Characteristics of Latino smokers in different stages of change living in Minnesota.

Abstract

Tobacco use among Latino communities living in Minnesota is a cause of concern due to their vulnerabilities. Recent immigrants face the stress of acculturation, immigration- related issues, inadequate health insurance access, lack of family and social networks, lack of knowledge about the short-and long-term consequences of exposure to second-hand smoke (SHS), and the absence of culturally-appropriate and linguistically-competent tobacco cessation programs. Tobacco cessation interventions have traditionally been designed and implemented for the mainstream population and then translated to be used among minority communities. This approach does not recognize the unique characteristics of smokers from other cultures and ethnic groups. For this reason, in order to develop culturally-appropriate and linguistically-competent smoking cessation interventions, it is necessary to understand and address the complexities of Latino tobacco users. In order to understand these characteristics, the Stages of Change (SOC) model was used to classify Latino smokers and former smokers into the preparation, contemplation, pre-contemplation, and maintenance stages of change. Objectives The objectives of this study are 1) to describe the characteristics of Latino tobacco smokers living in Minnesota; 2) to determine if there are significant differences between Latino smokers not willing to quit using tobacco, in the pre-contemplation SOC; Latino smokers willing to quit using tobacco, in the preparation SOC; and Latino former smokers in the maintenance SOC; by socioeconomic status and level of acculturation; self reported physical and mental health, consumption of fruits and vegetables, and physical activity; beliefs regarding smoking, positive aspects of smoking, and knowledge of tobacco-related diseases; attitudes and level of exposure to SHS; and the level of cigarette addiction and willingness to quit smoking; finally, the study will 3) identify significant characteristics of Latino smokers that would be relevant to develop culturally-competent and linguistically-appropriate tobacco cessation interventions. Methods This research is a cross sectional study, using secondary data from the Diverse Racial and Ethnic Groups and Nations (DREGAN) project, focused on adults, eighteen years old or older who self-identified as Latino or Hispanic, or born in a Latin-American country or who have a parent or grandparent born in a Latin-American country, who agreed to respond to the survey questionnaire. Minors of eighteen years old, who are not Latino or from Latino origin, or qualified respondents who refused to answer the survey questionnaire were excluded from the study. Definition of variables The SOC algorithm was used to address if there were relevant relationships between the independent variables and the SOC that could be used to design culturally-appropriate tobacco cessation programs. Using the DREGAN dataset, an analysis dataset was created by recoding and combining participant survey responses. Statistical analysis SPSS version 19.0 software was used to conduct all statistical analyses, including descriptive, bivariate and multivariate analysis. Descriptive statistics were performed to summarize the characteristics of the respondents. Percents, means, and standard deviation of the means were calculated for continuous variables. Numbers and percentages were calculated for categorical variables. The continuous variables were compared using one-way analysis of the variance (ANOVA), the dichotomous categorical variables were compared using Chi-square test, and the thricotomuos categorical variables were analyzed using order logistic regression. Variables that were moderately associated with the comparisons categories (p<0.1) were identified and analyzed using logistic regression controlling for age and gender to examine their association with smokers in the different stages of change. Results The study reported that current smokers are more likely to be men than ever smokers. Smokers in the maintenance SOC tend to be older than smokers in the preparation and pre-contemplation SOC, as well as those in the preparation compared to smokers in the contemplation and pre-contemplation SOC. Smokers in the maintenance SOC are more likely to be married or live in a marriage-like relationship than current smokers. Smokers who answered that they were uncomfortable asking for help to quit smoking are more likely to live with children under 18 years old. Never smokers are more likely to answer the survey in Spanish than ever smokers. Smokers who believed that they were unlikely to succeed if they wanted or decided to quit smoking are less likely to have friends from the same ethnic background than those who believed they were likely to succeed. Similarly, smokers in the preparation SOC are less likely to believe that smoking facilitates friendship than those in the pre-contemplation SOC. It was also found that never smokers and smokers in the maintenance SOC, compared to ever and current smokers, are less likely to be exposed and have their children exposed to SHS, be comfortable with others smoking around them, live in a house and ride in a car in which someone smokes; as well are more likely to live in a home and prefer to work where smoking is not allowed. Similarly, a lower percentage of smokers in the preparation SOC rode in a car in which someone smoked during the previous week and was exposed to SHS compared to smokers in the contemplation and pre-contemplation SOC. However, smokers who believed they were unlikely to succeed if they wanted to quit smoking are more likely to live in a house where someone smokes. Never smokers compared to ever smokers are less likely to report stressful events, major injury or illness during the previous year, and a belief that smoking relieves stress. Similarly, never smokers and smokers in the preparation SOC are less likely to believe that smoking provides pleasure than ever smokers and those in the pre-contemplation SOC, and smokers who answered they were unlikely to succeed if they decided to quit smoking are less likely to believe that people smoke because they want to. Smokers who answered they were unlikely to succeed if they wanted to quit smoking are less likely to exercise adequately than those who answered they were likely to succeed. On the contrary, smokers who disagree with the belief that the only way to stop smoking is through will power are more likely to report a major injury or illness during the previous year, and are more likely to have a normal body mass index (BMI) than those who agreed. Never smokers and smokers in the preparation SOC are less likely to report major change in the health of a relative during the previous year than current and smokers in the pre-contemplation SOC; similarly, smokers in the preparation SOC are less likely to report major change in family reunions during the previous year than smokers in the pre-contemplation SOC, and are more likely to report interesting things in their daily life than those in the pre-contemplation SOC. It was also found that never smokers and smokers in the maintenance SOC, compared to ever and current smokers, are more likely to believe that there are no positive aspects of smoking, and live in a home and work where smoking is not allowed. Similarly, never smokers are more likely to report happiness than ever smokers. Never smokers are more likely to believe that smoking causes heart disease than ever smokers. Similarly, smokers in the maintenance SOC are more likely to believe that smoking causes more harms than benefits than current smokers. However, smokers who disagree with the belief that the only way to stop smoking is through will power are less likely to believe that smoking causes more harms than benefits than those who agreed with those beliefs. The study also found that smokers in the maintenance SOC are less likely to smoke their first cigarette and smoke regularly after their 18th birthday than current smokers. However, a larger percentage of smokers in the preparation SOC smoked cigarettes regularly after their 18th birthday compared to those in the contemplation and pre-contemplation SOC. Smokers in the preparation SOC are more likely to believe that they would be very likely to succeed if they want or decide to stop smoking than those in the pre-contemplation SOC; similarly, a larger percentage of smokers in the preparation SOC does not enjoy smoking compared to smokers in the contemplation and pre-contemplation SOC. Finally, as expected, smokers who disagree with the belief that the only way to stop smoking is through will power are more likely to feel very comfortable asking for help to stop smoking than those who agreed with that belief. Conclusions The results show that Latino smokers living in Minnesota share some of the characteristics described by previous studies including high level of exposure to SHS, the trend to quit smoking when older, to smoke cigarettes and are not willing to quit when are exposed to stressful events, the belief that smoking facilitates friendship and provides pleasure, enjoyment of smoking, and negative expectations for successfully quitting smoking. These hypotheses should be tested in prospective intervention studies of smoking cessation interventions using the SOC algorithm, taking into account the prevalence of smoking differences between women and men and the causes of smoking. As the most accessible health care practitioner, pharmacists are in a privileged position to provide smoking cessation interventions, especially to Latino recent immigrants who do not know how to navigate the complex health care systems in the U.S. By learning the unique characteristics of Latino smokers, pharmacists will be able to address their needs and increase the possibilities for successful outcomes.