The data suggests that effective community-based heart disease prevention program that emphasizes risk factor screening and cardiovascular risk reduction through heart healthy eating are needed? (p. 425). 13.3 percent of the participants lived or worked with people who smoked.  

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