disertation gs format printed

CHARACTERISTICS OF LATINO SMOKERS IN DIFFERENT STAGES OF CHANGE LIVING IN MINNESOTA

A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL

OF THE UNIVERSITY OF MINNESOTA BY

JOSÉ WILLIAM CASTELLANOS

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF

DOCTOR OF PHILOSOPHY

STEPHEN SCHONDELMEYER, PH.D., ADVISOR

MAY, 2011

i

Acknowledgements

I would like to express my sincere gratitude to those who have encouraged and

helped me complete my doctoral program and this dissertation. First, I wish to recognize

my advisor Dr. Stephen Schondelmeyer for his friendship and invaluable guidance and

patience during this journey. Without his support and wisdom it would have not been

possible to complete this dissertation.

I owe great thanks to Dr. Jon Schommer, the Director of Graduate Studies of

Social and Administrative Pharmacy and my thesis committee chair, for his thoughtful

comments, recommendations and advice. He always had the proper words to encourage

me when I most needed it.

I want to express a special gratitude to Dr. Bob Cipolle, a fine friend and

committee member, who always cared when I needed it. His kindness, wisdom, and

understanding constantly provided me support and confidence to reach my goals.

I recognize Dr. Steven Foldes, a friend and colleague from the Diverse Racial

Ethnic Groups and Nations (DREGAN) Project, also a committee member, who

facilitated my access to the data set and assisted me through the complexities of

community based participatory research.

I would also like to express my appreciation to Dr. Michael Oakes, who guided

me throughout the design and methodological approaches of the dissertation.

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I wish to thank Dr. Peter Morley for his friendship and sophisticated intellect,

who through endless conversations helped me to think about new roles and new personal

and professional challenges.

I recognize my colleagues and staff at the College of Pharmacy for their

friendship and support.

I would like to thank my friend Dr. Gabriela Vazquez for her practical

recommendations about the methodology and analysis.

I immensely appreciate Lauren Haun for her useful recommendations in the

revision of this dissertation.

Special gratitude is expressed to Comunidades Latinas Unidas En Servicio

(CLUES), Blue Cross Blue Shield of Minnesota, and CLEARWAY-MN, for their

generous funding, support, and implementation of the DREGAN project and for

facilitating my access to the data set, as well as allowing me the time and space to

complete this study.

Finally, I would like to express immense gratitude to my family, especially to my

beloved sons Camilo José, Francisco Javier, and William Ricardo, my sisters Claudia

Mireya and Martha Socorro, my brother, Juan Luis, my nephews Julian Guillermo and

Johan Dario, and my dear friend Lupita Alba, for their unconditional love, emotional

support and permanent encouragement to finish this dissertation.

iii

Dedication

In memoriam of my parents, Blanca Luisa and José Guillermo.

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Abstract

Introduction

Tobacco use among Latino communities living in Minnesota is a cause of concern

due to their vulnerabilities. Recent immigrants face the stress of acculturation,

immigration- related issues, inadequate health insurance access, lack of family and social

networks, lack of knowledge about the short-and long-term consequences of exposure to

second-hand smoke (SHS), and the absence of culturally-appropriate and linguistically-

competent tobacco cessation programs.

Tobacco cessation interventions have traditionally been designed and

implemented for the mainstream population and then translated to be used among

minority communities. This approach does not recognize the unique characteristics of

smokers from other cultures and ethnic groups. For this reason, in order to develop

culturally-appropriate and linguistically-competent smoking cessation interventions, it is

necessary to understand and address the complexities of Latino tobacco users.

In order to understand these characteristics, the Stages of Change (SOC) model

was used to classify Latino smokers and former smokers into the preparation,

contemplation, pre-contemplation, and maintenance stages of change.

Objectives

The objectives of this study are 1) to describe the characteristics of Latino tobacco

smokers living in Minnesota; 2) to determine if there are significant differences between

v

Latino smokers not willing to quit using tobacco, in the pre-contemplation SOC; Latino

smokers willing to quit using tobacco, in the preparation SOC; and Latino former

smokers in the maintenance SOC; by socioeconomic status and level of acculturation;

self reported physical and mental health, consumption of fruits and vegetables, and

physical activity; beliefs regarding smoking, positive aspects of smoking, and knowledge

of tobacco-related diseases; attitudes and level of exposure to SHS; and the level of

cigarette addiction and willingness to quit smoking; finally, the study will 3) identify

significant characteristics of Latino smokers that would be relevant to develop culturally-

competent and linguistically-appropriate tobacco cessation interventions.

Methods

This research is a cross sectional study, using secondary data from the Diverse

Racial and Ethnic Groups and Nations (DREGAN) project, focused on adults, eighteen

years old or older who self-identified as Latino or Hispanic, or born in a Latin-American

country or who have a parent or grandparent born in a Latin-American country, who

agreed to respond to the survey questionnaire. Minors of eighteen years old, who are not

Latino or from Latino origin, or qualified respondents who refused to answer the survey

questionnaire were excluded from the study.

Definition of variables

The SOC algorithm was used to address if there were relevant relationships

between the independent variables and the SOC that could be used to design culturally-

vi

appropriate tobacco cessation programs. Using the DREGAN dataset, an analysis dataset

was created by recoding and combining participant survey responses.

Statistical analysis

SPSS version 19.0 software was used to conduct all statistical analyses, including

descriptive, bivariate and multivariate analysis.

Descriptive statistics were performed to summarize the characteristics of the

respondents. Percents, means, and standard deviation of the means were calculated for

continuous variables. Numbers and percentages were calculated for categorical variables.

The continuous variables were compared using one-way analysis of the variance

(ANOVA), the dichotomous categorical variables were compared using Chi-square test,

and the thricotomuos categorical variables were analyzed using order logistic regression.

Variables that were moderately associated with the comparisons categories (p<0.1) were

identified and analyzed using logistic regression controlling for age and gender to

examine their association with smokers in the different stages of change.

Results

The study reported that current smokers are more likely to be men than ever

smokers. Smokers in the maintenance SOC tend to be older than smokers in the

preparation and pre-contemplation SOC, as well as those in the preparation compared to

smokers in the contemplation and pre-contemplation SOC. Smokers in the maintenance

SOC are more likely to be married or live in a marriage-like relationship than current

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smokers. Smokers who answered that they were uncomfortable asking for help to quit

smoking are more likely to live with children under 18 years old.

Never smokers are more likely to answer the survey in Spanish than ever

smokers. Smokers who believed that they were unlikely to succeed if they wanted or

decided to quit smoking are less likely to have friends from the same ethnic background

than those who believed they were likely to succeed. Similarly, smokers in the

preparation SOC are less likely to believe that smoking facilitates friendship than those in

the pre-contemplation SOC.

It was also found that never smokers and smokers in the maintenance SOC,

compared to ever and current smokers, are less likely to be exposed and have their

children exposed to SHS, be comfortable with others smoking around them, live in a

house and ride in a car in which someone smokes; as well are more likely to live in a

home and prefer to work where smoking is not allowed. Similarly, a lower percentage of

smokers in the preparation SOC rode in a car in which someone smoked during the

previous week and was exposed to SHS compared to smokers in the contemplation and

pre-contemplation SOC.

However, smokers who believed they were unlikely to succeed if they wanted to

quit smoking are more likely to live in a house where someone smokes. Never smokers

compared to ever smokers are less likely to report stressful events, major injury or illness

during the previous year, and a belief that smoking relieves stress. Similarly, never

smokers and smokers in the preparation SOC are less likely to believe that smoking

provides pleasure than ever smokers and those in the pre-contemplation SOC, and

viii

smokers who answered they were unlikely to succeed if they decided to quit smoking are

less likely to believe that people smoke because they want to.

Smokers who answered they were unlikely to succeed if they wanted to quit

smoking are less likely to exercise adequately than those who answered they were likely

to succeed. On the contrary, smokers who disagree with the belief that the only way to

stop smoking is through will power are more likely to report a major injury or illness

during the previous year, and are more likely to have a normal body mass index (BMI)

than those who agreed.

Never smokers and smokers in the preparation SOC are less likely to report major

change in the health of a relative during the previous year than current and smokers in the

pre-contemplation SOC; similarly, smokers in the preparation SOC are less likely to

report major change in family reunions during the previous year than smokers in the pre-

contemplation SOC, and are more likely to report interesting things in their daily life than

those in the pre-contemplation SOC.

It was also found that never smokers and smokers in the maintenance SOC,

compared to ever and current smokers, are more likely to believe that there are no

positive aspects of smoking, and live in a home and work where smoking is not allowed.

Similarly, never smokers are more likely to report happiness than ever smokers. Never

smokers are more likely to believe that smoking causes heart disease than ever smokers.

Similarly, smokers in the maintenance SOC are more likely to believe that

smoking causes more harms than benefits than current smokers. However, smokers who

disagree with the belief that the only way to stop smoking is through will power are less

ix

likely to believe that smoking causes more harms than benefits than those who agreed

with those beliefs.

The study also found that smokers in the maintenance SOC are less likely to

smoke their first cigarette and smoke regularly after their 18th birthday than current

smokers. However, a larger percentage of smokers in the preparation SOC smoked

cigarettes regularly after their 18th birthday compared to those in the contemplation and

pre-contemplation SOC.

Smokers in the preparation SOC are more likely to believe that they would be

very likely to succeed if they want or decide to stop smoking than those in the pre-

contemplation SOC; similarly, a larger percentage of smokers in the preparation SOC

does not enjoy smoking compared to smokers in the contemplation and pre-

contemplation SOC. Finally, as expected, smokers who disagree with the belief that the

only way to stop smoking is through will power are more likely to feel very comfortable

asking for help to stop smoking than those who agreed with that belief.

Conclusions

The results show that Latino smokers living in Minnesota share some of the

characteristics described by previous studies including high level of exposure to SHS, the

trend to quit smoking when older, to smoke cigarettes and are not willing to quit when

are exposed to stressful events, the belief that smoking facilitates friendship and provides

pleasure, enjoyment of smoking, and negative expectations for successfully quitting

smoking. These hypotheses should be tested in prospective intervention studies of

x

smoking cessation interventions using the SOC algorithm, taking into account the

prevalence of smoking differences between women and men and the causes of smoking.

As the most accessible health care practitioner, pharmacists are in a privileged

position to provide smoking cessation interventions, especially to Latino recent

immigrants who do not know how to navigate the complex health care systems in the

U.S. By learning the unique characteristics of Latino smokers, pharmacists will be able to

address their needs and increase the possibilities for successful outcomes.

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Table of Contents

Page No

Acknowledgements……………………………………………………………………….i

Dedication………………………………………………………………………………..iii

Abstract……………………………...…………………………………………………...iv

Table of Contents………………………………………………………………………..xi

List of Tables……...…………………………………………………………………...xxii

List of Graphics...……………………………………………………………………..xxvi

List of Appendices...…………………………………………………………………xxvii

Chapter I. Introduction...……………………………………………………………….1

Significance of the problem…………………………………………………………...1

History of tobacco use...………………………………………………………………2

The Latino population in Minnesota...………………………………………………...5

Health care barriers facing Latino communities in Minnesota………………………..9

Public health priorities for Latino communities in Minnesota………………………12

Objectives of the Study………………………………………………………………12

Significance of the Study……….……………………………………………………13

Chapter II. Literature Review...……………………………………………………….15

Nicotine addiction……………………………………………………………………15

xii

Tobacco-related diseases ……………………………………………………………17

Tobacco-related mortality……………………………………………………………20

Smoking prevalence among the U.S. adult population…...………………………….21

Smoking prevalence among the U.S. Latino adult population………...…………….21

Smoking prevalence by gender among the U.S. adult population…...……...……….22

Smoking prevalence by gender among the U.S. Latino adult population……….......22

Smoking prevalence by country of origin among the U.S. adult Latino population...23

Smoking prevalence among the Minnesota adult population…...…………….……..23

Smoking prevalence by gender among the Minnesota adult population…...………..23

Smoking prevalence among the Minnesota adult Latino population…...………........24

Smoking prevalence by age………………………………………….....………........24

Smoking prevalence by marital status……………………………….....………........25

Smoking prevalence by level of education…….…………………….....………........25

Smoking prevalence by income…..………………………………….....………........26

Smoking prevalence by level of acculturation.…...………………….....………........27

Self-reported health status and smoking.................………………….....………........28

Mental health disorders and smoking.....................………………….....………........30

Smoking and stress……………….………………………………….....………........30

Smoking and weight, Body Mass Index (BMI), consumption of vegetables and fruits,

and physical activity…….…….…….……………………………….....………........31

Smoking and friendship….……….………………………………….....………........34

Smoking and knowledge of tobacco-related diseases.........………….....………........34

xiii

Exposure to second-hand smoke............................………………….....……….........35

Smoking bans………………….….………………………………….....………........36

Quitting Smoking……..……….….………………………………….....………........38

Chapter III. Theoretical Framework and Hypotheses……...………………………..39

Stages of change model……………………………………………………………...39

Hypotheses……..……………...….………………………………….....………........40

Hypothesis 1……..…..………...….………………………………….....………........40

Hypothesis 2……..…..………...….………………………………….....………........42

Hypothesis 3…....……………...….………………………………….....………........44

Hypothesis 4……..…..………...….………………………………….....………........46

Hypothesis 5……..…..………...….………………………………….....………........48

Chapter IV. Methodology..…………………………………………………………….51

Study Design..………………………………………………………………………..51

The Diverse Racial Ethnic Groups and Nations (DREGAN) Project………………..51

DREGAN research design…………………………………………………….……..52

DREGAN survey instrument design………….……………………………….……..52

Survey instrument description………….…….……………………………….……..53

DREGAN survey methodology ………..…….……………………………….……..53

Sample description……..…..………...….…………………………………...............54

Interviewers training…..…..….……...….…………………………………...............55

xiv

Data collection…..…………………………………………………………………..56

Study statement research question…….……………………………………………..56

Survey inclusion criteria……………………………………………………………..57

Survey exclusion criteria……………………………………………………………..57

Definition of variables………………...……………………………………………..57

Statistical analysis.…………………………………………………………………..62

Institutional Review Board (IRB) approval………………………...………………..63

Chapter V. Results...……………………………………………………………………64

Sample characteristics…………………………………………………………..…....64

Demographic characteristics of the sample..………..…………………………...64

Self-reported health status ..……..……………………………………….………65

Acculturation ..……..…………………………………………………………….67

Smoking status..………………………..………………………………………...69

Smoking beliefs………………..………………………………………………...70

Second-hand smoke behaviors……...…………………..………………………..71

Smoking behavior………...……..………………….…………………………....71

Socioeconomic characteristics given smoking status and stages of change………....75

Comparison by socioeconomic status variables between never smokers and ever

smokers…………………...…………………………….………………………..75

Comparison by socioeconomic status variables between current and former

smokers………………...…………………………….……………………..…....76

xv

Comparison by socioeconomic status variables between former smokers in the

maintenance SOC, current smokers willing to quit, in the preparation SOC, and

current smokers no willing to quit, in the pre-contemplation SOC………….......77

Comparison by socioeconomic status variables between smokers in the

preparation and pre-contemplation SOC……..….……………………………....78

Comparison by socioeconomic status variables between smokers in the pre-

contemplation, contemplation, and preparation SOC…………...……….….…...78

Comparison by socioeconomic status variables given likelihood of success if

wanted to quit smoking……….………………….……………………………....79

Comparison by socioeconomic status variables given believes about the

likelihood of success if decided to quit smoking…….……………………..…....80

Comparison by socioeconomic status variables given level of comfort asking for

help…………………………………………………….……...…………….…....80

Comparison by socioeconomic status variables given level of agreement about the

belief that the only way to stop smoking is through will power…….…….…......81

Summary results for hypothesis one……………......…………….……......………...82

Self-reported health status given smoking status and stages of change………...........84

Comparison by self-reported health status among never smokers and ever

smokers……….......................……………………….……...…………………...84

Comparison by self-reported health status among former smokers and current

smokers……………………………………………….……...…………………..85

xvi

Comparison by self-reported health status among former smokers in the


current smokers no willing to quit, in the pre-contemplation SOC………….…..86

Comparison by self-reported health status among smokers in the preparation and

pre-contemplation SOC……………………………….……...………………….86

Comparison by self-reported health status among smokers in the pre-

contemplation, contemplation, and preparation SOC…...……………………….88

Comparison by self-reported health status given likelihood of success if wanted to

quit smoking……………...……………………….……...……………………...88

Comparison by self-reported health status given likelihood of success if decided

to quit smoking……………………………………………...…………………...89

Comparison by self-reported health status variables given level of comfort asking

for help…….………………………………………….……...…………………..89

Comparison by self-reported health status variables given level of agreement

about the belief that the only way to stop smoking is through will power….…...90

Summary results for hypothesis two……………..…………….……...……………..91

Beliefs about smoking variables given smoking status and stages of change……….94

Comparison by beliefs about smoking variables among never smokers and ever

smokers…………………………………………………………………………..94

Comparison by beliefs about smoking variables among former and current

smokers…………………………………………………………………………..95

xvii

Comparison by beliefs about smoking variables among former smokers in the


current smokers no willing to quit, in the pre-contemplation SOC……………...96

Comparison by beliefs about smoking variables among smokers in the preparation

and pre-contemplation SOC……………………………………………………...97

Comparison by beliefs about smoking variables among smokers in the pre-

contemplation, contemplation, and preparation SOC…………………………....98

Comparison by beliefs about smoking variables given likelihood of success if

wanted to quit smoking…………………………………………………………..98

Comparison by beliefs about smoking variables given likelihood of success if

decided to quit smoking………………………………………………………….98

Comparison by beliefs about smoking variables given level of comfort asking for

help…………………………………………………………………………….....99

Comparison by beliefs about smoking variables given level of agreement about

the belief that the only way to stop smoking is through will power……..……....99

Summary results for hypothesis three……………………………………………....100

Behaviors about second-hand smoke variables given smoking status and stages of

change…...…….……………………………………………………………………102

Comparison by behaviors about second-hand smoke variables among never and

ever smokers………………...…………………………………………….……102

Comparison by behaviors about second-hand smoke variables among former and

current smokers……………...…………………………………………….……104

xviii

Comparison by behaviors about second-hand smoke variables among former

smokers in the maintenance SOC, current smokers willing to quit, in the

preparation SOC, and current smokers no willing to quit, in the pre-contemplation

