Tobacco is the leading cause of preventable death and disease among adults in the U.S. and one-third ofall cancers are directly attributable to tobacco use. Minority and underserved populations experienceprofound tobacco-related disparities because of inequities in access to treatment, the health consequencesof tobacco, marketing by tobacco companies, and many other factors. For example, Hispanics are less likelythan non-Hispanic whites to receive help from their health care provider during a quit attempt or to haveaccess to pharmacotherapy. Moreover, tobacco is a major public health problem among Hispanics as 3 ofthe 4 leading causes of death among Hispanics are related to smoking (i.e., cancer, heart disease, stroke).Thus, a cornerstone of disease prevention among Hispanics in the U.S. is reducing tobacco use. Despite thecritical importance of reducing smoking in Hispanic populations, the search for effective methods to do so ishampered by the paucity of research on the mechanisms underlying smoking cessation in this population. Asnoted in one prominent report, 'underlying the challenge to eliminate health disparities is the inadequateempirical understanding of the proximal and distal determinants of tobacco use, nicotine addiction, andrelated consequences among understudied and historically underserved populations' (Eliminating Tobacco-Related Health Disparities: Summary Report). The proposed study addresses this gap.This longitudinal cohort study will examine the influence of neighborhood, individual, and acuteintrapersonal and contextual determinants of smoking cessation among adult, Spanish-speaking, Hispanicsmokers recruited from the Mexican-American (MA) Cohort Study (N=200). All study procedures, treatmentmaterials, and assessments will be conducted in Spanish. Participants will be tracked from 2 weeks prior totheir quit date through 26 weeks post-quit date. They will be assessed for 4 contiguous weeks (1 week precessationthrough 3 weeks postcessation) using state-of-the-science ecological momentary assessment(EMA) procedures. All participants will receive smoking cessation treatment consisting of nicotine patchtherapy, self-help materials, and brief in-person and telephone counseling based on our empirically-validatedintervention for Spanish-speaking Hispanic smokers (Wetter et al., in press).There have been exceedingly few studies examining the mechanisms underlying smoking cessationamong Spanish-speaking or Hispanic smokers, and to the best of our knowledge, none that that have: (a)investigated the influence of neighborhoods, or (b) included the use of EMA to investigate the acuteintrapersonal and contextual influences on the process of quitting. Thus, the proposed study will make aunique contribution to the field, as well as address key recommendations from major reports on smokingamong minorities (USDHHS, 1998) and reducing health disparities (USDHHS.2002).
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