Effectiveness of Smoking Cessation Strategies Among Latin Population in Miami

Cigarette Smoking in the US

Smoking kills more than 400,000 people in the US and robs the country of $96 billion annually due to reduced productivity. In curbing the smoking behavior, there’s a need to employ effective smoking cessation strategies among smokers, who show the willingness to quit smoking behavior. The purpose of the research is to discuss the effectiveness of smoking cessation strategies among the Latino population in Miami. This study will answer the following questions: 1) what are the most effective strategies for smoking cessations among Latino population in Miami? 2) What percentage of complete-quit and recurrent habits do smoking cessation strategies have in Latino populations? 100 current or former Latino smokers from Miami who tried smoking cessation strategies will participate. The sample will be equally divided into two strata, one for female and the other for male participants. The study is cross-sectional with 100 current or former smokers. Quota sampling will be used to determine the sample size. Data will be collected by the use of questionnaires while analysis will employ t-tests that will answer the first question and Chi-squares for data that will answer the second question.

Introduction

The effects of smoking are devastating since it negatively affects the human population to a great extent. Smoking tobacco is the biggest cause of preventable diseases in the US (Gierisch, Bastian, Calhoun, McDuffie, & Williams, 2012). Half of those who smoke fail to quit and, as a result, this population is likely to acquire a smoking-related disease. In the US alone, smoking is responsible for over 400,000 premature deaths and more than $96 billion loss due to a reduction in productivity (Kaplan et al., 2014). The situation is further worsened when conditions associated with this unhealthy behavior are brought into the big picture. The use of tobacco among inhabitants of Miami and other areas of the US is the chief cause of morbidity and mortality, contributing to the loss of approximately $156 billion in loss of productivity and over 480,000 deaths annually (Lewis, Morris, Andrew, Pangilinan, Chen, Tiozzo, Woolger, & Konefal, 2014).The number of deaths is larger because of the involvement of disease conditions emanating from addictive smoking behaviors. Despite the reduction in the prevalence of smoking since 1964 (Lewis et al., 2014), it’s still a big problem not only for the country’s economy but also to its health status. Currently, about a quarter of the population in both Miami and other areas of the US are smokers. However, there’s hope for improvements in reducing the prevalence of smoking. Maziak, Taleb, Bahelah, Islam, Jaber, Auf, & Salloum (2012) say that about 70% of the current 44.5% US smokers are willing to quit. Such a thing is realistic due to various effective smoking cessation strategies. The purpose of this research study is to identify and discuss the effectiveness of smoking cessation strategies among the Latino population in Miami.

Research Questions

This research study looks forward to addressing the following research questions by studying the Latino population of Miami.

  • What are the most effective strategies for smoking cessations among the Latino population in Miami?
  • What percentage of complete-quit and recurrent habits do smoking cessation strategies have in Latino populations?

Theoretical Framework

The theoretical framework for this proposal is the Behavioral System Model by Dorothy Johnson. Johnson views humans as composed of biological and behavioral systems and the role of the nurse is to focus on the behavioral system (Gonzalo, 2011). A human being strives behaviorally to adjust and maintain stability or achieve a steady state of adaptation. According to the model, health is the opposite of illness. In the context of this research proposal, smoking is a behavior that affects health of individuals such as the Latinos in Miami. There’s adequate evidence to prove that death and diseases have been caused by smoking. The role of a nurse or other people interested in offsetting the behavior is to propose and enforce behavioral changes among the smokers in the Miami’s Latino population. Such a thing will happen through the use of smoke cessation strategies that are effective in achieving the goals of enforcing behavioral changes for the realization of healthy lives.

Review of Literature

Cigarette smoking in the US accounts for more than 400,000 premature deaths (Kaplan et al., 2014). Furthermore, the country loses over $96 billion due to the productivity loss associated with smoking behaviors among citizens. There is less literature that shows the patterns of smoking in Miami and other parts of the US as well as the nation itself. Although little is known about smoking behaviors across the US, there are no recent extensive surveys on the topic that target the Latino population living in the country as well as any of the states (Kaplan et al., 2014). However, some of the surveys show that the overall rate of smoking is relatively modest among the Latinos in the country. Merzel et al. (2015) state that they examined smoking behaviors among Latino adults who lived in different parts of the US. The population studied comprised of more than 16,000 Latino adults. Such an examination revealed that that the smoking behaviors vary, but the fact remained that it’s one of the major social problems and a solution should be searched for.