SOC………………………………………………………………………..……105

Comparison by behaviors about second-hand smoke variables among smokers in

the preparation and pre-contemplation SOC……………………………..…..…107

Comparison by behaviors about second-hand smoke variables among smokers in

the pre-contemplation, contemplation, and preparation SOC……………..……107

Comparison by behaviors about second-hand smoke variables given believes

about the likelihood of success if wanted to quit smoking…...…………...……108

Comparison by behaviors about second-hand smoke variables given believes

about the likelihood of success if decided to quit smoking………………….....108

Comparison by behaviors about second-hand smoke variables given level of

comfort asking for help…………………………………………………..…..…109

Comparison by behaviors about second-hand smoke variables given level of

agreement about the belief that the only way to stop smoking is through will

power……………………………………………………………………....……109

Summary results for hypothesis four………………………………………….……110

Behaviors about smoking and beliefs about stopping smoking variables given

smoking status and stages of change……….........……………………..……..……112

Comparison by behaviors about smoking and beliefs about stopping smoking

variables among never and ever smokers………………………..…………..…112

xix


variables among former and current smokers……………………………..……113


variables among smokers in the maintenance, preparation, and pre-contemplation

SOC...…….……………………………………………………..………………113


variables among smokers in the preparation and pre-contemplation SOC…..…114


variables among smokers in the pre-contemplation, contemplation, and

preparation SOC…………………………………………..……………….……115


variables given believes about the likelihood of success if wanted to quit

smoking…………………………………………………………………………116


variables given believes about the likelihood of success if decided to quit

smoking………................................................................................................…116


variables given level of comfort asking for help……………..……………...…117


variables given level of agreement about the belief that the only way to stop

smoking is through will power.…….………………………….....………….…117

Summary results for hypothesis five……………..……………….…..………….…118

xx

Chapter VI. Discussion and Conclusions...…………………………………………..121

Key findings...……………………………………………………………………....121

Socioeconomic characteristics…….…………………………………………....121

Relevant comparisons given socioeconomic status………………………….....123

Relevant comparisons given self-reported health status……………………......125

Relevant comparisons given beliefs about smoking…………………………....126

Relevant comparisons given behaviors about second-hand smoke………….....127

Relevant comparisons given behaviors about smoking and beliefs about stopping

smoking….…………………………………………………….....…………..…129

Discussion………………………………………………………………………......130

Smoking prevalence……………………………………….....……………....…130

Smoking and socioeconomic variables…...……………….....……………....…130

age………………………………………………..…………………......131

Marital status…………...………………………..………………….......131

Acculturation…………………...………………………..……………...131

Smoking addiction……………………………...………………………..……..133

Exposure to SHS behavior……………………...………………………..……..134

Smoking beliefs and behaviors…………….…...………………………..……..136

Smoking and stressful events…………………...………………………..……..138

Expectations about quitting and confidence to succeed………..………..……..139

Quitting smoking and smoking restrictions…...………………………..…..…..140

xxi

Limitations……………………………………………………………………….....140

Recommendations………………………………………………………………......141

Conclusions……………………………………………………………………........144

References………………………..………………………………………………….....145

Appendices………...……………..………………………………………………….....159

xxii

List of Tables

Table 1. Sample disposition and response rate………………………………………......55

Table 2. Demographic characteristics of the sample………….………………………....65

Table 3. Self reported health status, physical activity, and stress……………………......66

Table 4. Summary of health variables…………………………………….…………......67

Table 5. Summary of acculturation categorical variables……………………………......68

Table 6. Acculturation scales……………………………………………...…………......69

Table 7. Self-reported smoking behavior………………………………...…………........69

Table 8. Smoking status……………………………..…………………...…………........70

Table 9. Smoking beliefs…......……………………..…………………...…………........70

Table 10. Second-hand smoke behaviors………………………………...…………........72

Table 11. Smoking outcomes continuous variables……………………...…………........72

Table 12. Smoking Behavior....……………………..…………………...…………........74

Table 13. Former smokers........……………………..…………………...…………........74

Table 14. Statistically significant differences between never smokers and ever smokers

given socioeconomic status ………………………….………………..……........76

Table 15. Statistically significant differences between former and current smokers given

socioeconomic status …………………………………..………..…………........77

Table 16. Statistically significant differences between smokers in the maintenance,

preparation, and pre-contemplation SOC given socioeconomic status….............78

Table 17. Statistically significant differences between smokers in the preparation,

contemplation, and pre-contemplation SOC given socioeconomic status.............79

xxiii

Table 18. Statistically significant differences by likelihood to succeed if wanted to quit

smoking given socioeconomic status.……………….…...…………....................80

Table 19. Statistically significant differences by likelihood to succeed if decided to quit

smoking given socioeconomic status.……………….…...…………....................80

Table 20. Statistically significant differences by level of comfort asking for help to quit

smoking given socioeconomic status.……………………….…...…....................81

Table 21. Statistically significant differences by agreement about the belief that the only

way to stop smoking is through power given socioeconomic status.…..…………..…....82


given self-reported health status……………….…….………………..……........85

Table 23. Statistically significant differences between former and current smokers given

self-reported health status ……………………………..………..………….........86

Table 24. Statistically significant differences between smokers in the preparation and pre-

contemplation SOC given self-reported health status …………...…………........87


smoking given self-reported health status………………………………..............88

Table 26. Statistically significant differences by level of comfort about asking for help to

quit smoking given self-reported health status.…….............................................89


way to stop smoking is through will power given self-reported health status…...91


given beliefs about smoking.……...……………..….…...…………....................95

xxiv

Table 29. Statistically significant differences between former and current smokers

given beliefs about smoking ………………….....….…...…………....................96


preparation, and pre-contemplation SOC given beliefs about smoking. ..............97

Table 31. Statistically significant differences between smokers in the preparation and pre-

contemplation SOC given beliefs about smoking……………......…………........97


smoking given beliefs about smoking………………..…………………..............99


way to stop smoking is through will power, given beliefs about smoking….….100

Table 34. Statistically significant differences between never and ever smokers given

behaviors about second-hand smoke…………...….…...………........................103


given behaviors about second-hand smoke……..….…...………........................105


preparation, and pre-contemplation SOC given behaviors about second-hand

smoke…….………………………………………………….…….....................106


contemplation, and pre-contemplation SOC given behaviors about second-hand

smoke...................................................................................................................108


smoking given behaviors about second-hand smoke……………………...........108

xxv


smoking given behaviors about second-hand smoke……………………...........109


given behaviors about smoking and beliefs about stopping smoking ………….113


preparation, and pre-contemplation SOC given behaviors about smoking and

beliefs about stopping smoking ………………………………………………..114

Table 42. Statistically significant differences between smokers in the preparation and

pre-contemplation SOC given behaviors about smoking and beliefs about

stopping smoking……………………………………………………………….115


contemplation, and pre-contemplation SOC given behaviors about smoking and

beliefs about stopping smoking…………..............…………………………….116


way to stop smoking is through will power given behaviors about smoking and

beliefs about stopping smoking……...………………………...……………….117

xxvi

List of Graphics

Graphic 1. Total U.S. cigarette consumption 1900 – 2006………….…….………………5

Graphic 2. Per Capita U.S. adult cigarette consumption 1900 – 2006……...…………….5

xxvii

List of Appendices

Appendix A. U.S. Smoking status by selected demographic variables 1965 – 2006…..160

Appendix B. DREGAN phone bilingual survey………..……………………………....162

Appendix C. DREGAN face to face bilingual survey………..………………………...191

Appendix D. Study variables………………………………....………………………...245

Appendix D 1. Dependent variables……….……..……....………………………...246

Appendix D 2. Hypothesis 1 Independent variables………....……………………..246





Appendix E. Demographic characteristics of the sample…………………………........249

Appendix E 1. Demographic characteristics of the sample categorical variables….250

Appendix E 2. Demographic characteristics of the sample continuous variables….252

Appendix F. Self-reported health status, physical activity, and stress variables…….....253

Appendix F 1. Self-reported health status, physical activity, and stress categorical variables………………………………………………………………………..…...254 Appendix F 2. Self-reported health status, physical activity, and stress continuous variables…………………………………………………………………..………...256

Appendix G. Summary of acculturation categorical variables……..…...……………...257 Appendix H. Smoking beliefs ……..…………………………………………………...262

xxviii

Appendix I. Second-hand smoke behaviors………..…………………………………...264

Appendix J. Smoking behaviors…………………...…………………………………...265

Appendix K. Group comparisons given socioeconomic status……….............……......267

Appendix K 1. Never and ever smokers given socioeconomic status………...........268

Appendix K 2. Former and current smokers given socioeconomic status………….268

Appendix K 3. Smokers in the maintenance, preparation, and pre-contemplation

SOC given socioeconomic status…...........................................................................268

Appendix K 4. Smokers in the preparation and pre-contemplation SOC given

socioeconomic status.................................................................................................269

Appendix K 5. Smokers in the preparation, contemplation, and pre-contemplation

SOC given socioeconomic status...............................................................................269

Appendix K 6. Likelihood to succeed if wanted to quit smoking, given

socioeconomic status.……………………................................................................270

Appendix K 7. Likelihood to succeed if decided to quit smoking given

Socioeconomic status.…………….…………...……….…...…………....................270

Appendix K 8. Level of comfort asking for help to quit smoking given

Socioeconomic status.…………………….………………...….…...…....................270

Appendix K 9.Agreement about the belief that the only way to stop smoking is

through power given socioeconomic status.…..……................................................271

Appendix L. Group comparisons given self-reported health status……………...…......272

Appendix L 1. Never and ever smokers given self-reported health status………....273

Appendix L 2. Former and current smokers given self-reported health status …….273

xxix

Appendix L 3. Smokers in the maintenance, preparation, and pre-contemplation

SOC given self-reported health status…............................................…………........274

Appendix L 4. Smokers in the preparation and pre-contemplation SOC given

self-reported health status………………………………………...…………...........274

Appendix L 5. Smokers in the preparation, preparation, contemplation, and pre-

contemplation SOC given self-reported health status…………........…………........275

Appendix L 6. Likelihood to succeed if wanted to quit smoking given

self-reported health status…………………………..…………..…………..............275

Appendix L 7. Likelihood to succeed if decided to quit smoking given

self-reported health status……………………………..………..…………..............276

Appendix L 8. Level of comfort about asking for help to quit smoking given self-

reported health status.…….......................……….....................................................276

Appendix L 9. Agreement about the belief that the only way to stop smoking is

through will power given self-reported health status.……............……....................277

Appendix M . Group comparisons given beliefs about smoking.…………......……..…278

Appendix M 1. Never and ever smokers given beliefs about smoking.……....……279

Appendix M 2. Former and current smokers given beliefs about smoking ………..279

Appendix M 3. Smokers in the maintenance, preparation, and pre-contemplation

SOC given beliefs about smoking..............................................................................280

Appendix M 4. Smokers in the preparation and pre-contemplation SOC given beliefs

about smoking……………......……………………………………………..............280

xxx

Appendix M 5. Smokers in the preparation, contemplation, and pre-contemplation

SOC given beliefs about smoking……………..................................…………........281

Appendix M 6. Likelihood to succeed if wanted to quit smoking given beliefs about

smoking………………………………………………………………......................281

Appendix M 7. Likelihood to succeed if decided to quit smoking given beliefs

about smoking………………….……………………………………………….......282

Appendix M 8. Level of comfort asking for help to quit smoking given beliefs

about smoking……………………………………………………………................282

Appendix M 9. Agreement about the belief that the only way to stop smoking is

through will power given beliefs about smoking….……………..………………....283

Appendix N. Group comparisons given behaviors about second-hand smoke………...284

Appendix N 1. Never and ever smokers given behaviors about second-hand

smoke……………………………………………………………………………….285

Appendix N 2. Former and current smokers given behaviors about second-hand

smoke……..……...…...……….................................................................................285

Appendix N 3. Smokers in the maintenance, preparation, and pre-contemplation

SOC given behaviors about second-hand smoke….…………….…….....................285

Appendix N 4. Smokers in the preparation, and pre-contemplation SOC given

behaviors about second-hand smoke.........................................................................286

Appendix N 5. Smokers in the preparation, contemplation, and pre-contemplation

SOC given behaviors about second-hand smoke.......................................................286

xxxi

Appendix N 6. Likelihood to succeed if wanted to quit smoking given behaviors

about second-hand smoke……………………….…………………………….……286

Appendix N 7. Likelihood to succeed if decided to quit smoking given behaviors

about second-hand smoke………………….………………………..………...........287

Appendix N 8. Level of comfort asking for help to quit smoking given behaviors

about second-hand smoke………………….…………………………..……….......287

Appendix N 9. Agreement about the belief that the only way to stop smoking is

through will power given behaviors about second-hand smoke…………….……...287

Appendix O. Group comparisons given behaviors about smoking and beliefs about

stopping smoking …………………..……………………………………………....288

Appendix O 1. Never and ever smokers given behaviors about smoking and beliefs

about stopping smoking ………………………………………………………...….289

Appendix O 2. Former and current smokers given behaviors about smoking and

beliefs about stopping smoking ……………………………………………...…….289

Appendix O 3. Smokers in the maintenance, preparation, and pre-contemplation

SOC given behaviors about smoking and beliefs about stopping smoking….……..289

Appendix O 4. Smokers in the preparation and pre-contemplation SOC given

behaviors about smoking and beliefs about stopping smoking……………….…....290

Appendix O 5. Smokers in the preparation, contemplation, and pre-contemplation

SOC given behaviors about smoking and beliefs about stopping smoking…….......290

Appendix O 6. Likelihood to succeed if wanted to quit given behaviors about

smoking and beliefs about stop smoking………………………………………..….291

xxxii

Appendix O 7. Likelihood to succeed if decided to quit given behaviors about

smoking and beliefs about stop smoking…………………...…………………...….292

Appendix O 8. Level of comfort asking for help to quit given behaviors about

smoking and beliefs about stop smoking…………………...……………………....293

Appendix O 9. Agreement about the belief that the only way to stop smoking is

through will power given behaviors about smoking and beliefs about stopping

smoking……………………………………………………………………………294

1

CHAPTER ONE

INTRODUCTION

Significance of the problem

The combination of the addictive substance nicotine with potent mutagens,

including polonium-210, has made tobacco the principal human poison of the last century

(U.S. Department of Health, 1979; Ravenholt, 1990). Tobacco use is considered the

primary cause of preventable deaths in the world. In the United States, it is associated

with more than 430,000 deaths per year since 1999. In Minnesota, the Department of

Health reported more than 5,600 deaths per year attributable to tobacco use and exposure

to second-hand smoke (SHS) since 2002 (Minnesota Department of Health, the

Minnesota Partnership for Action Against Tobacco (MPAAT), Blue Cross and Blue

Shield of Minnesota (Blue Cross), and the University of Minnesota, 2004).

Tobacco use among Latino communities in Minnesota is a cause of concern due

to the vulnerabilities of this population, particularly recent immigrants who face the

stresses of acculturation, immigration-related issues, inadequate health insurance

coverage, lack of family and social networks, and the absence of culturally-appropriate

and linguistically-competent tobacco cessation programs.

Tobacco cessation interventions have traditionally been designed and

implemented for the mainstream communities and then translated to be used among

minority populations. This approach does not recognize the unique characteristics of

smokers from other cultures and ethnic groups. For this reason, in order to develop

2

culturally-appropriate and linguistically-competent tobacco cessation interventions, it is

necessary to understand and address the complexities of Latino tobacco users.

This research contributes to the better understanding of the characteristics of

Latino smokers living in Minnesota.

History of tobacco use

Considered a sacred plant by natives of the Americas, tobacco has been used for

medicinal, ritual, and economic purposes for more than 5,000 years. According to Musk

and De Klerk (2003), tobacco has been snuffed, smoked, chewed, eaten, drunk, smeared

over bodies, and used in eye drops and enemas; tobacco was also blown onto warriors’

bodies before battle, over fields for agricultural success, over women’s bodies for

fertility, and it has been offered in ritual ceremonies. The Native Americans primarily

smoked tobacco using pipes, although some sniffed tobacco dust through a tube.

The first contact of the Western civilization with tobacco occurred on the islands

of present day Cuba and Haiti by Christopher Columbus and his crew in November 1492

(Ravenholt, 1990), and later by Cortes in what today is Mexico (Crawford, 1853);

however, they did not understand the spiritual, ritual, and social contexts of its use.

Known during some years as “paetum” (Ravenholt, 1990), it is widely accepted

that the Spaniards took the name “tobacco” from the name of the pipe the natives of the

Caribbean used to smoke tobacco leaves (Crawford, 1853).

After the conquest of the natives of the Americas, Spaniards and the Portuguese

extensively cultivated tobacco in the West Indies and in the territory of present day

3

Brazil. They introduced tobacco to Europe and the Philippines in the sixteenth century.

Jean Nicot, the French ambassador to Lisbon, sent tobacco seeds as medicine to Queen

Catherine de Medici and the House of Lorraine, initiating tobacco use and cultivation in

France in 1559 (Ravenholt, 1990). At that time, only pharmacists were authorized to sell

tobacco in Europe, and only based on medical prescriptions (Austin, 1979).

