Helping Latinos quit smoking

If a person isn’t physically dependent on nicotine, then what motivates them to keep smoking? Yessenia Castro, an assistant professor at the Steve Hicks School of Social Work, seeks to address this conundrum regarding Latino smokers — a group that research shows as less likely to smoke and less likely to be physically dependent on it compared to non-Hispanic white smokers.

Yessenia Castro

Yessenia Castro, PhD

Castro said current research initiatives regarding smoking dependence of Spanish-speaking Latinos might not implement culturally appropriate or reliably translated measures — such as survey or interview questions — to assess smoking dependence. Castro’s four-part research project, funded by the National Institute on Minority Health and Health Disparities, aims to fill this gap by developing a grounded, multidimensional measure of smoking dependence that is valid to use with Spanish-speaking smokers.

“What we’re trying to do is get a sense of how Latinos, and especially Spanish-speaking Latinos, experience and describe tobacco dependence or use,” Castro said. “There is reason to suggest the way they talk about and experience these things might differ from non-Hispanic or English-speaking groups. If we can get a better sense of how they view it, than we can figure out a way to measure dependence and talk about it in a way that’s relevant to them.”

In the text below, Castro explains how her team and others in the same field first took note of problems with Spanish translations of smoking dependence research measures, such as the Wisconsin Inventory of Smoking Dependence Motives (WISDM) and Nicotine Dependence Syndrome Scale (NDSS), and what she is trying to accomplish with her project.

How can the cultural appropriateness and language translation of measures affect outcomes in smoking dependence research?

Any self-report measure goes through scientific analyses to make sure that it actually measures what researchers intend for it to measure. When we develop a measure for smoking dependence in English, we make sure that people understand the items as they were intended to, that the items that we expect to go together do just that, and so on. There are a couple of strong, popular measures of dependence in English that help us predict behaviors and outcomes.

What we found, and what another research group found separately on a different measure, was that when translated into Spanish from English, these measures’ properties don’t hold up. This could be because of any number of things. It’s possible that the way the measure was translated it was wrong and the language doesn’t communicate what we want it to, or it could be that the way we understand dependence among English speakers doesn’t work the same for Spanish-speaking Latinos. They could experience smoking differently. So these measures were not useful. This tells us that just translating them into Spanish isn’t sufficient to really measure and capture tobacco dependence the way that we want.

My study is trying to see which or how much of these factors — translation problems or the way we understand dependence — affect the effectiveness of the smoking dependence measures.

What do smoking-related health disparities look like in the Latino community?

We know that there are racial or ethnic differences in the patterns of how folks smoke, in particular Latinos compared to white smokers. First of all, Latinos are less likely to be smokers to begin with. But among populations who do smoke, Latinos tend to smoke less and tend to be light smokers. They don’t tend to smoke every day, which is what we call “non-daily smokers.” The most important thing is that they tend to be less physically dependent on tobacco because of all of these factors. Because Latinos tend to smoke less on average, we tend to not think of their smoking as a problem. But, there is definitely a difference in terms of how smoking impacts Latinos.

Traditionally, researchers have focused on how to help individuals cope with physical dependence when smokers try to quit smoking. The pattern of smoking among Latinos suggests that this is less important because they’re less likely to be dependent. We as researchers want to understand what motivates a person to continue smoking if they are not physically dependent. That way, we can target those things to help these people quit.

What does the timeline look like for this four-phase project?

Phase one looks at possible translation problems within the NDSS and the WISDM. Phase two will examine the way that  Mexican, Spanish-speaking smokers experience smoking dependency. The third phase will refine and develop items in the measures based on data from phases one and two. Lastly, phase four will validate the new scales for these measures and examine everything gathered to potentially develop a different or more appropriate measure.

Our official start date was August 14, 2017, so we’re just finishing our preparation phase. We’re getting everything together to start collecting data. Come December, we’ll start phase one and phase two because those can be done at the same time. We expect this to take about two years. I believe we’ll get into phases three and four by the end of year one.

Are there any organizations or groups collaborating with you on this project?

We also have a community partner who is helping us with recruitment. The Latino Healthcare Forum is a non-profit organization in town whose goal is to help Latino populations and other underserved populations get access to health services. We recruit for study participants at their events and within their outreach efforts.

What are the long term goals or real-world applications that you hope this project accomplishes?

One concrete goal is develop a measure of dependence that works among Spanish-speaking smokers. The other goal that is more long term is to use this information to get a better understanding of what dependence is to a person who speaks Spanish and is a very light smoker. If we can understand how smoking is important to them, then we can develop our interventions to target those things important to them. It can inform tailoring interventions for specific groups that may be experiencing something a little bit differently than we’ve known in other groups.

What  inspired you to look at tobacco use among the Latino community?

I think it’s part of my broader initiative as a health disparities researcher. I really want to help identify, understand, and eliminate any gap in health services among groups, and that focus has always been on Latinos partly because of my background. I can definitely communicate and relate to the population myself, but the bottom line is that this is a gap or a difference that was existing in an already disadvantaged group, and it was something that I wanted to help eliminate.

My core interests have always been to research Latino populations more generally. Historically, they’re an understudied group. One of my broad goals is to develop a program of research that advances knowledge among this group so that we know how to help them. The idea to research smoking, specifically, I just fell upon. A mentor had data and studies where he was targeting Latinos and it just happened to be about smoking. I was willing to do that because it’s a community I’m interested in. Ten years later, I’m still doing it!

By Lynda Gonzalez. Posted May 1, 2018.