Success of "Promotores De Salud" in Identifying Immigrant Latino Smokers and Developing Quit Plans

Resumen

IntroductionTobacco use remains the leading preventable cause of morbidity and mortality among Latinos in the United States (1-3). Despite the Clinical Practice Guidelines for Treating Tobacco Use and Dependence recommendations of counseling and pharmacotherapy to treat smokers, Latinos are significantly less likely than white non-Latinos to receive advice to stop smoking from their healthcare provider or to participate in smoking cessation programs (3-5). Multiple meta-analyses demonstrate support for the efficacy of pharmacotherapy and counseling in increasing abstinence for smokers trying to stop smoking (5). Nationwide state-sponsored telephone counseling quitlines (quitlines) offer smoking cessation counseling in Spanish (6-9) and tailored Spanish-language smoking cessation guides have been developed (10,11).Despite evidence-based smoking cessation interventions, Latinos report a general lack of knowledge about available smoking cessation resources and perceive a lack of cultural sensitivity within existing Spanish-language resources, particularly immigrants. These variables may contribute to lower use of pharmacotherapy and quitlines (7,12,13). Overall, disadvantageous social conditions (e.g., poverty, education), language barriers, socio-economic factors, healthcare access, and lack of insurance are further obstacles to accessing smoking cessation treatment (14-16). Nonetheless, Latinos have demonstrated a positive attitude toward quitting, and are interested in participating in smoking cessation interventions (13,17,18).Addressing tobacco related disparities among Latinos require the development of culturally appropriate community-based programs that can increase knowledge and utilization of efficacious smoking cessation treatment resources. Communitybased smoking cessation interventions among Latinos have focused on tailored self-help materials, multicomponent community interventions, and the use of lay health advisors, also known as promotores de salud (19-24). The broad understanding of promotores is aligned with the notion of natural helpers (25). As described by Israel, natural helpers are trusted people to whom others naturally turn to for advice, emotional support and tangible aid (25). The role of promotores can be particularly important in underserved communities with limited access to health services (26-28). As demonstrated in other studies, promotores can address lack of knowledge by disseminating culturally and linguistically appropriate information on existing appropriate efficacious preventive resources (29,30). Nevertheless, the role of promotores in smoking cessation has not been largely explored.Smoking cessation interventions incorporating social support for smoking abstinence have been successful in advancing smokers readiness to stop smoking (31). As further explained by Cupertino et al (32), interventions using promotores are grounded in social cognitive theory (33) wherein health changes occur within a network of social influence. Studies have found that in Latino communities, social support networks serve complementary roles as sources of support, advice, social interaction and role models (25,26,32).Social networks may be beneficial for impacting tobacco use and promoting healthy behavior change. Therefore, promotores-as community health workers who are simultaneously members of their own community and part of extended social networks- may also serve as a source of active social support and health behavior change (32).Several promotores trainings have successfully engaged its participants in positive behavior change (e.g., health belief model, stages of change) (34), but the feasibility of connecting Latino smokers to evidence-based cessation treatment using promotores merits further consideration. Our study examined the role of promotores to refer Latino smokers to existing smoking cessation resources rather than implementing the counseling themselves. …