Sir John Hawkins transported tobacco to England from his second expedition to

Florida in 1565; twenty years later, Sir Walter Raleigh, upon his return from his first

expedition to Virginia, introduced the practice of smoking tobacco to England. By 1607,

with the establishment of the namesake colony King James I on the James River in

Virginia, and upon the initiative of John Rolfe, tobacco quickly became Virginia’s

principal crop and export. By the end of the sixteenth century, the Portuguese were

trading tobacco in Africa, India, the Spice Islands, Japan, Macao, China, and other places

in Asia. By the seventeenth century, tobacco was widely used in all trading nations in

Europe, Asia, and Africa (Ravenholt, 1990) and after salt, tobacco likely became one of

the most universally consumed products (Crawford, 1853). While pipe smoking

continued to be the most popular form of tobacco use among the lower classes, snuffing

was a more popular option in Europe among the upper classes during the 1700s

(Ravenholt, 1990).

Throughout the nineteenth century, soldiers and tourists introduced cigarette

smoking and expanded tobacco use in Europe and America. British soldiers returning

from Wellington’s Napoleonic campaigns in the Iberian Peninsula (1808-14) introduced

cigarette smoking to England, and its use increased after the Crimean War (1853-6).

4

Tourists returning from Europe later brought the practice of cigarette smoking to the U.S.

Chewing tobacco, however, remained the most common form of tobacco use during the

nineteen century. In the U.S., tobacco use increased after the American Civil War (1861-

5) (Ravenholt, 1990).

During the nineteenth century, thanks to the development of the cigarette rolling

machine by James Bonsack and Washington Duke and Sons in 1884, U.S. cigarette

production expanded from 1.3 million cigarettes in 1880 to 2.5 billion cigarettes in 1900.

By 1890, Duke’s factory produced 90% of American cigarettes, leading to an antitrust

dismemberment in 1911 (Ravenholt, 1990). In the twentieth century, tobacco use

continued its ascendant trend; in the U.S., annual cigarette consumption per adult

increased from 54 cigarettes in 1900 to 4,345 cigarettes in 1963; a peak of 640 billion

cigarettes were produced in 1981 (Smith & Fiore, 1999).

After 1964, annual cigarette consumption has decreased in the U.S. as a

consequence of the release of 29 Surgeon General reports on tobacco and health,

extensive educational public health campaigns warning about the dangers of tobacco use

and exposure to SHS, as well as a better understanding of the potent addictive properties

of nicotine, the active ingredient in tobacco. Tobacco continues, however, to be

considered the most serious and widespread form of addiction in the world (Pollin &

Ravenholt, 1984).

Graphics 1 and 2 show the cigarette consumption trend in the U.S. from 1900 to

2006.

5

Graphic 1

Total U.S. Cigarette Consumption 1900 - 2006

Source: Source: http://www.cdc.gov/tobacco/data_statistics/tables/economics/consumption/ accessed March 27, 2011.

Graphic 2 Per Capita U.S. Adult Cigarette Consumption 1900 - 2006

Source: Tobacco Outlook/TBS-260/April 28, 2006. Economic Research Service, USDA.

The Latino population in Minnesota

Some authors have found diverse terminology for defining the Latino population;

the most commonly used definitions include “Mexican” and “Mexican-American”

6

(Acuña, 1988). Lillie-Blanton, Leigh, and Alfaro-Correa (1996), refer to those of

“Hispanic origin,” “Spanish-speaking,” “Spanish-surnamed,” “Spanish-origin,”

“Spanish-American,” “Spaniards,” “Hispanos,” (Ulrich, 1999), “Chicano,” “Hispanic,”

“Latino,” and the population’s self-identified terms “Mexicana” and “Mexicano”

(Valdes, 2000). “Hispanic” and “Latino” are the most accepted terms to identify

members of the populations who trace their origin to Latin-American countries. This

study uses the term “Latino” to identify the population which recognizes its Latin-

American ancestry or has immigrated to the U.S. from Latin-American countries.

Since the nineteenth century, Latinos have come to Minnesota employed by

farmers, then by the sugar beet industry, and in the twentieth century by the food

processing, landscape, and leisure industries primarily in hotels, bars and restaurants.

During the last decades of the twenty century, some Latinos from Central America and

South America came to Minnesota as political refugees. Latinos have also been coming

to Minnesota under the family reunification program and as students.

Migrant workers in Minnesota tend to migrate with their families from their home

community in the Rio Grande Valley along the Texas-Mexico border, directly to a

Minnesota location in the Northeast or Southern regions. Most of them are of Mexican

descent, and are U.S. citizens or permanent residents of Texas (Ulrich, 1999). The sugar

beet-growing region of the Red River Valley, straddling the Minnesota-North Dakota

border was, and continues to be, a major destination for Latino seasonal workers;

however, advances in sugar beet production, such as improved seeds and herbicides, have

reduced the demand for migrant workers (Ulrich, 1999).

7

The south-central and southeast regions of the state, where canneries process

sweet corn, green peas, and other vegetables, are also destinations of migrant workers.

Typically, processing facilities recruit workers through company representatives or

through hired labor contractors who travel to southern Texas and northern Mexico each

winter to enroll workers (Contreras, Duran & Gilje, 2001).

Migrant workers, like most Latinos, come to Minnesota to improve their family’s

quality of life. Originally, they provided the seasonal workforce necessary to thin sugar

beets, pick strawberries, cut asparagus, and perform the hand labor necessary to produce

the wide variety of perishable fruits and vegetables grown in the state. Later, as

agricultural production practices became more mechanized and specialized, field work

shifted to driving trucks, operating machinery in the fields, and processing and packaging

seasonal vegetable crops. In Minnesota, many migrant workers now perform field work

and factory work, and more are employed in nursery settings in the expanding ornamental

crop industry (Ziebarth & Byun, 2002). The estimated value added annually to the local

economy due to the presence of the Latino labor force employed in agricultural industries

is approximately $24.7 million (Ziebarth & Byun, 2002).

The first Latinos in the Twin Cities metropolitan area settled on the west side of

the Mississippi river in Saint Paul in the late 1880s, during the winter season, while

waiting to work in agriculture during the spring, summer and fall seasons. Other Latinos

settled in neighborhoods around Lake Street in South Minneapolis, and on the East Side

of Saint Paul. Recently, Latinos have settled in the Frogtown area in Saint Paul. Hispanic

Advocacy and Community Empowerment through Research (HACER) has observed

8

Latino enclaves throughout the metropolitan area, including Ecuadorians and Peruvians

in the northeast area of Minneapolis and Salvadorans in Richfield. Ulrich (1999)

observed that first-generation Latinos tend to settle in the city, while the second

generation is moving to the suburbs. Suburban residents tend to be older and have higher

incomes and educational levels than Latinos living in the city. Of city residents, Latinos

in St. Paul tend to have lived in Minnesota longer than Latinos in Minneapolis, by a

median time period of 13 years in St. Paul vs. four years in Minneapolis, and are more

likely to have been born in the United States. In addition, St. Paul residents are far more

likely to own their own home than those living in Minneapolis (Ulrich, 1999).

Among Latinos currently living in Minnesota, almost 90% of the population of

Mexican descent and 74% of other Latino ancestry are native-born U.S. citizens, and over

half (54%) of the population of Mexican descent and 31% of other Latino origin are

native-born Minnesotans. Approximately three percent of Minnesota’s Mexican born

residents and nine percent of other Latinos living in Minnesota are naturalized U.S.

citizens. In 1990, 93% of the population of Mexican descent and 83% of other Latino

ancestry living in Minnesota were U.S. citizens (Compean, 1995).

Census data from the year 2000 (U. S. Census Bureau, 1990, 2000) show that

Latinos in Minnesota are immigrating from different countries, including Mexico

(66.7%), Puerto Rico (4.6%), Cuba (1.8%), and other Latin American countries (26.9%).

Approximately 53.6% of the Latino population is located in the Twin Cities metropolitan

area. The city with the largest Latino population is Minneapolis, with 29,175 Latinos

representing 7.6% of its population; St. Paul follows with 22,715 Latinos, about 7.9% of

9

its population; Faribault has 4,084; Northfield has 3,488; and Willmar has 2,911 Latinos,

representing 15.9% of its population.

The 2000 census also shows that Latinos have become the largest minority in the

U. S. They are a significant work force that contributes to the economic progress of the

country. In Minnesota, the Latino population has grown 466% since the 1980 census, and

166% during the 1990s, from a population of 53,884 in 1980 to 143,382 in 2000,

representing 2.9% of the total population.

The Latino population is vulnerable to high morbidity and mortality rates, due to

the low utilization of health services and the fact that about 30% of Mexican- Americans

do not have health insurance or are under-insured. In addition, the health care barriers

affecting the Latino population add to their vulnerability and increase the need for

developing sound risk factor reduction programs, including prevention of tobacco use and

the implementation of smoking cessation programs (Trevino & Moss, 1984). Previous

studies do not reflect the reality of the tobacco problem in the Latino community of

Minnesota. Most of the studies have a margin of error higher than 2.9%, which prevents

the results from being generalized to the Latino population living in Minnesota.

Health care barriers facing Latino communities in Minnesota

According to HACER, many Latinos find it difficult to understand the dynamics

of the U.S. health care system and the concept of health insurance. Latinos who are

enrolled in Medical Assistance and Minnesota Care meet obstacles when it comes to

finding out more information about these programs. They must communicate

10

predominantly with English-speaking program officers. Lack of materials in Spanish and

the shortage of Spanish-speaking case-workers is a common complaint. Some Latinos

have stated that they, or others whom they know, have assumed they were not eligible for

services before applying for the programs. These assumptions were based on rumors,

eligibility requirements from other states where they previously lived, and expectations

about income qualifications (Smaida & Blewett, 2002).

Information is often shared by word-of mouth between community and family

members. Many Latinos fear encounters with government institutions because, despite

being residents or American citizens, many have concerns about the role of the U.S.

government and fear of deportation. It is because of this situation that government

sponsorship or government involvement in public health care programs is often a concern

for Latinos. The cost of health care, including the cost of premiums, deductibles, and co-

pays is a significant barrier to health care services as reported by focus group

participants. Many individuals find the cost of private and even some public insurance

programs to be prohibitive. Even when their employers offer insurance options, many

individuals feel they cannot afford to purchase them. They often have to make difficult

financial decisions and must weigh the need for health care against other basic needs.

This leads to access problems and infrequent use of clinics and health care services

(Castellanos, Flores & Giles, 2004).

In rural settings, geographic location is more often an issue than in the

metropolitan area. In such areas, Latinos have transportation difficulties, and it has been

11

noted that the only available health care facility is sometimes located a long distance

from their homes.

There are numerous issues that affect Latinos’ health, including housing

problems, occupational safety, and problems affecting the more vulnerable members of

their communities such as the elderly and community members suffering from chronic

diseases. Several Latinos have stated that they feel knowledgeable about the need for

health promotion and prevention services, but believe that prevention is not always

financially possible if it means extra visits to the clinic for screenings (Castellanos, Flores

& Giles, 2004).

There is a general clash of cultures, lack of comprehensible information, and a

limited understanding of Latino cultural issues by public health and health care

professionals. Together, these limitations create a situation that is extremely frustrating to

Latinos who are new to Minnesota. Some Latinos associate any trip to the doctor or

hospital with significant out-of-pocket costs. This dilemma often leads to difficult

choices, like whether to pay the rent or pay for the health care service.

In urban areas, neighborhood and housing issues such as a lack of affordable

housing are more often related as a cause of health care access barrier than in rural areas.

Latinos living in rural areas report employer discrimination and occupational hazards as

health care access barriers more often than their metropolitan counterparts do. In

addition, Minnesota’s weather is also a challenge, especially during the winter season, for

a population who migrated from tropical and subtropical latitudes. (Castellanos, Flores &

Giles, 2004).

12

Public health priorities for Latino communities in Minnesota

The Minnesota Department of Health has determined the following to be Hispanic Latino

Health Priority Areas: diabetes, healthy youth development, HIV/AIDS and STDs,

immunization for children and adults, breast and cervical cancer, cardiovascular disease,

unintentional injuries and violence, and infant mortality (Minnesota Department of

Health, Office of Minorities and Multicultural Health. Eliminating Health Disparities

Initiative, 2003). Tobacco use and environmental exposure to tobacco smoke do not

appear to have been seen as a priority problem among Latino communities, because these

communities have not been exposed to decades of public health campaigns and warnings

emphasizing tobacco use and SHS exposure dangers (Blue Cross and Blue Shield of

Minnesota, ClearWay Minnesota, & Comunidades Latinas Unidas en Servicio, 2006). In

addition, the tobacco industry is targeting the Latino population, particularly women and

the youth, to expand its market, which has been reduced among mainstream communities

in the U.S.

Objectives of the Study

The objectives of the study are:

1. To describe the characteristics of Latino cigarette smokers living in

Minnesota.

2. To determine if there are significant differences between Latino smokers not

willing to quit smoking, in the pre-contemplation Stage of Change (SOC);

13

Latino smokers willing to quit smoking, in the preparation SOC; and Latino

former smokers, in the maintenance SOC. Differences will be evaluated by

socioeconomic status and level of acculturation; self-reported physical and

mental health, consumption of fruits and vegetables, and physical activity;

beliefs regarding smoking and positive aspects of smoking, and knowledge of

tobacco-related diseases; attitudes and level of exposure to SHS; and the level

of cigarette addiction and willingness to quit smoking.

3. To identify the significant characteristics of Latino smokers that would be

relevant to develop culturally-competent and linguistically-appropriate

tobacco cessation interventions.

Significance of the study

This study addresses, for the first time, the relevant characteristics of Latino

smokers living in Minnesota. Frequently, characteristics of smokers from minority

populations in the state of Minnesota have been generalized from studies targeting the

mainstream population; minority populations have been included, but the sample sizes

and the margins of error have precluded generalization of these results to those

populations. No previous studies to determine the characteristics of Latino smokers have

been conducted in Minnesota.

The Latino population of Minnesota has unique characteristics, such as broader

ethnic and cultural diversity, that must be taken into account in order to design, develop,

14

and implement culturally and linguistically-appropriate tobacco control interventions and

smoking cessation programs.

15

CHAPTER TWO

LITERATURE REVIEW

Nicotine Addiction

Nicotine, discovered by Gaspare Cerioli in Italy and Louis Nicholas Vauquelin in

France in 1807, was isolated by Ludwig Heinrich Reimann and Karl Wilhelm Heinrich

Posselt in Germany in 1828 (Goodman, 1994). Nicotine is an alkaloid that mimics the

effects of acetylcholine, increases the flow of dopamine, and boosts the activity of the

brain's reward system, producing pleasure. Nicotine also induces cravings to keep it in

the bloodstream at sufficient levels to maintain its effects. As with other psychotropic

substances, the brain develops tolerance; therefore, in order to have the same level of

effect, users increase their dose of nicotine continuously to prevent withdrawal

symptoms. These include: heart rate and blood pressure changes, sleeping problems,

brain wave disturbances, and anxiety (Nestler & Malenka, 2004).

Addiction involves the progression from acute use to the development of drug-

seeking behavior, vulnerability to relapse, and the decreased, slowed ability to respond to

naturally rewarding stimuli (Koob & Kreek, 2007). Nicotine is as addictive as heroin and

cocaine. In 1988, the Surgeon General Report on Nicotine Addiction defined addiction as

“the compulsive use of a drug that has psycho-activity and that may be associated with

tolerance and physical dependence (i.e., may be associated with withdrawal symptoms

after the cessation of drug use)” (Department of Health and Human Services, 1988). The

report describes tobacco addiction as requiring daily cigarette consumption, difficulty

16

going a day without smoking, and a high likelihood of withdrawal symptoms after

cessation of smoking. Denial, rationalization, and reinforcement are key elements in the

addictive process (Hurt & Robertson, 1998).

According to Connolly, Alpert, Wayne, and Koh (2007), "Cigarettes are finely-

tuned drug delivery devices, designed to perpetuate a tobacco pandemic.” The

concentration of nicotine per cigarette sold in the U.S. increased by 11% from 1999 to

2005; on average, each cigarette contains 13.46 mg of nicotine, of which 1.79 mg are

metabolized as cotinine (Connolly, Alpert, Wayne, & Koh, 2007). The average blood’s

cotinine concentration in addicted smokers is about 300 ng per milliliter. The cotinine

level normalized for cigarette consumption is 14 ng per milliliter per cigarette, or 70 ng

per milliliter for a person who smokes five cigarettes per day. Benowitz and Henningfield

(1994) estimated a level of 50 to 70 ng of cotinine per milliliter, five cigarettes per day, as

the cut off point for the addictive threshold.

The revised fourth edition of the Diagnostic and Statistical Manual of Mental

Disorders –Test Revision (American Psychiatric Association, DSM-IV-TR, 2000),

includes nicotine dependence and nicotine withdrawal as substance-related disorders,

characterized by tolerance, withdrawal syndrome, patterns of compulsive use, desire to

cut down or regulate use, spending a great deal of time obtaining, using or recovering

from its effects, spending more time with substance-using friends, and continuing to use

the substance despite recognizing its contributing role to psychological or physical

problems. Once dependence is established, evidence suggests that tobacco motivation is

strongly influenced by a reduction in withdrawal symptoms, an expectation of stress

17

reduction, and conditioned reinforcement. Nicotine motivation may also be influenced by

modulation in stimulus incentive value (Baker, Brandon, & Chassin, 2004).

Tobacco-related diseases

According to the 2006 Report of the Surgeon General, tobacco smoke contains, in

addition to the addictive nicotine, more than 4,000 chemicals of which more than 60 are

recognized carcinogens. These include: acetaldehyde, acrolein, aromatic amines,

benzene, butadiene, carbon monoxide, cyanide, formaldehyde, hydroquinones, ketones,

nitrosamines, phenols, cadmium, chromium, hydrazine, lead, nickel, and the radioisotope

polonium-210. These substances, when absorbed, affect almost all the organs and

systems of the human body, particularly the cardiovascular, respiratory, and

gastrointestinal systems (U.S. Department of Health and Human Services, 2006).

Tobacco-related diseases have been described for more than four centuries.

