August 27, 2010

The National Latino Tobacco Control Network is one of the six National Networks for Tobacco Control and Prevention funded by Centers for Disease Control and Prevention.  ActionToQuit recently spoke with the director of the NLTCN to find out more about its activities.

ActionToQuit:

For the record, can you give us your name, title, and a little about your background?

Jeannette:

I am Jeannette Noltenius, MA, PhD, National Director of the National Latino Tobacco Control Network.  I am an immigrant from El Salvador.  Previously I worked for the Pan American Health Organization (PAHO), the regional office of WHO for the Americas, and also was executive director of the Latino Council on Alcohol and Tobacco.

ActionToQuit:

What motivated you to get involved in tobacco control?

Jeannette:

Tobacco killed both my parents.  That is my personal motivation.

Also, I am motivated by the need for community empowerment on this policy issue.  The tobacco industry creates a product that is not needed.  Then it markets this product to specific communities, changes the image of women and affects personal relationships and society.  Communities and regular citizens can take action to support policies that reduce the use of tobacco.

ActionToQuit:

What is history of the National Latino Tobacco Control Network?

Jeannette:

In 2008, CDC launched a five year cooperative agreement with the NLTCN as part of the National Networks for Tobacco Control and Prevention.  The six Networks are intended to provide leadership and expertise in the development of policy related initiatives and utilization of proven or potentially promising practices.  Each Network is expected to target specific subgroups experiencing tobacco-related disparities within their respective populations for interventions. Our target population is Hispanic/Latino.  We have about 18 collaborating organizations in our network, with the Indiana Latino Institute serving as the lead agency.

ActionToQuit:

One of your goals is to deal with tobacco-use disparities—what is the data for Hispanic/Latinos?

Jeannette:

The overall Hispanic/Latino population living in the U.S. is diverse. As of July, 2007, 15% of the U.S. population was Hispanic/Latino. Of this group, 64% are of Mexican background, 9% are Puerto Rico (not including those living on the island itself), 3.4% Cuban, 3.1% Salvadoran, and 2.8% Dominican.  The remaining 17.7% are of other Central or South American or other Hispano/Latino origin.

The smoking prevalence data for the Hispanic/Latino population is not disaggregated by ethnic subgroups in most surveys.  What is known about smoking prevalence for this population is:

Overall Hispanic/Latino – 16.2% (compared to 20.9% for all U.S. adults)
Puerto Ricans living in the continental U.S. – 18.4%
Puerto Ricans living on the island – 11.6%
Hispanic/Latino males – 21.1%
Hispanic /Latina females –11.1%
Cubans and Puerto Ricans (in continental U.S) are more likely to be heavy smokers (more than 15 cigarettes per day) than other Hispanic groups.

ActionToQuit:

What are some of the successes of your community?

Jeannette:

Puerto Rico has the third lowest level of smoking prevalence of U.S. jurisdictions at 11.6%, with only the U.S. Virgin Islands and Utah having lower rates.  As recently as 1996 the rate in Puerto Rico was 20.3%.  Despite having a budget of just $768,000 (compared to the CDC recommended level of $25 million), the Puerto Rico Department of Health, the Puerto Rico Tobacco Free Coalition, and other sectors of society, including research-academia and non-profit organizations, worked to promote a comprehensive tobacco control approach, with emphasis on education and promotion, public policy, and treatment.  The Strategic Plan for Tobacco Control in Puerto Rico 2005-2010 and the Research Agenda for Tobacco Control provided a guide for tobacco control activities on the island.

ActionToQuit:

Treatment, or cessation, is one focus in Puerto Rico—what is being done in this area?

Jeannette:

The Puerto Rico Cessation Quitline called “Déjalo ya!” (Leave It Now) was implemented in 2004.  The University of Puerto Rico Cancer Center developed an outreach program which, together with the Tobacco Free Coalition, promoted referrals to the Quitline by health professionals and health and community-based organizations.  Cessation services and support or education were also provided by the School of Dental Medicine of the University of Puerto Rico, the Seventh Day Adventist Church, and the Health Department’s Division of Community Health.  Minimum cost cessation services are also provided by the Lung Association, the Ponce School of Medicine, Veterans’ Clinic, and 600 physicians and 300 dentists.

Healthcare providers were offered training and “kits” containing cessation materials.  Liaisons were designated in 60 organizations to institutionalize the Quitline as tool for cessation.   A strong cessation campaign helped to change the environment.

In addition to our success in Puerto Rico, I want to mention a few other examples.  In Colorado, quitline money was used to target Hispanics using both English and Spanish.  In Indiana, Latino organizations have been funded to work with the Indiana University medical school.  Medical students in community health centers are using the 5 A’s for cessation and five clinics serving Hispanics, including one dental clinic, followed up the quitline referrals.  About 30% of the calls to quitline are from Hispanics.

ActionToQuit:

What culturally specific considerations can be helpful in working with your community?

Jeannette:

An important motivation for Hispanics to quit smoking is concern about the impact of smoking on their families, and their children in particular.  The messages about the danger posed by secondhand smoke are not reaching everyone, but can motivate quitting.

Studies indicate that Hispanics respond to the white coat effect—they trust the information given by their health care providers.  The link between smoking and chronic diseases is an important message.

Because many Hispanics/Latinos are low and intermittent smokers, some of the approved medications may not be appropriate for them.  This is something that needs to be considered in cessation services for this population.