Helping Latinos quit smoking: Miriam Hospital studies offers new insight

(Press-News.org) PROVIDENCE, R.I. – Latinos looking to quit smoking are more successful when they have a significant other and partner support, say researchers from The Miriam Hospital's Centers for Behavioral and Preventive Medicine. According to the study, published in the May/June issue of the American Journal of Health Promotion, this support can also buffer the demonstrated negative effect that depression can have on smoking cessation.

Latinos are the largest, fastest growing minority population in the country, based on U.S. Census data. Smoking prevalence among Latinos is 15.8 percent and is even higher among those who are more adapted to U.S. culture. Overall, Cubans have the highest rates of smoking, followed by American-born Mexicans, Puerto Ricans, Central and South Americans, immigrant Mexicans and Dominicans.

Although previous research suggests that social support appears to facilitate smoking cessation, other factors, such as depressed mood, can hinder those efforts, since depression and depressive symptoms are associated with lower likelihood of quitting. Given that Latinos have slightly higher rates of depressive symptoms compared to other racial or ethnic groups, they may have particular difficulty quitting smoking.

The study included 131 Latino smokers who have children with asthma. The majority of participants were Puerto Rican (52 percent), Dominican (23 percent) and Central American (11 percent), while nearly three-quarters were female. Participants reported smoking an average of 10.8 cigarettes per day with an average of three quit attempts.

Overall, approximately 46 percent of participants reported having a significant other, defined as being married, engaged or living together. Questionnaires determined their perceived levels of social support, which was defined as having someone to talk to about their problems, people with whom they can do things, tangible or material support and self-esteem support. Participants also reported on perceived supportive and non-supportive smoking cessation-related behaviors from their significant others. A separate assessment measured participants' levels of depression and depressive mood.

Approximately 30 percent of participants with a partner quit smoking compared to 14.3 percent of those without a partner. More than 43 percent of those with high levels of perceived partner support quit smoking, versus 17.4 percent of participants with low levels.

"Simply having a partner, regardless of the type of support they offer, may be important to Latino smokers who are trying to quit smoking," said Belinda Borrelli, Ph.D., senior author on the study and a psychologist with The Miriam Hospital's Centers for Behavioral and Preventive Medicine.

The study also examined whether or not having a partner buffered the effect of depressed mood on quitting smoking. Among smokers without a partner, quit rates were higher for those with low levels of depressed mood (37 percent) than those with high levels of depressed mood (9 percent). Depressive symptoms did not affect quitting smoking among those with a partner. According to researchers, this finding suggests that simply having a partner, regardless of whether that partner offers positive or negative support, buffers the effect of depressive symptoms on smoking cessation.

"Latino smokers who are depressed and/or those without a partner may need to be connected to additional supportive resources to successfully quit smoking," says Borrelli. Although she says the study provides a first step in exploring possible factors – such as social support and depression – that may either help or hinder smoking cessation, future research is needed to discover ways to capitalize on the social context of Latinos to promote smoking cessation.

Are there differences in smoking behavior and attitudes among Puerto Rican, Dominican and non-white Latino smokers?

In a related study, also published in the May/June issue of the American Journal of Health Promotion, Borrelli and colleagues set out to determine whether smoking behavior and attitudes differ among Puerto Ricans and Dominicans and if so, how do they compare to non-Latino whites (or Caucasians).

Researchers focused their study on 225 smokers who are also caregivers of children with asthma. They examined smokers' motivation to quit, risk perception, social support, depressed mood and perceived stress because these factors are associated with poor smoking cessation outcomes among the majority population.

"No studies have examined the differences in smoking attitudes and behavior between Dominicans and Puerto Ricans," said Borrelli. "Exploring differences between these two subgroups as well as how each differs from non-Latino whites is important for determining whether smoking cessation interventions developed for the majority population are relevant to specific Latino populations."

Overall, researchers say there were important differences between Dominicans and Puerto Ricans compared to each other and with non-Latino whites that make it less likely that evidence-based treatments that are effective for the majority of adult smokers will be equally effective for Latinos, suggesting the need for cultural adaptation of smoking cessation treatments for Latinos.

Borrelli and colleagues also note that Puerto Ricans appear to have more factors associated with risk of smoking cessation treatment failure, such as less motivation and confidence to quit, lower levels of social support, and greater levels of U.S. acculturation and depressed mood. On the other hand, Dominicans appear to have the most protective factors among the three groups to facilitate quitting, including low nicotine dependence and high motivation to quit, and they also identified more negative consequences of smoking.

Only 13.3 percent of Dominicans lived with another smoker, compared to 35.8 percent of Puerto Ricans. 60% of Dominicans had a household ban on smoking, versus 44.8% of Puerto Rican smokers.

"Although it may not be feasible to have numerous smoking cessation treatments for different subgroups, we found meaningful differences between subgroups that could be used in treatment tailoring," said Borrelli. "We need to examine the role of these smoking attitudes as potential moderators and mediators of smoking behavior in order to guide the cultural adaptation of evidence-based treatments."

### Both studies were funded by grants from The Robert Wood Johnson Foundation Smoke Free Families Initiative to Borrelli. Brittany M. Brothers, Ph.D., from The Ohio State University, co-authored the paper titled Motivating Latino Smokers to Quit: Does Type of Support Matter? Co-authors of the second paper, Differences in Smoking Behavior and Attitudes among Puerto Rican, Dominican and Non-Latino White Caregivers of Children with Asthma, included Elizabeth McQuaid, Ph.D., from the Bradley Hasbro Children's Research Center; Kristin Gregor, Ph.D., of The Miriam Hospital's Centers for Behavioral and Preventive Medicine; Rashelle B. Hayes, Ph.D., of the University of Massachusetts Medical School; and Christina S. Lee, Ph.D., of the Center for Alcohol & Addiction at Brown University and the Institute on Urban Health Research at Northeastern University.

The principle affiliation of Belinda Borrelli, Ph.D., is The Miriam Hospital (a member hospital of the Lifespan health system in Rhode Island), and direct financial and infrastructure support for this project was received through the Lifespan Office of Research Administration. The researcher also has an academic appointment at The Warren Alpert Medical School of Brown University.

The Miriam Hospital (www.miriamhospital.org) is a 247-bed, not-for-profit teaching hospital affiliated with The Warren Alpert Medical School of Brown University. It offers expertise in cardiology, oncology, orthopedics, men's health, and minimally invasive surgery and is home to the state's first Joint Commission-certified Stroke Center and robotic surgery program. The hospital is nationally known for its HIV/AIDS and behavioral and preventive medicine research, including weight control, physical activity and smoking cessation. The Miriam Hospital has been awarded Magnet Recognition for Excellence in Nursing Services four times and is a founding member of the Lifespan health system.