Between 1603 and 1640, Ahmed I and his successor, Murad IV, Sultans of the Ottoman

Empire, banned smoking as a threat to public morals and health (Grehan, 2006). In 1604

in Oxford, England, King James I displayed “black brains and black viscera,” allegedly

obtained from the bodies of smokers (Whelan, 1984); in 1634, the Patriarch of Moscow

forbade the sale of tobacco (Price, 1961). More than one century later, Dr. John Hill

described the cancer of “the nasal passages” of a tobacco snuffer in 1761, followed by

Benjamin Rush’s description of the negative effects of smoking in 1798 (Rush, 1806). In

1851 in France, Jean Piaget described leukoplakia on the tongue of a pipe-smoking

patient (Ravenholt, 1990).

18

During the twentieth century, scientific evidence associates tobacco use with

cancer, cardiovascular diseases, respiratory diseases, and with the complication of many

other health problems. Fritz Lickint published the first statistical evidence linking lung

cancer and smoking in Germany in 1929 and introduced the term “passive smoking” in

1936; three years later, Oschner and DeBakey reported the association between smoking

and lung cancer, which has been validated consistently throughout the twentieth century

(Mackay, Eriksen, & Shafey, 2006).

In the early 1950s, scientific publications in the U.S. confirmed that tobacco is an

etiologic factor for bronchogenic carcinoma (Wynder & Graham, 1950; Doll & Hill,

2004). Due to the significant evidence linking tobacco and serious health problems, the

U.S. Surgeon General has published 29 reports on smoking and health, including:

Tobacco and Health (1964), Nicotine Addiction (1988), The Health Benefits of Smoking

cessation (1990), Tobacco Use among U.S. Racial and Ethnic Minority Groups (1998),

Women and Smoking (2001), The Health Consequences of Smoking (2004), and The

Health Consequences of Involuntary Exposure to Tobacco Smoke (2006). The first report

on Tobacco and Health confirmed that cigarette smoking is causally related to lung

cancer, oral cancer, cancer of the larynx, cancer of the esophagus, cancer of the urinary

bladder, chronic bronchitis, pulmonary emphysema, coronary disease, peptic ulcer, lower

birth weight, and accidental fires in the home (U.S. Department of Health, Education, and

Welfare. Public Health Service, 1964).

Further reports recognized that tobacco use is addictive and is the cause of cancer

in directly exposed tissues, such as the lips, mouth, nasopharynx, trachea, and bronchi. In

19

addition, prospective studies have shown the role of tobacco in causing cancers in many

other organs and tissues, including the pancreas, liver, spleen, stomach, kidneys, cervix,

prostate, skin, and bone marrow, and as a cause of acute myeloid leukemia (Ravenholt,

1990).

Studies have also documented the close relationship between cigarette smoking

and early coronary disease, atherosclerosis, and premature death from cardiovascular

diseases (Sargent, Shepard, & Glantz, 2004). In 1983, the U.S. Department of Human

Services acknowledged the temporal relationship between trends in cigarette smoking

and mortality from coronary heart disease, lung cancer, emphysema, chronic pulmonary

obstructive disease, cardiovascular diseases, cavities, halitosis, and other disorders.

According to the 2001 Surgeon General’s Report on Women and Smoking,

tobacco use negatively affects pregnancy outcomes, fertility, and contraception. Smoking

is also associated with higher rates of stillbirth and neonatal death, and is linked with

ectopic pregnancy and spontaneous abortion. Infants born to mothers who smoke during

pregnancy tend to have lower birth weight, and are small for their gestational age.

Obesity and smoking have been associated with birth defects and miscarriages. (U. S.

Department of Human Services, 2001). The report associates smoking with infertility,

alerts that smoking may be detrimental to in-vitro fertilization, and warns that women

who smoke and use contraceptives are at especially high risk for heart and cardiovascular

diseases (Sonfield, 2003).

In 2005, the Office of Environmental Health Hazard Assessment (OEHHA) of the

State of California found that SHS exposure is causally associated with respiratory

20

illnesses, infertility, cancer in young patients, perinatal problems, and cardiovascular

diseases. The assessment describes how SHS causes respiratory illnesses and lung cancer,

and its adverse impact on human reproduction, sudden infant death syndrome (SIDS),

increased respiratory tract infections, increased middle ear infections, and perinatal and

postnatal manifestations of developmental toxicity, resulting in low birth weight,

impaired lung function and growth, and pre-term delivery. Also, SHS causes acute lower

respiratory tract infections and other chronic respiratory symptoms in children including

bronchitis and pneumonia, asthma induction and exacerbation in children and adults; eye

and nasal irritation in adults; nasal sinus cancer; breast cancer in younger, primarily pre-

menopausal women; and acute and chronic coronary heart disease (OEHHA, 2005).

The health effects assessment also describes how there is some evidence of a

causal association of SHS exposure and the following conditions: spontaneous abortion,

intrauterine growth retardation, and adverse impact on cognition and behavior. Other

reported effects include allergic sensitization, infertility, elevated risk of stroke in adults,

decreased pulmonary function, exacerbation of cystic fibrosis, chronic respiratory

symptoms, and nasopharyngeal and cervical cancer in adults, as well as brain cancer and

lymphomas in children, (OEHHA, 2005).

Tobacco-related Mortality

During the period 1997- 2001, the Centers for Disease Control (CDC) estimated

an annual average of 437,902 deaths, 259,494 among men and 178,408 among women,

attributable to smoking in the U.S. Among adults, 158,529 (39.8%) of these deaths were

21

attributed to cancer; 137,979 (34.7%) to cardiovascular diseases; and 101,454 (25.5%) to

respiratory diseases. The three leading specific causes of smoking-attributable death were

lung cancer (123,836), chronic obstructive pulmonary disease (COPD) (90,582), and

ischemic heart disease (86,801). In the same period, smoking during pregnancy resulted

in an estimated 910 infant deaths annually. It is estimated that 38,112 lung cancer and

heart disease deaths annually were attributable to exposure to SHS, and 918 deaths were

also estimated from smoking-attributable fires (CDC, 2005).

Smoking prevalence among the U.S. adult population

Data from the CDC show that since 1965, the prevalence of cigarette smoking

among the U.S. population 18 years of age and older has consistently decreased, dropping

from 42.4% in 1965 to 20.8% in 2006. At the same time, the percentage of those who

never smoked has consistently increased from 44% in 1965 to 58.2% in 2006. During the

same period, the percentage of former smokers has changed from 13.6% in 1965 to 21%

in 2006 (CDC, 1992, 1999, 2000, 2001, 2004, 2005, 2007). A comprehensive description

of the cigarette consumption prevalence in the U.S. is shown in Appendix A.

Smoking prevalence among the U.S. adult Latino population

According to the National Health Interview Surveys (NHIS), the smoking

prevalence among the U.S. Latino population has consistently decreased from 34.3% in

1978 to 15.2% in 2006. Mirroring this reduction, the percentage of the Latino population

who has never smoked has increased from 52.9% to 72.1% in the same period. The

22

percentage of former smokers, however, has remained around 13% during the same

period, with a variation from 17.2% in 1985 to 12.7% in 2006.

Smoking prevalence by gender among the U.S. adult population

In the U.S., there is a higher prevalence of smoking among adult men who have

experienced a greater reduction in smoking prevalence, compared to women. From 1955

to 2006, smoking prevalence among adult men decreased from 68% to 23.9%; during the

same period, the smoking prevalence among adult women decreased from 32.4% to

18.0% (US Surgeon General, 1964; CDC, 2007).

Smoking prevalence by gender among the U.S. adult Latino population

Similarly, the “Morbidity and Mortality Weekly Report” (MMWR) shows

significant gender differences in the smoking prevalence and its reduction among U.S.

Latino populations, from 30.9% in 1990 to 20.1% in 2006 for men and from 16.3% in

1990 to 10.1% in 2006 for women respectively.

In 1989, in San Francisco, California, a study reported a smoking prevalence of

32.4% among Latino men and 16.8% among Latino women (Marin, Perez-Stable, &

VanOss, 1989). Five years later, in 1994, the reported smoking prevalence among Latino

men and women was 26% and 8% respectively (Perez-Stable, Marin, & VanOss, 1994).

In 2001, the smoking prevalence reported for Latino men and women living in the eight

cities with the largest concentration of Latino communities in the U.S. were 25% and

12.1% respectively (Perez-Stable et al., 2001).

23

Smoking prevalence by country of origin among the U.S. adult Latino populations

In addition to gender, studies have also found differences in the prevalence of

smoking among Latino populations by country of origin and age. According to the

Hispanic Health and Nutrition Examination Survey (HHANES), during the period 1982 –

1984, among Mexican, Puerto Rican, and Cuban populations in the U.S., approximately

40% of men and 26% of women were current smokers (Haynes, Harvey, Montes,

Nickens, & Cohen, 1990). In 1999, the reported smoking prevalence for Latino men and

women from Cuba, Puerto Rico and Mexico combined were 26.2% and 14.3%

respectively (CDC, 1999).

Smoking prevalence among the Minnesota adult population

Data from the Behavioral Risk Factor Surveillance System (BRFSS) show in

Minnesota a similar trend reduction of the smoking prevalence than in the U. S.

population, from 26.5% in 1984, to 18% in 2006.

Smoking prevalence by gender in the Minnesota adult population

Data from the Minnesota Adult Tobacco Survey (MATS) show a higher

prevalence of smoking among men compared to women as follows: 24% among men and

20.3% among women in 1999, 21.5% and 16.9% in 2003, and 18.6% and 15.5% in 2007

respectively (ClearWay Minnesota, Blue Cross and Blue Shield of Minnesota, and

Minnesota Department of Health, 2008).

24

Smoking prevalence among the Minnesota adult Latino population

The prevalence of tobacco use among adults 18 years and older in Minnesota’s

Latino population has not been assessed consistently state-wide. In Hennepin County

however, data from the Survey of the Health of Adults, the Population, and the

Environment (SHAPE) showed a reduction in the adult Latino population’s prevalence of

tobacco smoking, from 21.2% in 1998 to 13.6% in 2006 (Hennepin County Human

Services and Public Health Department, 2008).

Smoking prevalence by age

According to the CDC, data from 1965 to 2006 show how the number of smokers

has decreased for all age-groups as follows: Young adults, 18 to 24 year old, from 45.5%

in 1965 to 23.9% in 2006; 25 to 44 year old, from 51.2% in 1965 to 23.5% in 2006; 45 to

64 year old, from 41.6% in 1965 to 21.8% in 2006; and 65 year old and oldest, from

17.9% in 1965 to 10.2% in 2006. The 65 year old and oldest age group has consistently

reported the lowest prevalence of smoking.

As reviewed previously, in the U. S., the smoking prevalence difference by

gender remains in all age groups. For example, in 2006 the reported smoking prevalence

by gender and age group was: 18 to 24 year old (men, 29.5%; women, 19.3 %); 25 to 44

year old (men, 26%; women, 21%); 45 to 64 year old (men, 24.5%; women, 19.3%); and

65 year old and older (men, 12.6%; women, 8.3%) (CDC, 2007).

25

For the Latino populations, comprehensive data of smoking prevalence by age

group is not available. Some studies suggest a greater prevalence of smoking among

younger Latinos. According to the HHANES report, between 1982 and 1984, the age-

adjusted smoking rates were 42.5% for Mexican-Americans, 39.8% for Puerto Ricans,

and 41.6 % for Cubans. The age-adjusted rate for 20 to 34 year old Cuban-American men

was 50.1%, compared with 23.8% for Mexican-American women (Haynes, Harvey,

Montes, Nickens, & Cohen, 1990). Another study from HHANES found that age-specific

prevalence rates were lower for women than for men; however, when compared by age,

women in some age-cohorts have a higher prevalence of smoking (Escobedo &

Remington, 1989).

Smoking prevalence by marital status

A recent report shows that compared to the married, the likelihood of smoking is

significantly greater for single (continually never-married and continually divorced or

separated) men and women (Umberson & Liu, 2006).

Smoking prevalence by level of education

Some studies show that as the level of education increases, the ethnic differences

in smoking decrease and become negligible among those who completed college. A high

percentage of less-educated white men (92.5%) and most less-educated white women

(73.1%) were either current or former daily smokers (Winkleby, Schooler, Kraemer, Lin,

& Fortmann, 1995). Similarly, a study reported that Latino respondents with 12 years of

26

education or less increased their odds of smoking (OR = 1.17, 95% CI = 1.01, 1.35)

(Perez-Stable et al. 2001).

Data from the CDC show that since 1970, smoking prevalence among the adult

population with less than 12 years of education decreased from 37.5% to 26.6% in 2004

(Appendix A. Smoking Prevalence among U.S. adult population with less than 12 years

of education, 1970 – 2004). A study that analyzed data in California from 1979 to 1990

found large differences in smoking prevalence rates between Latino and white pairs with

lower levels of education. White men and women with less than a high school degree

were approximately twice as likely to be current, daily cigarette smokers compared with

similarly educated Latino men and women, 52.7% white men vs. 30.1% Latino men and

46.1% white women vs. 20.6% Latino women (Winkleby, Schooler, Kraemer, Lin, &

Fortmann, 1995).

Smoking prevalence by income

Data from the CDC show a higher smoking prevalence among the adult

population below the poverty level. Although there is a reduction in the smoking

prevalence for the total population since 1983, the difference remains stable. For the adult

population above the level of poverty the smoking prevalence decreased from 31.5% in

1983 to 20.4% in 2006; similar change was observed for the adult population below the

poverty level, from 40.2% in 1983 to 30.6% in 2006. During the same period, the

percentage of those who never smoked increased in both groups, from 45.8% in 1983 to

57.3% in 2006 for the adult population above the poverty level, and from 47.7% in 1983

27

to 55.8% in 2006 for the adult population below the level of poverty (CDC, 2007). A

comprehensive description of smoking prevalence in the U.S. is shown in appendix A.

Recent studies show that smoking behavior in developed countries is strongly

related to socioeconomic status (SES), with a higher prevalence among lower SES and

less educated populations, the unemployed, and single mothers. During the last 30 years,

the prevalence of smoking was reduced by more than 50% in the upper socioeconomic

levels of British society, but there were not significant changes in the most disadvantaged

groups. Smoking cessation rates in the Great Britain have an inverse relationship with

social deprivation (Fagerström, 2002).

Smoking prevalence by level of acculturation

Several studies have shown that among Latino populations, there are differences

between gender and level of acculturation. For example, in 1989 in San Francisco,

California, a telephone survey found that the age-adjusted overall smoking prevalence

among Latinos was 25.4%, with more men (32.4%) than women (16.8%) smoking, and

also that the age-adjusted smoking prevalence was higher among less acculturated men

(37.5%) compared with the more acculturated (26.7%). It was, however, higher among

more acculturated women (22.6%) compared with the less acculturated women (13.6%)

(Marin, Perez-Stable, & Vanoss, 1989).

Data from the 1995–1996 and 1998–1999 Current Population Survey Tobacco

Use Supplement showed that Latino immigrants exhibited significantly lower smoking

prevalence rates than non-immigrants. However, rates varied according to country of

28

origin (Baluja, Park, & Myers, 2003). Perez-Stable et al. (2001) found that smoking rates

were not significantly different by national origin among men, but Puerto Rican women

had higher rates of smoking than women from other Latino American countries. In

addition, they found that Central American men and women had the lowest smoking

rates. Foreign-born respondents were less likely to be smokers (odds ratio = 0.77, 95% CI

= 0.66 - 0.90) than U.S.-born respondents, and a high level of acculturation was

associated with the highest likelihood to be smokers for women (OR = 1.12, 95% CI =

1.00 - 1.25) and the lowest for men (OR = 0.86, 95% CI = 0.78 - 0.95). Puerto Rican and

Cuban respondents were more likely to be current smokers and to smoke more than 20

cigarettes per day. Older, U.S.-born, and more-educated Latino respondents were less

likely to be current smokers. Respondents of Puerto Rican and Cuban origin were more

likely to smoke. They concluded that acculturation has different effects on smoking

behavior by gender (Perez-Stable, et al.., 2001). Other researchers described how

acculturation, as indicated by English language use, increases the risk of smoking among

Latino adolescents which, associated with smoking-related psychosocial variables, may

lead to an increased risk of experimentation with smoking (Unger, Cruz, Rohrbach,

Ribisl, et al., 2000).

Self-reported health status and smoking

Several studies have found an inverse relationship between smoking and self

reported health status. Yaffe (2006) reported, after adjusting for demographics and other

health status measures, that perceived health status was affected significantly by smoking

29

status; the coefficient of smoking varied from -0.43 in the univariate model to -0.26 when

all the explanatory variables such as pain, any physical limitation, and high blood

pressure, were included in the model. Another study that examined the relationship

between smoking status and health-related quality of life (HRQOL) from the West

Virginia 2001 BRFSS found that compared to current smokers, non-smokers had greater

odds of reporting good, very good or excellent health (OR = 1.80, 95% CI = 1.34 - 2.34);

lower odds of reporting 14 or more days of poor mental health during the previous month

(OR = 0.48, 95% CI = 0.36 - 0.63); and lower odds of reporting 14 or more days of poor

physical health during the previous month (OR = 0.57, 95% CI = 0.43 - 0.76). Similarly,

non-smokers and former smokers had lower odds of reporting 14 or more days of activity

limitations during the previous month (non-smokers OR = 0.39, 95% CI = 0.27 - 0.55;

and former smokers OR = 0.62, 95% CI = 0.43 - 0.89) (Mody & Smith, 2003). The same

authors found similar significant associations in a cross-sectional analysis with self-

reported data from the U.S. 2001 BRFSS (Mody & Smith, 2006). Smoker status was also

found to negatively influence health self-rating (Wright, 1987).

A study using data from the Southwestern sample of the Hispanic Health and

Nutrition Examination Survey (HHANES) found that younger Mexican-American men

who smoke more than 10 cigarettes per day were more likely to report greater activity

limitation due to poor health, and that non-smoking middle-aged men and women

generally reported better health than lighter smokers (Lee & Markides, 1991).

