Programa Latino para Dejar de Fumar (Latino Program to Stop Smoking)

Cigarette smoking is the leading cause of preventable morbidity and mortality in the United States and in most Latin American countries. Although there has been considerable progress in promoting cigarette smoking cessation and the prevention of smoking initiation in the United States, this effort has been most effective among White, non-Latino men and less effective among minority groups and women. Tailoring anti-smoking interventions for a defined racial/ethnic group in order to address culturally relevant issues is more acceptable to minority communities and may be more effective in promoting nonsmoking. Also, it is believed that some smokers use cigarettes to address problems in mood regulation. Alternative strategies to manage their mood may help these smokers more successfully quit.

Programa Latino para Dejar de Fumar (Latino Program to Stop Smoking) is a program to help Spanish-speaking smokers successfully quit. The materials focus on motivation to quit smoking. They provide information on adverse health consequences and the immediate physical consequences of smoking, the effects on the family, the costs of continued smoking, the benefits of quitting, and quitting techniques. The materials address alternative strategies to manage participants' moods, and they summarize potential quitting techniques.

Participants in the study were mailed program materials and were given 2 weeks to complete the self-monitoring chart.

Study participants were Spanish-speaking residents of the San Francisco Bay area who were current smokers and who were at least very sure that they wanted to quit smoking. Some participants also suffered from depression.

The program is suitable for implementation in participants' homes through mailings and phone calls.

Required resources include the Guía para Dejar de Fumar, a 36-page booklet focusing on motiviation, adverse health consequence, effects and costs of smoking and benefits of quitting. Also included are the Tomando Control de su Vida materials which include an audiotape with instructions on how to use the materials and a 30-minute relaxation exercise, a relaxation tape, a booklet to note the number of cigarettes smoked and pleasurable activities, and a self-monitoring chart to record daily behavioral observations. All materials are in Spanish.

Tomando Control de Su Vida was tested as a self-administered mail intervention and audiotape on an entirely Spanish-speaking Latino sample. The sample also included people suffering from current depressive episodes. The established association between smoking, high levels of self-reported depression, and clinical depression has led to smoking cessation approaches that include a mood management component as an adjunct to standard smoking cessation interventions.

Participants were recruited via television, radio, newspaper, and bulletin board announcements, as well as face-to-face at health fairs and other community events. Subjects were randomly assigned to the immediate or delayed experimental conditions, subdivided in groups based on a history of major depressive episode. Those in the immediate intervention group received the Tomando Control de Su Vida package, which included an audiotape with instructions on how to use the materials, a relaxation tape, a booklet to note cigarettes smoked and pleasurable activities, and a self-monitoring chart. Materials were sent by mail, and participants were called to verify receipt and to have the opportunity to ask questions. The delayed group received only the Guía after the initial call.

After a 3-month follow-up interview, the delayed group also received the mood management materials. All participants received subsequent follow-up assessments 6 months after the initial contact.

Evaluation of the program focused on abstinence, which was defined as self-reporting that no cigarettes had been smoked for at least the last 7 days. Results of the study indicate the following:

• At 3 months, the percentage abstinent in the immediate group (22.5%) was more than double that in the delayed group (10.8%).
• The immediate group maintained a significantly greater rate of abstinence than the delayed group. At 6 months, the percentage abstinent in the immediate group was 25.4%, compared to 9.2%.
• For those who did not quit completely, the mood management intervention plus the Guía reduced the number of cigarettes smoked from 13.9 to 7.8 per day, which was a significantly greater reduction than the Guía alone (from 14.5 to 10.6 cigarettes a day).