Variations in Smoking Among the Latinos

The presented survey has managed to show differences in smoking patterns in some of the areas in the US. For instance, a national survey that was done in four different places including Miami described cigarette use among Latinos of different genders, ages, socioeconomic statuses, birthplaces, backgrounds, etc. (Kaplan et al., 2014). This survey was carried out between 2008 and 2011 and included about 16,300 participants of 18-74 years of age from the Bronx, Miami, Chicago, and San Diego. The results showed that smoking is more prevalent among men than among females. Additionally, different subgroups of the Latino community have different patterns when it comes to the prevalence rates. This means that the effect of smoking varies across genders and Latino subgroups.

Along the same lines, the results of the survey showed that Puerto Ricans have the highest rate of smoking, with men representing 35% of the population while females stood at 32.6% (Kaplan et al., 2014). The Cuban people represented 31.3% and 21.9% for men and women respectively. However, Cubans had a high intensity of smoking is terms of pack-years and the number of cigarettes smoked per day. This reveals that although smoking prevalence may be high in a population, the intensity of smoking may be relatively small compared to those whose prevalence in low. The Dominicans were the lowest in the prevalence of smoking with men representing 11% and women – 11.7%. In this group, males smoke less than females, but the variation is less significant.

On the other hand, people with different sociological statuses show varied patterns of smoking and willingness to quit this addictive behavior. In addition, Latinos may have the highest rates of smoking among the US population. The assertion is based on the facts that Kaplan et al. (2014) explain in their research. They found that other people from different backgrounds show intermediate prevalence among the Latino groups. However, the variation in gender is more or less the same for both the Latino population and individuals from other backgrounds. Webb, Rodríguez-Esquivel, and Baker (2010) reiterate this by saying that females smoke less than males. That notwithstanding, the smoking rates vary relative to socioeconomic status and education level among many other things. For instance, Merzel et al. (2015) found that individuals with low socioeconomic and education status smoke more than those with high status and are less likely to quit this behavior. These findings are an accurate representation of the fact that those who experience sociological challenges are more likely to smoke. This includes the Latinos, who reside in Miami.

Solution to Smoking Behaviors

Smoking is an immense problem that needs a solution. Lewis et al. (2014) say that the use of tobacco is number one in causing morbidity and mortality among Americans in addition to contributing to the loss of about $156 billion annually due to lost productivity. Furthermore, approximately 480,000 people die from the effects of smoking. For instance, Lewis et al. (2014) say hearts attacks, cancer, strokes, and chronic obstructive pulmonary diseases, as well as other conditions, are associated with smoking and use of tobacco. These health conditions are deadly and result in death. Although the prevalence of smoking among the US nationals has dropped considerably since 1964 (Lewis et al., 2014), it’s still a significant challenge to the country’s economy and health status. This assertion is true since about a quarter of the US population including the Latinos of Miami continues smoking up till now (Lewis et al., 2014). The situation is further worsened, because the current rate of smoking is enough to lead to tobacco-related health conditions that are claiming the lives of many people not only in the nation at large, but also in Miami specifically. Therefore, there’s a need to solve this devastating problem.

It’s beneficial for individuals to quit or reduce the amount they smoke through various methods after willingness to quit. According to Zhu, Lee, Zhuang, Gamst, & Wolfson (2012), quitting smoking has numerous health benefits for current smokers. Most importantly, interventions that elevate the rate of quitting in any given population save a substantial amount of lives. Maziak et al. (2012) say that the single most significant opportunity for improving health and reducing premature death is a personal modification of behavior. Unhealthy behaviors account for about 40% of all deaths in the US (Maziak et al., 2012). Smoking has contributed to too many deaths in addition to other unhealthy behaviors. Evidence has shown that the change in the behavior of persons who smoke is necessary not only for reducing the deaths but also the suffering associated with these devastating and addictive behaviors.