30

Mental health disorders and smoking

Mental health diseases, including schizophrenia, depression, and drug abuse of

cocaine, heroin and alcohol are considered risk factors for nicotine addiction. Studies

have found that smokers are more likely to have a history of major depression and are

much less likely to quit than those with no history of depression, probably due to a

common genetic predisposition to the two disorders (Fagerström, 2002).

Smoking and stress

Several studies have found that smoking response to stress differs by gender and

stressor. For example, one study found that interpersonal loss events are associated with

continued abstinence, while women were more likely than men to relapse or continue

smoking in response to an adverse financial event. Health events were associated with the

increased likelihood of quitting for men than for women (McKee, Maciejewski, Falba, &

Mazure, 2003). A study found that Mexican-American women who smoke reported

higher levels of depressive symptoms (Lee & Markides, 1991). Similarly, another study

found that current smokers were more likely to report an increased level of depressive

symptoms compared with non-smokers (Ridner, 2005)

Studies have found that smoking is used to relieve stress; however, its effects vary

by gender. For instance, negative health and financial events have been described as

important risk factors for women and tobacco use. Men are more likely to quit smoking

in the presence of a health event, while women were more likely than men to continue

smoking in the presence of an adverse financial event (McKee, Maciejewski, Falba, &

31

Mazure, 2003). Smoking has been self-reported as relaxing and helping to reduce stress

(Kassel, Stroud, & Paronis, 2003). Nicotine dependence, however, appears to aggravate

stress. Parrot (1999) reported that smokers need nicotine to feel normal, and that their

stress level is higher than that of non-smokers.

Smoking, weight, Body Mass Index (BMI), consumption of vegetables and fruits,

and physical activity

Previous studies consistently reported that one of the reasons young adults smoke

is to control their body weight. (Rigotti, Lee, & Wechsler, 2000; Wee, Rigotti, Davis, &

Phillips, 2001). Some studies show that smokers have a lower weight than non-smokers

and suggest that smokers believe that smoking helps control their body weight. Smokers

are also more concerned about body weight than non-smokers (Wiseman, Turco, Sunday,

& Halmi, 1998). Some authors suggest that nicotine could have weight-control activity

(Wack & Rodin, 1982). Other authors suggest that men are less likely than women to

believe that smoking helps to control their weight (McKee, Nhean, Hinson, & Mase,

2006).

Another study found that for each point lower on the Body Discrepancy Score,

subjects were 19 percent more likely to smoke (Jackson, 2007). Some researchers have

found that a negative body image may decrease the number of cigarette cessation

attempts. In addition, weight gain during smoking cessation may adversely affect body

image and lead to an increased risk for relapse. (King, Matacin, White, & Marcus, 2005).

32

Among Latinos, a study using data from the Southwestern sample of the Hispanic

Health and Nutrition Examination Survey (HHANES) found less consistent findings

regarding smokers having lower body weight than non-smokers among Mexican-

Americans (Lee & Markides, 1991).

Studies suggest that body image and eating related disorders play a significant

role in smoking initiation (Stice & Shaw, 2003). A study found that smokers who use

media more than 4 hour per day do not have an increased risk for obesity or overweight,

contrary to non-smokers, who have 3.9 times greater risk for obesity and 1.6 times

greater risk of being overweight (Yore, Fulton, Nelson, & Kohl, 2007). Some authors

recognize that smoking is associated with weight control among middle age and older

smokers (Ward, Klesges, & Vander Weg, 2001).

Studies have consistently found that current smokers have lower BMI than former

smokers and those who have never smoked, independent of their dietary intake and

physical activity (Klesges, Eck, Isbell, Fulliton, Hanson, 1990; Klesges, Meyers, Klesges,

& LaVasque, 1989; Wack & Rodin, 1982). Goss and Grubbs (2005) found that smoking

has a greater effect on reducing BMI, disregarding fruit and vegetable consumption. A

study found that acculturation did not influence exercise and smoking status, but is

associated with adoption of some less desirable dietary habits. (Mainous III, Diaz, &

Geesey, 2008). Among rural Latinos in Yakima County, Washington, it was found that

socioeconomic status is not related to dietary behavior or smoking (Thompson,

Coronado, Solomon, McClerran, Neuhouser, & Feng, 2002).

33

Similarly, dietary and physical activity variables seem to be poor predictors of

post tobacco-cessation weight change (French, Hennrikus, & Jeffery, 1996). However,

the relationship between BMI and smoking status remains by gender (Eck, Hackett-

Renner, & Klesges, 1992). It has been reported, after adjustment for age, BMI, dietary

and alcohol intakes, and physical activity, that current smokers have a greater amount of

central adiposity, than former smokers and those who have not smoked (Troisi, Heinold,

Vokonas, & Weiss, 1991).

Obesity has been reported to be more prevalent among former smokers, men and

women, and less prevalent among women smokers (Lahti-Koski; Pietinen, Heliövaara, &

Vartiainen, 2002).

Some studies show, in general, that smokers are less likely to self-report physical

activity and to adhere to physical activity goals than never smokers and former smokers.

Former smokers tend to increase their physical activity. A study found that former and

never smokers are engaged in leisure time physical activity more frequently than current

smokers (French, Hennrikus, & Jeffery, 1996). One study on middle age women reported

less physical activity for current smokers compared to former smokers and never

smokers. Similarly, it was found that former smokers significantly increased physical

activity (Perkins, Rohay, Meilahn, Wing, Matthews, & Kuller, 1993). A study of physical

activity and physical activity adherence in the elderly based on smoking status showed

that smokers walked significantly shorter distances than non-smokers. In addition,

smoking status was found to be a significant predictor of adherence to physical activity

goals (Cooper, Resor, Stoever, & Dubbert, 2007).

34

Smoking and friendship

Several studies of close friends and group influence on adolescent cigarette

smoking have found that friendship predicted transition into current cigarette use

(Urberg, Degirmencioglu, & Pilgrim, 1997). Similarly, other researchers found that

among Hispanic seventh-graders, friends who smoke influenced smoking initiation

directly and indirectly. Researchers show that, while parental smoking affected smoking

initiation only indirectly, parental approval of smoking played a significant mediating

role for girls but not for boys (Flay, Hu, Siddiqui, Day, et al, 1994). In order to decrease

smoking initiation and prevent relapse on college campuses, Ridner (2005) recommended

developing strategies to alter social environments and decrease the exposure of students

to others who model smoking behaviors. Some studies have found that peer influence

changes smoking behavior, particularly in eighth grade boys. When the measure of peer

influence was the proportion of friends who smoke, the effect of peer influence was

stronger for 11th graders (Urberg, Cheng, & Shyu, 1991).

Smoking and knowledge of tobacco-related diseases

Several studies describe how knowledge of tobacco-related diseases influences

tobacco use. For instance, a study found that women, older respondents, respondents with

lower levels of education, and current smokers have lower awareness of the health

consequences of smoking (Brownson, Jackson-Thompson, Wilkerson, Davis, Owens, &

Fisher, 1992; Price & Everett, 1994). Other studies reported that people who confer more

35

importance to the health consequences of smoking were less likely to smoke. For those

who do not attribute importance to effects on their health, this belief was not found to

have an impact on their smoking behavior (Krosnick, Chang, Sherman, Chassin, &

Presson, 2006). Smoking cessation could involve the acceptance that smoking causes

disease and acknowledge information about the diseases caused by smoking (Chapman,

Wong, & Smith, 1993).

Other studies found that smokers tend to minimize their risk for lung cancer when

comparing themselves with other smokers. For example, smokers assess their risk of lung

cancer to be similar to that of non-smokers; they believe that this risk is unrelated to the

number of cigarettes smoked, that the consequences of smoking can be reversed by

exercise or consumption of vitamins, and that lung cancer is principally determined by

the genes of the individual (Weinstein, Marcus, & Moser, 2005). Smokers have similar

beliefs for myocardial infarction, hypertension, angina, or family history of

cardiovascular diseases, even if they actually suffer the disease. These beliefs were more

likely to be found among the older, less educated, and light smokers (Ayanian & Cleary,

1999).

Exposure to second-hand smoke (SHS)

Some studies show that 74% of current smokers are more likely to accept

smoking in restaurants and 42% found it to be acceptable in indoor work areas. Thirty-

four percent of non-smokers accept smoking in restaurants, and 18% accept smoking at

indoor work areas (CDC, 2001). The majority of the population recognized, however,

36

that exposure to SHS is dangerous; for example, in 2000, more than 66% of smokers,

88% of non-smokers, 80% of men, 86% of women, 79% of the population below the

level of poverty, and 84% at or above the level of poverty believed that SHS is harmful.

In 2001, 95% of the adult population in the U.S. agreed that SHS is harmful to children,

and in 2002 – 2004, 86% believed that SHS was harmful to adults (U. S. Department of

Health and Human Services, 2006).

Data from the Hispanic Health and Nutrition Examination Survey (HHANES)

showed that more than 22% of non-smoking Latino women of reproductive age were

exposed to SHS in the workplace, and a similar percentage was exposed to SHS at home.

Young Mexican-American, Puerto Rican, and Cuban-American women were the

populations with the highest exposure to SHS at home or in the workplace (Pletsch,

1994).

Glantz and Jamieson (2002) found that, controlling for age, ethnicity, and

education, smokers were less likely than non-smokers to consider smoking risky, and that

the only statistically significant variable to predict planning to quit smoking or having

actually quitted was the believe that SHS harmed non-smokers.

Smoking bans

Data from the 1994 National Health Interview Survey and Year 2000 Objectives

supplement, showed that 35% of children under 18 years old were exposed to SHS at

homes where residents or visitors smoke on a regular basis (Schuster, Franke, & Pham,

2002). The percentage of adults, smokers and non-smokers, who support smoking bans

37

in public and private places increased during the period 2000 – 2001 (McMillen,

Winickoff, Klein, & Weitzman, 2003).

Regarding banning smoking at home or in the car, in 1999 a study found that in

the general population, 76% of adults has home-smoking bans and 66% have car-

smoking bans. Among Latinos, the percentages were similar; 79.9% reported home-

smoking bans and 66.6% reported car-smoking bans. Among the deciding factors for

lower smoking-bans at home or in the car, researchers described not having children in

the home, having more friends who smoke, and lower household income (Norman,

Ribisl, Howard-Pitney, & Howard, 1999). Similarly, the presence of nonsmoking adults

and children was associated with smoking restrictions in homes of inner-city smokers

(Okah, Choi, Okuyemi, & Ahluwalia, 2002).

A study of Latino mothers in the southwestern U.S., found that those who were

born in the U.S., are currently smokers, or have the presence of another adult smoker in

the household, were associated with significantly increased odds of not having a home-

or-car smoking ban (Gonzales, Malcoe, Kegler, & Espinoza, 2006). More recently, in San

Diego, California, a survey of the Mexican-American population found that home bans

on smoking are more likely among individuals who do not smoke, live with children, and

are more acculturated to U.S. society. These individuals reported greater aversion to SHS,

and/or more social pressure against indoor smoking. Similarly, smoking bans were less

likely among Mexican-Americans who live with smokers (Martinez-Donate, Hovell,

Hofstetter, González-Pérez, Adams, & Kotay, 2007).

38

Quitting smoking

Studying the reasons for smoking is necessary in order to devise smoking

cessation therapies (Leventhal & Avis, 1976), as well as to understand the relevant role of

reinforcement in the genesis, maintenance, and recovery from tobacco addiction

(Higgins, Heil, & Lussier, 2004). Another study found that a successful long-term

cessation program should individualize the approach and identify interesting and/or

pleasurable stimuli to replace smoking (Moghaddam, & Ferguson, 2007).

In England, a study using the Transtheoretical Model, found that variations in

intentionality and anticipated ease of quitting were associated with individual factors

such as smoking intensity, parental smoking, age, length of time as a smoker, the nature

of the counseling, household composition, and household income. The study also shows

that being older, of high socioeconomic status, employed, having a stable relationship

with a non-smoking partner, and being motivated to quit were associated with successful

smoking cessation. The intention to quit and one’s personal rating of the likelihood of

success are also strong predictors of eventual cessation. (Twigg, Moon, Szatkowski, &

Iggulden, 2009). Similarly, Loon, Tijhuis, Surtees, and Ormel (2005) found that older,

married, and heavy smokers are more likely to quit smoking.

39

CHAPTER THREE

THEORETICAL FRAMEWORK AND HYPOTHESES

Stages of Change (SOC) model

The SOC model, developed from the original Transtheoretical Model developed

by Prochaska and DiClemente (1983), includes a set of five classifications to describe

smokers and former smokers. The first three stages describe the various phases during

which current smokers decide to quit smoking. The first stage is the pre-contemplation

stage, which comprises smokers who are least motivated to quit. The second, or the

contemplation stage, represents an intermediate level of motivation to quit smoking,

while the third, or preparation stage, comprises smokers possessing the highest

motivation to quit. The action stage is defined as the first six months post-cessation. The

final, maintenance stage, is defined as cessation beyond six months; former smokers are

classified in this SOC. (Herzog, Blagg, & Moffitt, 2007).

Zimmerman, Olsen, and Bosworthan (2000), define the five SOC as follows:

Pre-contemplation stage: In this stage, patients do not even consider changing

their behavior. Smokers who are “in denial” may not see that the advice to quit applies to

them personally.

Contemplation stage: At this stage, patients are ambivalent about changing.

During this stage, patients assess barriers and the benefits of change.

Preparation stage: During the preparation stage, patients prepare to make a

specific change. They may experiment with small changes as their determination to

40

change increases. Switching to a different brand of cigarettes, for example, could signal

that they have decided to change.

Action stage: Any action taken by a smoker demonstrates the desire for a lifestyle

change to stop smoking.

Hypotheses

Variables included in the hypotheses have been adopted and developed from the

extensive review of the available publications in tobacco control and smoking cessation.

A better understanding of the relationship between these variables and smoking status is

necessary to develop tobacco control and smoking cessation programs for Latino

communities.

Hypothesis 1: There are significant differences by socioeconomic status, including

gender, age, marital status, level of education, and income, and level of acculturation

between Latino former smokers, classified in the maintenance SOC; Latino smokers who

are willing to quit smoking, classified in the preparation SOC; and those who are not

willing to quit smoking, classified in the pre-contemplation SOC.

H1.1: Latino men who smoke are more likely to be willing to quit smoking than

Latino women who smoke.

H1.2: Latino smokers who are not willing to quit smoking are younger than Latino

former smokers and Latino smokers who are willing to quit smoking.

41

H1.3: Latino smokers who are not willing to quit smoking are more likely to be

single than Latino former smokers and Latino smokers who are willing to quit

smoking.

H1.4: Latino smokers who are not willing to quit smoking are less likely to live

with minors (under de age of 18) than Latino former smokers and Latino smokers

who are willing to quit smoking.

H1.5: Latino smokers who are not willing to quit smoking have a lower level of

education than Latino former smokers and Latino smokers who are willing to quit

smoking.


unemployed than Latino smokers who are willing to quit smoking.

H1.7: Latino smokers who are not willing to quit smoking are more likely to have

lower income than Latino former smokers and Latino smokers who are willing to

quit smoking.

H1.8: Latino smokers who are not willing to quit smoking are more likely to live in

rural areas than Latino smokers who are willing to quit smoking.

H1.9: Latino smokers who are not willing to quit smoking are more likely to

answer the survey in Spanish than Latino former smokers and Latino smokers



fewer years living in the U.S. than Latino former smokers and Latino smokers


42


home country oriented than Latino former smokers and Latino smokers who are

willing to quit smoking.


more friends with the same cultural background than Latino former smokers and

Latino smokers who are willing to quit smoking.

Hypothesis 2: There are significant differences between Latino former smokers,

classified in the maintenance SOC; Latino smokers who are willing to quit smoking,

classified in the preparation SOC; and those who are not willing to quit smoking,

classified in the pre-contemplation SOC. These differences pertain to self-reported health

status, interesting things in their life, happiness, physical activity, stress, consumption of

vegetables and fruits, and body mass index (BMI).

H2.1: Latino smokers who are not willing to quit smoking are more likely to self-

report fair or poor physical health during the previous year than Latino former

smokers and Latino smokers who are willing to quit smoking.

H2.2: Latino smokers who are not willing to quit smoking are less likely to self-

report interesting things in daily life during the previous month than Latino


H2.3: Latino smokers who are not willing to quit smoking are less likely to report

that they are happy with their personal life during the previous month than Latino


43

H2.4: Latino smokers who are not willing to quit smoking are less likely to report

that they are healthy compare to other people their age than Latino former


H2.5: Latino smokers who are not willing to quit smoking are more likely to report

injury or illness affecting daily routine during the previous year than Latino



report physical activity during the previous week than Latino former smokers and



report adequate exercise during the previous week than Latino former smokers

and Latino smokers who are willing to quit smoking.


report stressful events during the previous month than Latino former smokers and



report a major personal injury or illness during the previous year than Latino



report change of residence during the previous year than Latino former smokers


44


report major change in the health of a family member during the previous year

than Latino former smokers and Latino smokers who are willing to quit smoking.


report major change in the number of family get-togethers during the previous

year than Latino former smokers and Latino smokers who are willing to quit

smoking.


report adequate fruit and vegetable consumption during the previous week than

Latino former smokers and Latino smokers who are willing to quit smoking.

H2.14: Latino smokers who are not willing to quit smoking have a lower BMI than


Hypothesis 3: There are significant differences in beliefs regarding smoking, positive

aspects of smoking, and knowledge of tobacco-related diseases between Latino former

smokers, classified in the maintenance SOC; Latino smokers who are willing to quit

smoking, classified in the preparation SOC; and those who are not willing to quit

smoking, classified in the pre-contemplation SOC.


believe that smoking facilitates friendship than Latino former smokers and Latino

smokers who are willing to quit smoking.

