This is a proposal to conduct a one year study to tailor smoking cessation interventions for Latino persons with depression with depression served in public health settings in order to prepare for a larger multi-site trial testing those interventions. In the U.S., lung cancer is the leading cause of cancer death among Latinos and second among Latinas; however most cases of lung cancer can be prevented by implementing smoking cessation interventions for adult smokers. Persons with depression have significantly higher rates of smoking than the general population and Latinos with depression have significantly higher rates of tobacco use than Latinos without depression. Unfortunately, persons with depression have less success with smoking cessation than persons without depression and are at increased risk for relapse of depressive symptoms during their quit attempts; thus they require additional supportive therapy and resources. Although culturally appropriate smoking cessation interventions for Latino populations have demonstrated success in facilitating abstinence from smoking, these programs have not been specifically tailored for Latinos with depression, a population that faces significant barriers in terms of treatment for mental health and tobacco cessation (e.g., stigma, access to care, language). The current project proposes to tailor a low burden provider toolkit and intervention materials (developed by the Drs. Morris, Waxmonsky, Giese, and Ms. Graves, MPH) for persons with mental illnesses served in community mental health clinics for Latinos/as persons with depression who wish to quit tobacco use and who primarily are treated in public community health centers in Larimer County, Colorado. In order to effectively engage this target population in tobacco cessation interventions, Drs. Waxmonsky and Morris are partnering with the Latino/a Research and Policy Center to provide direction and cultural expertise. Through the use of health care provider focus groups, patient/family member focus groups (separate Spanish and English focus groups), and structured interviews with key community stakeholders (Latino/a persons with depression, community members, mental health and primary care providers in Larimer County Colorado, and cultural experts), the project will (1) obtain input on strategies to recruit/retain Latinos in tobacco cessation treatments; (2) Modify the existing toolkit and interventions based on stakeholder input and translate the existing intervention materials to insure the cultural appropriateness and relevance of the tobacco cessation intervention to address specific/unique needs of Latino persons with depression; and (3) Garner qualitative data about the acceptance, feasibility, and usability of the targeted intervention materials. The project will create tailored intervention materials in both Spanish and English and implementation strategies for the targeted population based on the feedback from the stakeholder groups for a multisite clinical trial and eventual dissemination statewide. ? ? ? ?
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