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Smoking Cessation in Latinos Using Community Health Advisors

Institution: San Diego State University Research Foundation
Investigator(s): Gregory Talavera, M.D., M.P.H.
Award Cycle: 1997 (Cycle 6) Grant #: 6PT-2001H Award: $992,121
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Integrated Research Project

Initial Award Abstract
Although studies have demonstrated the need to develop culturally-appropriate cessation programs that take into account the specific cultural beliefs and experiences of the Latino smoker, few resources and strategies have been developed to help Latinos quit smoking. The present study uses the concept of Community Health Advisors (CHAs) to deliver a culturally-sensitive intervention that will promote smoking cessation and its maintenance among Latino smokers. Specific aims are to develop, implement, and evaluate an innovative multicomponent intervention that focuses on videotape programming and social support for behavior change. Theoretical and empirical underpinnings for the intervention stem from the Community Health Advisor model and peer-delivered programs that have shown that indigenous lay health advisors promote identification with positive role models, foster feelings of empowerment, and provide social support, which can have a lasting affect on health-related attitudes and behaviors of the target population.

Latino community recruiters will use their existing social networks and organizations to recruit 500 adult, Spanish-dominant Latino smokers from their geographic areas. Half of the participants (n-250) will be randomly assigned to the intervention condition, and half (n=250) to a comparison condition where they will be encouraged to access the Spanish-language California Smoker's Helpline. Those assigned to the intervention condition will receive a 4-month smoking cessation program delivered in the home by promotores. Components of the promotor-based intervention include video, brochures, scripted discussion of key topics, and referral to more formal cessation support, all designed to be linguistically- and culturally-relevant.

This longitudinal research study will include 3 repeated assessments over about a 16-month period. Two types of smoking measures will be collected from all participants: (1) self-reports of smoking and cessation from paper-and-pencil surveys, and (2) carbon monoxide from exhaled breath samples. Measures will be collected at baseline, immediately following the 4-month intervention, and at a 12-month follow-up. Survey and carbon monoxide measures will be collected from participants in small groups by trained, bilingual/bicultural measurement technicians at designated and convenient community locations (e.g., churches, schools). Aggressive cohort maintenance strategies and incentives are expected to help retrain 85% of the study group over time. Primary analyses will focus on testing control-intervention differences in smoking/quit rates, as well as reduction in smoking, and stage-of-change processes. In addition, behavioral, attitudinal, environmental, and sociodemographic variables (e.g., acculturation) that are potentially important in explaining motivation to quit will be measured at each assessment.