45


believe that smoking provides pleasure than Latino former smokers and Latino



believe that smoking relieves stress than Latino former smokers and Latino



believe that smoking helps to focus on activities than Latino former smokers and



believe that smoking helps to lose weight than Latino former smokers and Latino



believe that smoking has positive aspects than Latino former smokers and Latino


H3.7: Latino smokers who are not willing to quit smoking are less knowledgeable

that smoking causes lung cancer than Latino former smokers and Latino smokers


H3.8: Latino smokers who are not willing to quit smoking are less knowledgeable

that smoking causes heart disease than Latino former smokers and Latino smokers


46

H3.9: Latino smokers who are not willing to quit smoking are more willing to

believe that people smoke because they want to than Latino former smokers and



believe that people smoke because it is a habit than Latino former smokers and


H3.11: Latino smokers who are not willing to quit smoking are less likely to

believe that people who smoke cannot control whether they smoke or not than



believe that it is okay to smoke as long as you are healthy than Latino former



believe that smoking causes more harms than benefits than Latino former smokers


Hypothesis 4: There are significant differences in the attitudes and level of exposure to

SHS between Latino former smokers, classified in the maintenance SOC; Latino

smokers who are willing to quit smoking, classified in the preparation SOC; and those

who are not willing to quit, classified in the pre-contemplation SOC.

47

H4.1: Latino smokers who are not willing to quit smoking are more likely to feel

comfortable when others smoke around them than Latino former smokers and



a house where someone smokes than Latino former smokers and Latino smokers


H4.3: Latino smokers who are not willing to quit smoking are more likely to ride

in a car with a smoker than Latino former smokers and Latino smokers who are



a household where smoking is allowed than Latino former smokers and Latino


H4.5: Latino smokers who are not willing to quit smoking are more likely to work

where someone smokes in their work area than Latino former smokers and Latino


H4.6: Latino smokers who are not willing to quit smoking are more likely to work

where smoking is allowed in common areas than Latino former smokers and


H4.7: Latino smokers who are not willing to quit smoking are more likely to prefer

to work in a workplace where smoking is allowed than Latino former smokers


48


exposed to SHS than Latino former smokers and Latino smokers who are willing

to quit smoking.

H4.9: Latino smokers who are not willing to quit smoking are more likely to live

with minors exposed to SHS than Latino former smokers and Latino smokers who

are willing to quit smoking.

Hypothesis 5: There are significant differences between Latino smokers willing to quit

smoking, classified in the preparation SOC, and Latino smokers not willing to quit

smoking, classified in the pre-contemplation SOC, in the perception of smoking as a

behavior, the level of cigarette addiction, smoking when facing stressful events, the level

of comfort when exposed to SHS, the likelihood of success if they want or decided to quit

smoking, the age at which the smoking began, the attempt to quit smoking, the likelihood

of asking for help to quit smoking, and the likelihood of quitting using will power.


perceive smoking as a habit than Latino smokers who are willing to quit smoking.


smoke every day than Latino smokers who are willing to quit smoking.


smoke the first cigarette within 30 minutes after waking up than Latino smokers


49


report that they smoke more when facing stressful events than Latino smokers



comfortable smoking around others than Latino smokers who are willing to quit

smoking.

H5.6: Latino smokers who are not willing to quit smoking are more likely to enjoy

smoking than Latino smokers who are willing to quit smoking.

H5.7: Latino smokers who are not willing to quit smoking are less likely to think

they would be successful if they want to stop smoking than Latino smokers who



they would succeed if they decided to stop smoking than Latino smokers who are


H5.9: Latino smokers who are not willing to quit smoking are less likely to feel

comfortable asking for help to stop smoking than Latino smokers who are willing

to quit smoking.


think that the only way they would be able to stop smoking is through their own

will power than Latino smokers who are willing to quit smoking.

50


smoked their first cigarette at a younger age than Latino smokers who are willing

to quit smoking.


report smoking cigarettes regularly at a younger age than Latino smokers who are



smoke a larger number of cigarettes daily than Latino smokers who are willing to

quit smoking.

H5.14: Latino smokers who are not willing to quit smoking are less likely to quit

smoking for a day or more, one or more times during the last year, than Latino


51

CHAPTER FOUR

METHODOLOGY

Study design

This research is a cross sectional study, using secondary data from the Diverse

Racial and Ethnic Groups and Nations (DREGAN) project.

The Diverse Racial Ethnic Groups and Nations (DREGAN) Project

The DREGAN project was a community-based participatory research and action

project implemented to better understand the unique cultural characteristics of tobacco

use, to determine the prevalence of smoking and other health risk behaviors, and to

develop and implement intervention projects designed to reduce tobacco use among

Minnesota’s Latino, Hmong, Cambodian, Vietnamese, and Laotian communities.

Since 2002, the project developed a partnership between Comunidades Latinas

Unidas en Servicio (CLUES), Blue Cross and Blue Shield of Minnesota, and The

Minnesota Partnership for Actions Against Tobacco (MPAAT), now known as ClearWay

Minnesota. Since its beginning, a research team was integrated by researchers from all

the partner organizations and an advisory committee was appointed with community

leaders, Latino researchers, and representatives of Latino community based

organizations. The advisory committee provided feedback to the research process from its

beginning to the publication of the final report. Researchers from the Center for Survey

Research in Public Health at the University of Minnesota (CSRPH) joined the DREGAN

52

project in 2004. The author of this study was the coordinator of the DREGAN project at

CLUES.

DREGAN research design

The DREGAN quantitative research project was a cross-sectional survey of adults

eighteen years old or older living in Minnesota, who were self-identified as Latino or

Hispanic, were born in a Latin-American Country or had a parent or grandparent born in

a Latin-American country.

A culturally-appropriate instrument that included measures of acculturation, as

well as knowledge and attitudes toward smoking and quitting tobacco use, was developed

by the DREGAN research team with feedback from the Advisory Committee (Blue Cross

and Blue Shield of Minnesota, ClearWay Minnesota, Comunidades Latinas Unidas en

Servicio, 2006).

DREGAN survey instrument design

The DREGAN survey instrument included questions from the 2003 Minnesota

Adult Tobacco Survey (Minnesota Department of Health, the Minnesota Partnership for

Action Against Tobacco, Blue Cross and Blue Shield of Minnesota, and the University of

Minnesota, 2004), the 2004 Behavioral Risk Factor Surveillance System, and the

DREGAN qualitative research conducted by Blue Cross and Blue Shield of Minnesota,

ClearWay Minnesota, and Comunidades Latinas Unidas en Servicio (2006).

The survey items were developed through an iterative process based upon the core

53

issues identified in the previous qualitative study. This process occurred within a

participatory framework. The instrument was refined through input from the advisory

committee and tested using cognitive interviewing. Once approved, the final instrument

was translated into Spanish with the focus on a cultural and conceptually-equivalent

rather than a linguistically-equivalent translation. Community groups were active in the

translation process. Their input was sought to ensure conceptual equivalence as well as

consultation on language. The final versions of the instrument were reviewed and

approved by the DREGAN research and management teams (Appendix B DREGAN

Phone Bilingual Survey and Appendix C Face to Face Bilingual Survey).

Survey Instrument Description

The survey instrument included the following topics: Phenotype, fluency,

orientation, latent variable, Latino community variables, theory test, health behavior,

exercise/nutrition, smoking, benefits of smoking, addiction or choice, harms of tobacco,

smoking items, prior smoking, quitting/other smoking related items, use of other tobacco,

household rules around smoking and SHS exposure, employment, refugee history,

demographics, household information (Appendix B DREGAN Phone Bilingual Survey

and Appendix C Face to Face Bilingual Survey).

DREGAN Survey methodology

Households were probabilistically sampled, using random digit dialing, for

telephone and face to face interviews. Once a household was randomly selected, a letter

54

was sent informing the household that it was selected and that a phone call would be

made for the interview. Approximately two weeks later, a phone call was made to the

household asking for the person 18 years old or older with the most recent birthday. If the

person was available, a short telephone screening interview determined if the person was

eligible to be included in the study. Face-to-face interviews were then conducted with

eligible respondents who agreed to participate.

Trained community members, fluent in both English and Spanish, conducted all

interviews in the participant’s language of choice. In July 2006, the DREGAN project

investigators shifted solely to the use of telephone interviews in order to increase the

response rate and minimize the potential social desirability bias of face-to-face

interviews. A $10.00 gift certificate and a thank-you note were mailed to each respondent

who completed the survey. The Computer-Assisted Telephone Interviewing (CATI)

program was used for the telephone screening and the face-to-face survey.

Sample description

A random sample was selected from a Latino surname list obtained from

Marketing Systems Group, a survey-sampling vendor, for the three Minnesota

geographical regions with the larger concentrations of Latino populations. The 11 county

metropolitan region include the counties of Anoka, Carver, Chisago, Dakota, Hennepin,

Isanti, Ramsey, Scott, Sherburne, Washington and Wright; the six southern counties

included Olmsted, Goodhue, Blue Earth, LeSuer, Nicollet, and Waseca. The sampling

also included the three northwestern counties of Polk, Norman, and Clay (Blue Cross and

55

Blue Shield of Minnesota, ClearWay Minnesota, Comunidades Latinas Unidas en

Servicio, 2008).

The number of respondents was calculated given the following assumptions: the

size of the estimate percent of smokers (P= 30%); the design effect (DE= 2.2); and the

desired precision (SE=2%). Estimates of the sample size were calculated using the

formula:

N = (P × (1− P) × DE) ÷ SE2

A minimum sample size of about 1,155 was calculated to make precise estimates

for major sub-groups of interest. For many estimates where the sample size is greater, the

level of precision will exceeded ±4% (Rockwood, Virnig, Constantine, Miazga, &

Turner, 2007). Table 1 shows the sample disposition and the response rates.

Table 1 Sample Disposition and Response Rate

Population Purchased List Community List Total Sample Ineligible Completes Response Rate Hmong 1605 0 1605 803 563 70% Cambodian 842 351 1193 679 355 69% Vietnamese 1140 0 1140 598 358 66% Laotian 223 484 707 257 352 78% Latino 3375 0 3375 1760 805 50% Total 7185 835 8020 4097 2433 62%

Rockwood, Virnig, Constantine, Miazga, and Turner (2007)

Interviewers training

Bilingual interviewers were selected and trained by the CSRPH managing

director. Each interviewer received four hours of general interview training, four hours of

project-specific training followed by computer training and an individual practice

session, a certification in English with a supervisor and also an additional training on

56

field interviewing. Interviewers also received the general Interviewer Manual and a set of

question-by-question specific protocol for the DREGAN Study (Rockwood, Virnig,

Constantine, Miazga, & Turner, 2007).

Data Collection

Data collection started in January 2006 and ended in March 2007. The Latino

survey achieved a 50% response rate. More than half (55%) were face-to-face interviews.

Most interviews (69%) were conducted in Spanish. The DREGAN Latino data set

includes 805 face-to-face or telephone interviews. Data were weighted for probability of

selection, age, and gender based on 2000 census data for the Latino population (Blue

Cross and Blue Shield of Minnesota, ClearWay Minnesota, Comunidades Latinas Unidas

en Servicio, 2008).

Study statement research question

The objectives of this study are to describe the characteristics of Latino tobacco

smokers living in Minnesota, to determine if there are significant differences between the

following groups: Latino smokers not willing to quit using tobacco, in the pre-

contemplation SOC; Latino smokers willing to quit using tobacco, in the preparation

SOC; and Latino former smokers in the maintenance SOC; differences will be evaluated

in term of socioeconomic status and level of acculturation; self reported physical and

mental health, consumption of fruits and vegetables, and physical activity; beliefs

regarding smoking, positive aspects of smoking, and knowledge of tobacco-related

57

diseases; attitudes and level of exposure to SHS ; and the level of cigarette addiction and

willingness to quit smoking. The goal is to identify significant characteristics of Latino

smokers that would be relevant to develop culturally-competent and linguistically-

appropriate tobacco cessation interventions.

Survey inclusion criteria

This study focuses on adults eighteen years old or older, who were self-identified

as Latino or Hispanic or born in a Latin-American country, or who had a parent or

grandparent born in a Latin-American country. All participants voluntarily agreed to

respond the survey questionnaire.

Survey exclusion criteria

Minors of eighteen years old, those who were not Latino or from Latino origin or

qualified respondents, who refused to answer the survey questionnaire, were excluded

from the study.

Definition of variables

The SOC algorithm was used to address if there were relevant relationships

between the independent variables and the SOC that could be used to design culturally-

appropriate tobacco cessation programs. Using the DREGAN dataset, an analysis dataset

was created by recoding and combining participant survey responses. The dependent

variables created are described below, including the original DREGAN data set variable

58

name, its original value, and the new assigned value. A complete description of the

variables used in this study is found in Appendix D, Study Variables.

The first dependent variable created from the DREGAN data set was ever smoker,

a dichotomous variable with the categories never smokers and ever smoker. Never

smoker (esmoker=0) was defined in the DREGAN data set as a respondent who never

smoked and did not meet the criteria for former or current smoker. Ever smoker

(smoker=1) was defined in the DREGAN data set as a respondent who met the criteria

for former smoker or current smoker as it is described in the variable smoker status.

The second dependent variable created from the DREGAN data set was smoker

status (dfs), a dichotomous variable with the categories former smoker and current

smoker. Former smoker (dfs=0) was defined in the DREGAN data set as FSMOKER=1,

using the BRFSS and MATS criteria, that includes respondents who have ever smoked a

cigarette, have smoked at least 100 cigarettes in their life, and have not smoked a

cigarette in the last six months. Respondents in this category are in the final stage,

maintenance, of the SOC algorithm. Current smokers (dfs=1), who are in the previous

SOC, were defined in the DREGAN data set as respondents who meets the BRFSS and

MATS criteria of having ever smoked a cigarette, having smoked at least 100 cigarettes

in their life, and currently smoking every day or some days.

The third dependent variable created from the DREGAN data set was former-

willingness to quit smoking (fwtq), a trichotomous variable created to determine if there

were differences between: a) former smokers, b) current smokers willing to quit smoking,

and c) current smokers not willing to quit smoking, defined as follows. a) former smoker

59

(fwtq=0), default category, was defined in the DREGAN data set (FSMOKER=1) by

respondents in the final stage, maintenance, of the SOC algorithm, b) current smoker

willing to quit smoking (fwtq=1) was comprised of respondents for whom the sum of

their responses to questions s57 (recoded into rs57 to conserve the same sequence as the

answers to questions s58 and s59), s58, and s59 were equal or lower than six.

Respondents in this category were classified into the stage of preparation of the SOC

algorithm, c) current smoker not willing to quit (fwtq=2) was defined as respondents for

whom the sum of responses to questions rs57, 58 and 59 was higher than six.

Respondents in this category were grouped into the pre-contemplation SOC.

Answers to question s57 “Which of the following best describes how do you

feel?” were weighted as follows: 1=I would like to stop smoking for some other reasons;

2=I want to stop smoking; 3=I would like to stop smoking, but don’t want to go through

the process; 4=I don’t want to stop smoking; 5=I don’t think about stopping smoking.

Answers to question s58 “If you wanted to stop smoking, how likely do you think you

would be to succeed?” were weighted as follows: 1=very likely; 2=somewhat likely;

3=somewhat unlikely; and 4=very unlikely. Answers to question s59 “If you decided to

stop smoking, how likely do you think you would be to succeed?” were weighted as

follows: 1=very likely; 2=somewhat likely; 3=somewhat unlikely; and 4=very unlikely.

The fourth dependent variable was willingness to quit (wtq), a dichotomous

variable, created from the previous variable to determine if there were differences

between current smokers classified in the preparation SOC (wtq=1) and those in the pre-

contemplation SOC (wtq=2).

60

The fifth dependent variable was pre-contemplation, contemplation, and

preparation SOC (s573G), a trichotomous variable, created from the data set to determine

if there were differences between smokers classified in the three SOC prior to taking

actions to quit smoking as follows: a) respondents of question s57 (“Which of the

following best describes how do you feel?”) were categorized as smokers in the pre-

contemplation SOC (s573G=0) if they answered “I don’t think about stopping smoking”

or “I don’t want to stop smoking;” b) smokers were categorized into the stage of

contemplation of the SOC algorithm (s573G=1) if they answered “I would like to stop

smoking, but don’t want to go through the process;” and c) smokers were categorized in

the preparation SOC (s573G=2) if they answered “I want to stop smoking” or “I would

like to stop smoking for some other reason.”

The sixth dependent variable, smokers who want to stop smoking (s582GT), was a

dichotomous variable created from question s58 of the survey to measure if there were

differences between respondents who answered the question “If you wanted to stop

smoking, how likely do you think you would be to succeed?” Those who answered very

likely or somewhat likely were classified as smokers who want to stop smoking

(s582GT=1); respondents who answered very unlikely or somewhat unlikely were

classified as smokers who do not want to stop smoking (s582GT=0).

The seventh dependent variable, smokers decided to stop smoking (s592GT), was

a dichotomous variable created from question s59 of the survey to determine if there were

differences between respondents who answered the question “If you decided to stop

smoking, how likely do you think you would be to succeed?” Respondents who answered

61

very likely or somewhat likely, were categorized as smokers who decided to stop

smoking (s592GT=1), and those who answered very unlikely or somewhat unlikely, were

classified as smokers who have not decided to stop smoking (s592GT=0).

The eighth dependent variable, asking for help to stop smoking (s602GT), was a

dichotomous variable created from question s60 of the survey to measure if there were

differences between respondents who answered to the question “How comfortable would

you be asking for help to stop smoking?” Respondents who answered very comfortable

or somewhat comfortable were categorized as smokers comfortable asking for help to

stop smoking (s602GT=1), and those who answered somewhat uncomfortable or very

uncomfortable were categorized as smokers uncomfortable asking for help to quit

smoking (s602GT=0).

