Tobacco-related Disparities among Hispanic/Latinos
Lourdes Baezconde-Garbanati, PhD, MPH
Cessation programs should integrate an understanding of the values and cultural practices of people of Hispanic or Latino heritage.
Addressing tobacco-related disparities in cessation services for Hispanic/Latinos is complex yet increasingly urgent with the growing numbers in this population. Hispanics represent 13.3% (38.8 million) of the US population. Hispanic/Latinos are the largest minority group in 23 states.1,2 However, Hispanic/Latinos have not benefited equally from recent advances in medicine that can prevent individuals from starting to smoke or help them quit permanently.
Hispanic/Latinos have the largest number of uninsured of any group.3 More than half of this population under the age of 18 in California, although uninsured, are eligible for state-sponsored health care programs, yet barriers limit their participation.4 Hispanic/Latino families are least likely to have job-based health coverage, although their work participation rates are the highest in California.5,6
In many instances, Hispanics quit on their own or use only pharmacological aids. Research,7 however, points to approaches with intense behavioral interventions as promising. Hispanic/Latino values, beliefs, and cultural practices provide protection against the deleterious effects of poverty, low education, and poor access to care.8,9 However, with assimilation and acculturation, these protective factors become compromised, particularly among Latinas, youth, and young adults.5,6
Cultural values can be integrated into interventions that recognize familismo (family seen as the main social unit), interdependencia (exchange of goods and services), respeto (respect for authority, age, knowledge), simpatia (preference for smooth social relations), and personalismo (value on personal interactions).9,10 Cessation strategies that work best include personal contacts, recommendations from those in positions of authority, including RTs and other clinicians.
Moving health care organizations and clinics that provide services to uninsured Hispanics toward abiding by the Public Health Service Guidelines11 for cessation is also an important way to help eliminate existent service disparities. Assessing a patients willingness to quit using personalismo in interactions and arranging cessation services to patients likely to engage support from the family may enhance use of services. Cessation materials can be reviewed to account for literacy levels and the incorporation of cultural values.12
Approximately 82% of Hispanics are involved with the Spanish language in some capacity. While 47% of Latinos in the United States are Spanish dominant, 28% are bilingual, and 25% are English dominant.12 Among Latino youth in California, 27% prefer to use Spanish, 54% are bilingual, and 19% are English dominant, meaning that cessation services that focus solely on the Spanish language may not be the most appropriate, especially regarding smoking among youth.
Medical providers are challenged by the increasing diversity in the United States to meet the needs of its various groups. Limited English proficiency, language capabilities in medical offices, time restrictions, and lack of materials or referral sources to address limited English-proficient populations in culturally appropriate ways are all barriers.
Solutions need to be found in how we transform the current infrastructure we work in; providing adequate reimbursements and incentives; having appropriate counseling support tools; and achieving an integrated system that includes reminder tools and prompts for follow-up. Institutions that wish to take on a leadership role in cessation will benefit from assessing staffs awareness of cessation services available. Referral resources should be available within each institution. Someone on staff can become knowledgeable of the availability, accessibility, readability, and cultural appropriateness of cessation patient materials.
At the Hispanic/Latino Tobacco Education Network of California, we envision a future in which those responsible for the treatment of tobacco dependence take on a major role in ensuring culturally competent services and participate in advocacy initiatives to reduce or eliminate disparities among Hispanic/Latinos in tobacco-related diseases. Celebrating Cesar Chavezs life, we know he would have said: ¡Si se puede! (Yes, we can!).
Lourdes Baezconde-Garbanati, PhD, MPH, is the director of the California Hispanic/Latino Tobacco Education Network and of the USC Transdisciplinary Tobacco Use Research Center Community Core, Los Angeles. This paper was made possible with funds from the California Department of Health Services, Tobacco Control Section contract number 00-91585, and the National Cancer Institute-funded USC Transdisciplinary Tobacco Use Research Center award No. 5 P50 CA084735. The author thanks Maureen Flannery and Marisol Romero.
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