Smoking Cessation Strategies and Their Effectiveness

Out of many smokers in Miami and the US at large, a substantial percentage is willing to quit the practice. According to Maziak et al. (2012), out of the current 44.5 million US smokers, 70% are ready to quit. Moreover, those who are willing to quit often visit physicians annually while 46% report attempting to cease smoking in the previous years. Surprisingly, despite the elevated rate of willingness to quit, quit rates are still very low. Maziak et al. (2012) say that only 2.5% of the smokers attempt quitting without counseling or pharmacotherapy, but a cessation rate of about 10% may help avoiding up to 1.1 million deaths in the US. Such a change can be instrumental to the nation.

The only solution is to use effective strategies so as to achieve the best results. In the past, the decline in the rates of smoking among men and women has been attributed to laws that promote smoke-free zones (Maziak et al., 2012). Furthermore, the decline has been caused by the increase in taxation rates of cigarettes and increased number of smoke-free public places. These strategies have been useful to some, but only to some extent, because they have not helped eliminate this challenge altogether. The challenge with most of these strategies is that they aren’t 100% efficient, since those who quit may go back to the previous smoking behavior. Therefore, there is a need to focus on more strategies.

Another strategy that can help individuals quit smoking is smoking cessation counseling. The most common type of counseling is through the use of self-help materials. These materials can entail books, pamphlets, and brochures among many others. According to Asvat, Cao, Africk, Matthews, & King (2014), although the use of counseling is not common, it is reported to be among the most effective methods in helping individuals quit smoking. Additionally, proactive use of telephones to call smokers and offer counseling services is useful. Asvat et al. (2014) explain that tobacco quitlines are not only accessible but also effective with approximated six-month abstinence rates of around 12.7%. However, only a small fraction of smokers (about 1.2%) employ them. Due to the effectiveness of phones, some states and regions have established quitlines that help provide this kind of counseling to most smoking residents at no charge (Asvat et al., 2014). Moreover, counseling can be done in a group setting.
Regardless of the type of counseling, information delivered to smokers who are willing to quit is helpful.

According to Asvat et al. (2014), a problem-solving approach can result in better results. A good example of how counseling can help is determining the frequency of smoking at the times one smokes most often. For instance, if it’s after a meal in the morning or evening, the counselor provides something that may distract the pattern. The effectiveness of this method can also be enhanced through group counseling since groups can be supportive to individuals who smoke. Asvat et al. (2014) assert that more intensive strategies like personal and group cessation counseling are more effective than the traditional ones. For instance, individual smoke cessation counseling has an estimated six-month abstinence rate of 16.8% while group counseling stands at 13.9%. The biggest challenge with the two strategies is that they aren’t very accessible to minority and low-income communities (Asvat et al., 2014). Therefore, counseling is one of the most effective smoking cessation strategies.

Furthermore, education and guidance from healthcare professionals, family members, and friends are effective in enabling people to cease smoking. Useful guidance and advice from professionals give smokers knowledge that can improve the quitting process. Asvat et al. (2014) ascertain that psychoeducation before the beginning of a quitting strategy improves knowledge and beliefs about the cessation of smoking. The knowledge acquired may be necessary to do away with beliefs and myths. Social encouragement to cease from this behavior can make this strategy more effective. Centers for Disease Control and Prevention (CDC), 2011) say that social support may come from healthcare professionals, friends and family members, and the community as a whole. Therefore, advice from health professionals and many other people is also an effective strategy.

Finally, mass campaigns are effective in encouraging the public to withdraw from smoking behaviors. Mass campaigns can entail the use of websites, disseminating self-help materials and print media, public rallies, etc. Mass media can also utilize radios, televisions, billboards, and print ads (Durkin, Brennan, & Wakefield, 2012). The campaigns have proved to be effective at reducing the prevalence of smoking at the public level. The most critical thing in this strategy is that a vast population is covered within a very short time (Durkin, Brennan, & Wakefield, 2012). The effectiveness of this method comes from the fact that it helps deliver information on why people should cease smoking and the effects of smoking among many others. Such information makes smokers acquire knowledge and clear misconceptions, hence achieve better outcomes.