The ninth and last dependent variable, will power (rs61), was a dichotomous

variable created from question s61 of the survey to determine if there were differences

between respondents who answered to the statement “The only way I would be able to

stop smoking is through my own will power.” Respondents who answered strongly agree

or somewhat agree were categorized as smokers who agree with the belief that the only

way they could be able to stop smoking is through their own will power (rs61=1), and

those who answered somewhat disagree or strongly disagree were categorized as smokers

who disagree with the belief that the only way they could be able to stop smoking is

through their own will power (rs61=0).

62

Statistical analysis

SPSS version 19.0 software was used to conduct all statistic analyses, including

descriptive, bivariate and multivariate analysis.

Descriptive statistics were performed to summarize the characteristics of the

respondents. Percents, means, and standard deviation of the means were calculated for

continuous variables. Numbers and percentages were calculated for categorical variables.

The continuous variables were compared using one-way analysis of the variance

(ANOVA), the dichotomous categorical variables were compared using Chi-square test,

and the thricotomuos categorical variables were analyzed using order logistic regression.

Variables that were moderately associated with the comparisons categories (p<0.1) were

identified and analyzed using logistic regression controlling for age and gender to

examine their association with smokers in the different stages of change. No further

multivariable models were explored due to the limited size of the sample. The 95%

confidence interval of the odds ratios for each variable and its P-value were calculated. In

order to determine whether the probability of having a particular effect of the

independent variables is associated with the different stages of change described

previously and to predict the probability and the magnitude of the effect in the dependent

variables, logistic regression was used as follows: A first set of comparison was made

between respondents who have never smoked and those who have ever smoked. A

second set of comparison was made between former smokers, who are in the

maintenance SOC, and current smokers who are in the previous stages of change. A third

set of comparisons was made between former smokers, who are in the maintenance SOC;

63

current smokers willing to quit, who are in the preparation SOC; and those not willing to

quit smoking, who are in the pre-contemplation SOC. A fourth set of comparison was

made between smokers in the preparation and pre-contemplation SOC. A fifth set of

comparison was made between smokers in the pre-contemplation, contemplation, and

preparation SOC. A final sets of comparisons were made between smokers who

responded they would be likely and those who responded they would not be likely to

succeed if they wanted to stop smoking; smokers who responded they would be likely

and would not be likely to succeed if decided to stop smoking; smokers who responded

they would feel comfortable and those who responded they would feel uncomfortable

asking for help to stop smoking; and smokers who responded they believed and those

who responded they did not believe the only way they would be able to stop smoking is

through their own will power.

Institutional Review Board (IRB) approval

The University of Minnesota Institutional Review Board (IRB), Human Subjects

Committee, determined that this study (0608E91768) was exempt from review under

federal guidelines 45 CFR Part 46.101(b) category # 4, existing data; records review;

pathological specimens.

64

CHAPTER FIVE

RESULTS

Sample characteristics

A comprehensive description of the characteristics of the sample is shown in

Appendices E to J. The Standard Deviation of the mean is shown in parentheses. A star

(*) symbol in the tables represents a p value = or < .005.

Demographic characteristics of the sample

The DREGAN survey was answered by 805 respondents, either by face-to-face or

by telephone interviews, from January, 2006 to March, 2007. Males were 51.3% of the

sample, the mean age of the respondents was 37.9 (12.6) years and their age range was

from18 to 91 years. The majority (87.7%) of the respondents was older than 24 years old;

71.9% were married or living in a marriage-like relationship; and 70.7% reported living

with children younger of 18 years old in their home. On average, respondents reported

four (1.9) people living per household. 61.2% of the participants completed high school

or some level of higher education; 83.8% had at least one current job, and the household

mean income was $54,860 (58,014).

The majority (88%) of the respondents self-identified as Latino, Hispanic or

Hispanic-American, and 12% as American. 55.4% of the respondents were born in

Mexico, 24.3% in the U.S., and 20.3% in other Latin-American countries. Of the

respondents born outside the U.S. the mean age of entry to the country was 23.8 (9.9)

65

years and on average they have been in the U.S. for 12.7 (10.3) years. The majority

(84.6%) of the respondents learned Spanish as their first language, and 66.6% of the

surveys were answered in Spanish. Table 2 describes selected continuous demographic

variables of the survey respondents. Appendices E 1 and 2 present a comprehensive

description of the demographic characteristics of the sample.

Table 2 Demographic Characteristics of the Sample

Continuous Variables N Mean Minimum Maximum SD Age (q26) (s801) 805 37.91 18 91 12.58 Age of Entry to the US (q7) 594 23.82 0 63 9.87 Immigrant's Years Living in the US (q7) 594 12.66 0 90 10.33 Year Migrated to US 594 1,993 1,916 2,006 10.33 Years living in the US 594 12.66 0 90 10.33 Household Last Year Income (q29) 218 54,860.50 1,200 500,000 58,014.54 Number of People Living in Household (s78) 805 4.09 1 15 1.86 Number of Adults Living in Household (s79) 805 2.49 1 10 1.24

Self-reported health status

Self-reported health status, stress, physical activity, consumption of fruits and

vegetables, and BMI variables are described in Appendices F1 and 2.

It was found that 75.1% of the respondents reported excellent, very good or good

health compared to other people of similar age; 66.8% self-reported excellent, very good

or good physical health; and 38.8% reported injury or illness affecting their daily routine

during the prior year. Only 35% of the respondents met the BRFSS’s criteria for adequate

exercise, and 19% reported some degree of stress during the past month. Selected self-

reported health status categorical variables are described in Table 3.

Stress, poor physical health, or depression prevented respondents from

performing their usual activities for an average of two days during the previous month.

66

On average, during three days the physical health of the respondents was not good during

the previous month.

Table 3

Self Reported Health Status, Physical Activity, and Stress Categorical Variables N % Health S1 Self Reported Health Status Compared to Other People of Respondent's Age

Excellent 161 20.02 Very good 179 22.26 Good 264 32.84 Fair 178 22.14 Poor 22 2.74 Total 804 100.00

q1 Self Reported Physical Health Excellent 116 14.50 Very good 144 18.00 Good 274 34.25 Fair 218 27.25 Poor 48 6.00 Total 800 100.00

S2 Self Reported Injury or Illness Affecting Daily Routine During the Past 12 Months

Not at all 493 61.20 A little bit 252 31.30 A lot 60 7.50 Total 805 100.00

BRFSS Standard for Adequate Exercise (Moderate or Vigorous) in a Week

0 523 65.00 1 282 35.00 Total 805 100.00

BMI 18.5 – 24.9 207 27.8 <18.5 and = or >25 538 72.2 Total 745 100.00

Stress S32 Self Reported Stress During the Past Month

Extremely 64 7.95 Quite a bit 74 9.19 Some 226 28.07 A little 288 35.78 Not at all 153 19.01 Total 805 100.00

Compared to the minimum daily consumption of five portions of fruits and

vegetables recommended by the U.S. Department of Health and Human Services and the

U.S. Department of Agriculture in 2005, a low consumption of fruits and vegetables was

reported; respondents consumed an average of 1.9 (1.5) servings of fruits and 1.7 (1.2)

servings of vegetables per day over the previous seven days. The respondents mean BMI

67

was 28.2 (5.2), determined from their self-reported height and weight. Only 27.8% had a

normal BMI (18.5 – 24.9) (CDC, 2011). Table 4 includes self-reported health status

continuous variables, consumption of vegetables and fruits, and body mass index (BMI).

Table 4 Summary of Health Variables

Continuous Variables N Mean Minimum Maximum SD Health

s30=During the past 30 days, for about how many days did stress, poor physical health, or depression keep you from doing your usual activities? 799 2.42 0 30 6.24 Nutrition

S28 Servings of Fruits Eaten Per Day over the Past Seven Days 804 1.92 0 14 1.49

S29 Servings of Vegetables Eaten Per Day over the Past Seven Days 782 1.65 0 10 1.21

Total Servings Fruits and Vegetables in last Day S28 804 3.53 0 20 2.23 BMI = Body Mass Index 745 28.17 16.1 61.2 5.22

Acculturation

Appendix G includes a comprehensive list of the acculturation variables.

A large majority (95.5%) of the respondents reported understanding U.S.

holidays, 90.3% reported understanding traditional Latino weddings and funerals, 92%

reported understanding Latino traditions, and 77.3% reported understanding American

ways; 79% of the respondents considered it important to practice Latino ways at home,

88.5% of the respondents strongly identified with Latino background, 88.8% reported

that they consider it important to keep in touch or learn about their ethnical and cultural

background, 54.2% spoke Spanish most of the time at home, 81.7% of the respondents

considered it important to speak Spanish and 89.6% considered it important to raise

children as Latinos to keep their Latino identity. Table 5 portraits selected acculturation

variables.

68

Table 5 Summary of Acculturation Categorical Variables

Fluency N % Understanding of US Holidays q14a Very well 578 72.3 Somewhat well 185 23.2 Not very well 28 3.5 Not at all 8 1 Total 799 100 Understanding of Traditional Latino Weddings and Funerals Q15 Very well 530 66 Somewhat well 195 24.3 Not very well 55 6.8 Not at all 23 2.9 Total 803 100 Very Good Understanding of American Ways -CS9B Strongly agree 335 42.1 Somewhat agree 251 31.6 Somewhat disagree 167 21 Strongly disagree 42 5.3 Total 795 100 Orientation N % Importance of Practicing Latino Ways at Home q17 Not at all 55 6.9 A Little 113 14.1 Somewhat 204 25.5 Very 428 53.5 Total 800 100 Close Friends from the Same Ethnic Background -Q18b None 86 10.8 A few 211 26.5 Some 184 23.1 A lot 135 16.9 Almost all 181 22.7 Total 797 100 S20a Importance of Keeping in Touch With/Learning About Ethnic/Cultural Background Not at all 17 2.1 A Little 73 9.1 Somewhat 214 26.6 A lot 501 62.2 Total 805 100 S21 Language of Conversations at Home More Spanish than English 436 54.2 More English than Spanish 157 19.5 About the same 212 26.3 Total 805 100 S22b Importance of Raising Children as Latinos to keep Latino Identity Very important 474 59 Somewhat important 246 30.6 Not very important 59 7.3 Not at all important 25 3.1 Total 804 100

Respondents tended to be more home country oriented; in a scale from 1 to 4,

their mean acculturation scale was 3.5 (0.6) for home country culture oriented, and 2.3

(0.8) for U.S. culture oriented. Table 6 shows the acculturation scales.

69

Table 6 Acculturation Scales

N Mean Minimum

Maximum S D ORIENTATION 1: CHANGE SINCE IMMIGRATION 611 2.95 1 4.30 0.81 ORIENTATION 2: COMPARISON TO TYPICAL MINNESOTAN 805 4.08 1 6.00 1.31 ORIENTATION 3: HOME COUNTRY WAYS IN HOME 805 3.42 1 4.00 0.63 ORIENTATION 4: FRIENDS 805 2.85 1 5.00 1.00 FLUENCY 1: US CULTURE 805 2.33 1 4.00 0.75 FLUENCY 2: HOME COUNTRY CULTURE 804 3.52 1 4.00 0.60

Smoking status

According to the BRFSS and Minnesota Adult Tobacco Survey criteria, 70.8% of

the respondents were classified as non-smokers, 15.9% as former smokers and 13.3% as

current smokers (20.1% of males and 6.1% of females); 70.5% of the current smokers

reported they were willing to quit. Table 7 shows the self reported smoking behavior of

the respondents and Table 8 shows their smoking status.

Table 7

Self-Reported Smoking Behavior Variables N % s40 Ever Smoked a Cigarette

Yes 555 68.94 No 250 31.06 Total 805 100.00

s42 Self Report of Having Smoked at Least 100 Cigarettes During Entire Life Yes 235 39.43 No 361 60.57 Total 596 100.00

s43 Self Report of Having Smoked a Cigarette in the Past 6 Months Yes 120 51.06 No 115 48.94 Total 235 100.00

s44 Self Reported Smoking Frequency Every day 55 45.83 Some days 52 43.33 Not at all 13 10.83 Total 120 100.00

70

Table 8 Smoking Status

No % Non smokers 570 70.81 Former smokers 128 15.90 Current Smokers 107 13.29 Male current smokers 83 20.10 Female current smokers 24 6.12 Total 805 100.00

Smoking beliefs

Respondents are divided about positive aspects of smoking; almost half (51.2%)

of the respondents believed that there are no positive aspects of smoking; however,

29.3% responded that smoking relieves stress, 23.9% that smoking helps to lose weight,

and 24.7% that smoking provides pleasure. The large majority of the respondents

believed that smoking causes cancer (99.1%) and heart disease (93.2%). Table 9

describes selected smoking beliefs variables.

Table 9

Smoking BeliefsVariables N %

Positive Aspects of Smoking s34c Smoking Relieves Stress/Anxiety Yes 226 29.31 No 545 70.69 Total 771 100 s34b Smoking Provides Pleasure Yes 196 24.69 No 598 75.31 Total 794 100 ps34e Smoking Helps to Lose Weight Yes 186 23.88 No 593 76.12 Total 779 100 RECODE: Number of Positive Aspects of Smoking (MAX=5) s34a-e 0 412 51.18 1 178 22.11 2 120 14.91 3 59 7.33 4 25 3.11 5 11 1.37 Total 805 100

71

Regarding choice or addiction, 44.1% of respondents believed that smoking is a

choice and 18% believed it is an addiction. 6.5% of the respondents believed that it is

okay to smoke as long as the person is healthy; 7.3% believed that the dangers and

benefits of smoking are equal, and 1.4% reported they believed that smoking has more

benefits than non smoking. A complete description of respondents’ smoking beliefs is

found in Appendix H.

Second-hand smoke behaviors

The majority of respondents (82.7%) feel uncomfortable when other Latinos

smoke around them; is not exposed to SHS at home (90.8%), at work (84.5%) or in the

car (81%); and 91% does not allow smoking at their homes; however, more than half of

them (52.2%) reported being personally exposed to SHS during the previous week, and

36.4% reported exposure to SHS to their children (under 18 years old). Exposure to SHS

was reported in the car (19%), at work (16.4%), at home (9.2%), and at other places

(36%); some respondents were exposed to SHS at various places. Table 10 shows

selected SHS behavior variables. A comprehensive description of behaviors regarding

SHS is shown in Appendix I.

Smoking behavior

Smokers reported smoking an average of 8 cigarettes per day and smoking on

average 9 days during the last month. They also reported smoking the first cigarette at the

age of 15 years old and that they starting smoking regularly when they were 18 years old.

72

The average smoker tried to quit smoking 13 times for at least one day during the

previous year. Selected continuous smoking outcomes are shown in Table 11.

Table 10 Second-Hand Smoke Behaviors

Variables N % S62 Comfort Level When Other Latinos Smoke Around You

Very comfortable 72 8.99 Somewhat comfortable 67 8.36 Somewhat uncomfortable 161 20.10 Very uncomfortable 501 62.55 Total 801 100.00

s64 Smoking Inside Home During the Past 7 Days Yes 74 9.19 No 731 90.81 Total 805 100.00

s66 Been in a Car With Someone Who Was Smoking in the Past Seven Days Yes 153 19.01 No 652 80.99 Total 805 100.00

s65 Statement Best Describing Smoking Rules at Home Smoking is not allowed anywhere 732 91.04 Smoking is allowed some places 40 4.98 People can smoke anywhere 17 2.11 Other rule 15 1.87 Total 804 100.00

Number of SHS Exposures In Past 7 Days (MAX=5.) 0 385 47.83 1 263 32.67 2 111 13.79 3 38 4.72 4 8 0.99 Total 805 100.00

Minors of 18 yo exposed to SHS Yes 293 36.40 No 512 63.60 Total 805 100.00

Table 11 Smoking Outcomes Continuous Variables

Continuous Variables N Mean Minimum Maximum SD s45 Self Reported Daily Average of Cigarettes Smoked 55 8.29 1 20 6.08 S46 Self Reported Number of Days Cigarettes Where Smoked during the

Past Month 51 9.27 0 30 7.20 S47 Self reported Average Daily Number of Cigarettes Smoked During the

Past Month 52 3.42 0 20 4.47 S50 Age When First Cigarette Was Smoked 234 15.21 6 35 4.23 S51 Age Began Smoking Cigarettes Regularly 235 18.58 8 37 4.71 S55 Number of Times Quit Smoking for a Day or More in the Past 12 Months 101 13.49 0 100 26.44

A small percentage of the respondents (17%) reported smoking the first cigarette

between the 30 minutes after waking and about half (51.4%) of the current smokers

73

responded that they smoked every day. The majority (79.5%) of the respondents smoked

their first cigarette and about half of the respondents (44.9%) started smoking regularly

before they were 18 years old. When facing stress 50% of the respondents increased the

amount of cigarettes smoked; 47% of Latino current smokers felt comfortable smoking

around other Latinos, and a similar percentage (48%) reported enjoying smoking;

however, 54.7% indicated that they wanted to stop smoking. A majority (83.8%) of

current smokers believed they would be somewhat or very likely to be able to stop

smoking if they wanted to quit, and (90.5%) responded they believed they were

somewhat or very likely to succeed if they decided to stop smoking. A similar percentage

(91.4%) somewhat or strongly agreed that they believed the only way they could be able

to stop smoking would be through their own will power; however, 59.4% responded that

they felt somewhat or very comfortable asking for help to stop smoking. The majority

(73%) of respondents have quit smoking for a day or more at least on one occasion

during the previous year. Table 12 shows selected smoking categorical variables. More

detailed results about smoking behavior are shown in Appendix J.

The majority (87.5%) of former smokers stopped smoking more than one year

before they responded to the survey and 29.9% reported that smoking restrictions

influenced their decision to stop smoking. Table 13 shows selected variables of former

smokers.