Research Methods

Research Design

It’s a cross-sectional study to assess the effectiveness of smoking cessation strategies among the Latino smokers in Miami. There will be two groups of participants divided according to their gender with each group having 50 members. Each participant will either have smoked in the past or is a current smoker from the Miami Latinos. Researchers will then collect data using questionnaires that will be distributed to each of the participants to fill. All the participants must meet the inclusion eligibility criteria before being recruited. Answering of the questionnaires will provide data on each of the research questions. Data collected from the questionnaires will then be analyzed and a discussion of the results presented.

Sample Size and Sampling Strategy

The research study determines the sample size and the sampling strategy in addition to how the participants will be recruited. To avoid bias the study plans to do a quota sample. This involves the researcher identifying population strata and determining the number of research participants required from each of the strata. Additionally, the study will do a consecutive sampling that involves recruiting study participants from the accessible population which meets the eligibility criteria over a particular interval of time or for a given sample size. In this research study, the accessible Latino population in Miami will be eligible to participate. This will involve Latinos, who visited a family medical practice within thirty days.

This study will have a sample size of 100 participants that will include former or current Latino smokers. They will be equally divided into two strata by gender. 50 males and 50 females will participate. The sample will be required to yield a power of 80% detect an effect size of 0.5% standard deviations with a significance level of 5%.

Recruitment of the sample will be based on the screening of the following questions:

  • Do you smoke or have you ever smoked?
  • Have you ever used smoking cessation strategies?
  • Have you quit smoking before?
  • Have you relapsed after quitting smoking?

Eligibility Criteria

At this juncture, the study will determine which participants will participate in the study. This study will only allow people from the Latino population in Miami to participate.

Inclusion Criteria

The following will take part in this research study:

  • Current or former smokers from the Miami’s Latino population who had used smoking cessation strategies

Exclusion Criteria

The following will not fit in the study:

  • Individuals who have never smoked
  • Current smokers who have never used smoking cessation strategies
  • Non-Latinos

Instruments

This research study will use questionnaires to collect data. The questionnaires have several questions the answers to which will address the research questions. The questions concern the following areas:

  • Gender
  • Whether participants are former or current smokers
  • Attempts to quit smoking
  • Methods of ceasing smoking
  • Stages of change for quitting
  • A copy of the research questionnaire is attached to this proposal as Appendix A.

Data Collection Procedures

Researchers will distribute the questionnaires to the participants who will have met the eligibility requirements. The participants will be given 5-10 minutes to answer the questions before questionnaires are collected by the researchers.

Data Analysis

Data will be gathered through the use of questionnaires and the raw data acquired will then be analyzed. Analysis of data will involve the use of t-tests and Chi-squares. T-tests will be utilized in analyzing the data that will answer the first research question: what are the most effective strategies for smoking cessations among Latino population in Miami? On the other hand, Chi-square analysis will yield information that will help answer the question: what the percentage of complete-quit and recurrent habits do smoking cessation strategies have in Latino populations?

Potential Limitations of the Proposal

Although the implementation of this project will yield useful information on the effectiveness of smoking cessation strategies among Latinos in Miami, the research is limited to a small population. This may not give conclusive results about the situation in this region. Different types of populations that may show variations in the effectiveness of these strategies are present.

Research Questionnaire

Instructions: Fill in the questionnaire by ticking or filling in the blank spaces appropriately.

Q 1: Please choose your gender

  • Female
  • Male

Q 2: At present, do you smoke cigarettes:

  • daily
  • occasionally
  • not at all

Q 3: How long since the last cigarette.

  • Less than 1 day
  • 1-30 days
  • 2-6 months
  • More than 6 months
  • More than 1 year

Q 4: In the time since using the Smoking Cessation Program, how many times have you stopped smoking for at least 24 hours, because you were trying to quit?

  • 1
  • 1-5
  • More than 5

Q 5: Did you use any other kind of assistance to help you quit? IF YES, What kind of assistance have you used? Please choose.

  • Advise from a health professional.
  • Website. If yes, which one(s)?
  • Telephone program. If yes, which one(s)?
  • Counselling program. If yes, which one(s)?
  • Self-help materials (booklets, pamphlets, books, etc.). If yes, which one(s)?
  • Quit with a friend(s) or family member(s) for support
  • E-cigarette
  • Special filters or holders
  • Others (specify)
  • None

Q 6: Considering quitting within the next 6 months (This question is asked only of “current smokers.”)

  • Yes
  • No