74

Table 12 Smoking Behavior

Variables N % Choice Vs. Addiction Scale -Choice=2 Addiction=8 -s36-37

2 102 12.81 3 102 12.81 4 147 18.47 5 302 37.94 6 73 9.17 7 37 4.65 8 33 4.15 Total 796 100.00

rs44 Smoke cigarettes every day Yes 55 51.40 No 52 48.60 Total 107 100.00

S52 Minutes Between Waking and First Cigarette Within 5 minutes 6 5.70 6 - 30 minutes 12 11.30 31 - 60 minutes 16 15.10 More than 60 minutes 72 67.90 Total 106 100.00

s53 Amount of Smoking When Facing Stress A lot 16 14.95 A little more 37 34.58 The same amount 38 35.51 A little less 6 5.61 A lot less 10 9.35 Total 107 100.00

s54 Level of Comfort Smoking Around Other Latinos Very comfortable 20 19.23 Somewhat comfortable 29 27.88 Somewhat uncomfortable 31 29.81 Very uncomfortable 24 23.08 Total 104 100.00

Table 13

Former Smokers Categorical Variables N %

S48 Elapsed Time Since End of Regular Cigarette Smoking

Never smoke regularly 4 3.10 1 month or less 1 0.80 More than one month but less than 3 months ago 2 1.60 More than three months but less than 6 months ago 4 3.10 More than six months but less than 1 year ago 5 3.90 More than one year but less than 5 years ago 26 20.30 More than 5 years but less than 10 years ago 22 17.20 10 or more years ago 64 50.00 Total 128 100.00

S49 How Much Smoking Restrictions Affect Decision to Quit Smoking None 89 70.10 A little 6 4.70 Some 10 7.90 A lot 22 17.30 Total 127 100.00

75

Socioeconomic characteristics given smoking status and stages of change

Results of the comparison of the socioeconomic characteristics between never

smokers and smokers in the different SOC are presented in Appendices K 1 to 9.

Comparison by socioeconomic status variables between never smokers and ever smokers

Appendix K 1 shows the socioeconomic status variables of never and ever

smokers.

When never smokers were compared to ever smokers there were statistically

significant differences by gender, age, living with children under 18 years old,

employment, income, language of the survey, and friends from the same cultural

background. Men were more likely to be ever smokers, 76.6% of ever smokers were men

compared to 40.9% of never smokers, p <.001; 86.1% of never smokers are older than 24

years compared to 91.5% of ever smokers, p=.044; never smokers are more likely to live

with children younger than 18 years (74%) compared to 62% of ever smokers, p=.002;

ever smokers are more likely to be employed (86%) compared to 75.5% of never

smokers, p=.001; ever smokers tend to have higher income than never smokers; 65.9% of

ever smokers reported more than $25,000.00 of annual household income compared to

53.3% of never smoker, p = .001; never smokers tend to respond the survey in Spanish

(70.7%) compared to 56.6% of ever smokers, p<.001; and never smokers tend to have

more friends from their same ethnic background (62.6%) compared to54% of ever

smokers, p=.027.

76

When controlling for age and gender, however, significant differences were found

for gender and language of the survey. Ever smokers were more likely than never

smokers to be male (OR=4.859, 95% CI=3.413, 6.918) and to respond the survey in

Spanish (OR=1.582, 95% CI=1.123, 2.229). Table 14 includes the statistical significant

socioeconomic variables of never smokers compared to ever smokers.

Table 14 Statistically Significant Differences Between Never and

Ever Smokers Given Socioeconomic Status

Univariate Multivariate Controlling by age and gender

Never Ever 95% CI

Variable No % No % P

FET OR Lower Upper P H1.1 Gender Male 233 40.88 180 76.60 0.000 4.859 3.413 6.918 0.000 * H1.2 Dage 25 (Older than 24 yo) 491 86.14 215 91.49 0.044 1.122 0.608 2.073 0.713 H1.4 Dminors 1=18yo 0r <; 0=>18yo 422 74.04 147 62.55 0.002 0.908 0.622 1.323 0.614 H1.6 rs67 Employed 429 75.53 202 85.96 0.001 0.745 0.460 1.205 0.229 H1.7 Dincome (>$25,000) 277 53.27 149 65.93 0.001 0.738 0.519 1.050 0.091 H1.9 Survey's language LangSurveySp 403 70.70 133 56.60 0.000 1.582 1.123 2.229 0.009 * H1.12 Orientation 4 Friends Dorient4f 357 62.63 127 54.04 0.027 1.106 0.788 1.552 0.559

Comparison by socioeconomic status variables between current and former smokers

Appendix K 2 describes the socioeconomic status variables of former and current

smokers.

When former smokers were compared to current smokers, statistically significant

differences were found for age, marital status, and friends from the same cultural

background. Former smokers tended to be older than current smokers; 97.7% of former

smokers were older than 24 years, compared to 83.8% of current smokers, p<.001; and

when looking at marital status, 79.7% of former smokers were married or living in a

marriage-like relationship compared to 60% of current smokers, p=.001. Finally, a larger

percentage (61%) of current smokers had more friends from the same ethnic background

77

compared to 47.7% of former smokers, p=.048; however, when the comparison was

controlled by age and gender only marital status was statistically significant. Former

smokers are more likely to be married or living in a marriage-like relationship

(OR=2.879, 95% CI=1.518, 5.460). Table 15 shows the statistical significant

socioeconomic differences between former and current smokers.

Table 15 Statistically Significant Differences Between Former and Current Smokers Given Socioeconomic Status

Univariate Multivariate Controlling by age and gender FS CS 95% CI

Variable No % No % P (FET) OR Lower Upper P H1.2 Dage 25 (Older than 24 yo) 125 97.66 88 83.81 0.000 3.256 0.834 12.720 0.089 H1.3 Marital Status dq12 M (married) 102 79.69 63 60.00 0.001 2.879 1.518 5.460 0.001 * H1.7 Dincome (>$25,000) 86 70.49 62 60.78 0.156 1.819 0.996 3.323 0.052 H1.12 Orientation 4 Friends Dorient4f 61 47.66 64 60.95 0.048 0.701 0.403 1.218 0.207

Comparison by socioeconomic status variables between former smokers in the

maintenance SOC, current smokers willing to quit, in the preparation SOC, and current

smokers not willing to quit, in the pre-contemplation SOC

Appendix K 3 describes the socioeconomic status variables of former smokers, in

the maintenance SOC, current smokers willing to quit, in the preparation SOC, and

current smokers not willing to quit, in the pre-contemplation SOC.

When smokers in the maintenance, preparation, and pre-contemplation SOC were

compared, statistically significant differences were found by age and marital status as

follows: former smokers tended to be older than current smokers; 97.7% of smokers in

the maintenance SOC were older than 24 years compared to 86.5% of smokers in the

preparation SOC and 77.4% of those in the pre-contemplation SOC, p<.001; and when

looking at marital status, 79.7% of smokers in the maintenance SOC were married or

78

living in a marriage-like relationship compared to 56.8% of smokers in the preparation

SOC and 67.7% of those in the pre-contemplation SOC, p = .002.

Contrary to what was expected, it was found that a lower percentage of smokers

in the preparation SOC was married or living in a marriage-like relationship than those in

the pre-contemplation SOC. Table 16 shows the statistically significant differences

between smokers in the maintenance, preparation, and pre-contemplation SOC.

Table 16 Statistically Significant Differences Between Smokers in the

Maintenance, Preparation, and Pre-Contemplation SOC Given Socioeconomic Status

Maintenance SOC Preparation SOC

Pre-contemplation SOC

Variable No % No % No % P FET H1.2 Dage 25 (Older than 24 yo) 125 97.66 64 86.49 24 77.42 0.000 * H1.3 Marital Status dq12 M (married) 102 79.69 42 56.76 21 67.74 0.002 *

Comparison by socioeconomic status variables between smokers in the preparation and

pre-contemplation SOC

There were no statistically significant differences between smokers in the

preparation and pre-contemplation SOC. Appendix K 4 shows the socioeconomic status

variables of smokers in the preparation and pre-contemplation SOC.

Comparison by socioeconomic status variables between smokers in the pre-

contemplation, contemplation, and preparation SOC

Appendix K 5 describes the socioeconomic characteristics of smokers in the pre-

contemplation, contemplation, and preparation SOC.

79

Only age was statistically significantly different between smokers in the pre-

contemplation, contemplation, and preparation SOC. A large percentage of smokers in

the preparation SOC were older than 24 years (91.4%), compared to 83.3% of smokers in

the pre-contemplation and 70% of those in the contemplation SOC, p=.032, as is shown

in Table 17.

Table 17 Statistically Significant Differences Between Smokers in the Preparation, Contemplation, and Pre-Contemplation SOC Given Socioeconomic Status

Univariate Pre-contemplation SOC Contemplation SOC Preparation SOC

Variable No % No % No % P FET H1.2 Dage 25 (Older than 24 yo) 15 83.33 21 70.00 53 91.38 0.032 *

Comparison by socioeconomic status variables given perceived likelihood of success if

wanted to quit smoking

Appendix K 6 describes the socioeconomic characteristics of smokers who

perceive themselves to be likely and unlikely respectively to succeed if they wanted to

quit smoking.

The only statistically significant difference was found in friends from the same

cultural background. Smokers who answered that they were unlikely to succeed if they

wanted to quit smoking tend to have less friends from the same ethnic background

(52.9%), than those who answered they were likely to succeed (80.7%), (OR=.270, 95%

CI=.089, .0813), as is shown in Table 18.

80

Table 18 Statistically Significant Differences by Likelihood to Succeed if

Wanted to Quit Smoking Given Socioeconomic Status Univariate

Multivariate Controlling by age and gender

Unlikely Likely 95% CI Variable No % No % P FET OR Lower Upper P

H1.11 Fluency 2 HC dfluency2hc 9 52.94 71 80.68 0.026 0.270 0.089 0.813 0.020 *

Comparison by socioeconomic status variables given believes about the likelihood of

success if decided to quit smoking

Appendix K 7 describes the socioeconomic characteristics of smokers who

perceive themselves to be likely and unlikely to succeed if they decided to quit smoking.

The only statistically significant difference was found in friends from the same

cultural background. Smokers who answered that they were unlikely to succeed if they

decided to quit smoking tend to have less friends from the same ethnic background

(50%), than those who answered they were likely to succeed (79%), (OR=.199, 95%

CI=.044, .903), as is shown in Table 19.


Decided to Quit Smoking Given Socioeconomic Status Univariate



H1.11 Fluency 2 HC dfluency2hc 5 50.00 75 78.95 0.055 0.199 0.044 0.903 0.036 *

Comparison by socioeconomic status variables given level of comfort asking for help

Appendix K 8 describes the socioeconomic characteristics of smokers who felt

comfortable and uncomfortable asking for help to quit smoking.

81

The only statistically significant difference was found in the percentage of

respondents living with children under 18 years old. Smokers who answered that they

were uncomfortable asking for help to quit smoking are more likely to live with children

under 18 years old (82.9%), than those who answered they were comfortable (60%),

(OR=3.507, 95% CI=1.293, 9.510), as is shown in Table 20.

Table 20 Statistically Significant Differences by Level of Comfort Asking for

Help to Quit Smoking Given Socioeconomic Status Univariate


Uncomfortable Comfortable 95% CI Variable No % No % P FET OR Lower Upper P

H1.4 Dminors 1=18yo 0r <; 0=>18yo 34 82.93 36 60.00 0.016 3.507 1.293 9.510 0.014 *

Comparison by socioeconomic status variables given level of agreement about the belief

that the only way to stop smoking is through will power

Appendix K 9 describes the socioeconomic characteristics of smokers who agree

and disagree about the belief that the only way to stop smoking is through their own will

power.

The only statistically significant difference was found by employment. A larger

percentage of smokers who answered that they agreed the only way to stop smoking is

through their own will power are employed (90.6%) compared to 55.6% of those who

disagree, p=.013. However, when controlling for age and gender this difference tended to

disappear (OR=0.194, 95% CI=.037, 1.022), as is shown Table 21.

82

Table 21 Statistically Significant Differences by Agreement About Only Way to Stop Smoking is Through Will Power Given

Socioeconomic Status Univariate Multivariate Controlling by age and gender

Disagree Agree 95% CI Variable No % No % P FET OR Lower Upper P

H1.6 rs67 Employed 5 55.56 87 90.62 0.013 0.194 0.037 1.022 0.053 *

Summary results for hypothesis one

The results for the first hypothesis, differences by socioeconomic status, show

that there are significant differences among Latino smokers classified in the maintenance,

preparation, contemplation, and pre-contemplation SOC, by age. Smokers in the

maintenance SOC tend to be older than smokers in the preparation and pre-contemplation

SOC; similarly, smokers in the preparation SOC tend to be older than smokers in the pre-

contemplation and than those in the contemplation SOC.

The data support the following subhypothesis:

H1.2: Latino smokers who are not willing to quit smoking are younger than

Latino former smokers, and Latino smokers who are willing to quit

smoking.

The following subhypotheses are not supported:

H1.1: Latino men who smoke are more likely to be willing to quit smoking than

Latino women who smoke.

83


single than Latino former smokers and Latino smokers who are willing to

quit smoking.

H1.4: Latino smokers who are not willing to quit smoking are less likely to live

with minors of 18 years old than Latino former smokers and Latino


H1.5: Latino smokers who are not willing to quit smoking have a lower level of

education than Latino former smokers and Latino smokers who are willing

to quit smoking.


unemployed than Latino smokers who are willing to quit smoking.


have lower income than Latino former smokers and Latino smokers who



in rural areas than Latino smokers who are willing to quit smoking.


answer the survey in Spanish than Latino former smokers and Latino



have fewer years living in the U.S. than Latino former smokers and Latino


84


home country oriented than Latino former smokers and Latino smokers



have more friends with the same cultural background than Latino former


Self-reported health status given smoking status and stages of change

Results of the comparison of the self-reported health status variables between

never smokers and smokers in the different SOC are presented in Appendices L 1 to 9.

Comparison by self-reported health status among never smokers and ever smokers

Appendix L 1 shows the self-reported health status variables of never and ever

smokers.

When never smokers were compared to ever smokers, there were statistically

significant differences by self reported injury or illness affecting daily routine during the

previous year, self reported major injury or illness during the past year, major change in

health of relative in the past year, and BMI. When the comparison was made controlling

for age and gender, the following were statistically significantly different: self reported

happiness, self reported major injury or illness during the past year, and major change in

health of relative in the past year.

85

A larger percentage of ever smokers (44.3%) self-reported an injury or illness

affecting their daily routines during the previous year compared to 36.5% of never

smokers, p = .047; similarly, 24.3% of ever smokers reported suffering a major injury or

illness during the previous year compared to 12.9% of never smokers, p <.001. 30.2% of

ever smokers reported a major change in health of a relative during the previous year

compared to 22.1% of never smokers, p =.019, and a larger percentage of never smokers

(30.3%) have a normal BMI than ever smokers (21.9%), p=.020. When controlling for

age and gender, never smokers are more likely than ever smokers to report happiness

(OR=1.794, 95% CI=1.033, 3.115), and less likely than ever smokers to report major

injury or illness during the previous year (OR=.512, 95% CI=.336, .779) and major

change in health of relative in the past year (OR=.609, 95% CI=.420, .884), as is shown

in Table 22.

Table 22 Statistically Significant Differences Between Never and Ever Smokers

Given Self-Reported Health Status

Univariate Multivariate Controlling by

age and gender Never Ever 95% CI

Variable No % No % P FET OR

Lower

Upper P

H2.3 Self Reported Happiness Rq3 519 91.86 205 88.36 0.137 1.794 1.033 3.115 0.038 * H2.5 Self Reported Injury or Illness affecting daily routine during the past 12 months Rs2 208 36.49 104 44.26 0.047

0.778

0.557

1.086

0.139

H2.9 Self reported Major Injury or illness in the Past Year Rs33a 73 12.85 57 24.26 0.000

0.512

0.336

0.779

0.002 *

H2.11 Major Change in Health of Relative in the past Year Rs33c

126

22.11 71

30.21 0.019

0.609

0.420

0.884

0.009 *

H2.14 DBMI 158 30.33 49 21.86 0.020 1.130 0.758 1.683 0.549

Comparison by self-reported health status among former smokers and current smokers

Appendix L 2 shows the self-reported health status variables of former and

current smokers.

86

When former smokers were compared to current smokers, there were no

statistically significant differences; however, a larger percentage of current smokers

(28.4%) have a normal BMI compared to former smokers (16.7%), p=.051. This

difference is no statistically significant when the comparison is made controlling for

gender and age, as is shown in Table 23.

Table 23 Statistically Significant Differences Between Former and

Current Smokers Given Self-Reported Health Status Univariate


FS CS 95% CI Variable No % No % P FET OR Lower Upper P

H2.14 DBMI 20 16.67 29 28.43 0.051 0.545 0.272 1.089 0.086

Comparison by self-reported health status among former smokers in the maintenance

SOC, current smokers willing to quit, in the preparation SOC, and current smokers not

willing to quit, in the pre-contemplation SOC

Appendix L 3 describes the self-reported health status variables of Latino smokers

in the maintenance, preparation, and pre-contemplation SOC. There were no statistically

significant differences.

Comparison by self-reported health status among smokers in the preparation and pre-

contemplation SOC

Appendix L 4 shows the self-reported health status variables of smokers in the

preparation and pre-contemplation SOC.

87

When smokers in the preparation SOC were compared to those in the pre-

contemplation SOC, there were statistically significant differences by self-reported major

change in health of relative in the past year. When the comparison was made controlling

for age and gender, there were statistically significant differences by self-reported

interesting things in daily life, self-reported major change in health of relative in the past

year, and self-reported major change in family reunions during the previous year.

Smokers in the preparation SOC (82.2%) were more likely to self-report

interesting things in daily life compared to those in the pre-contemplation SOC (64.5%),

(OR=2.645, 95% CI=1.000, 6.995). As was expected, smokers in the preparation SOC

were more likely to self-report a major change in health of relative during the previous

year (23%) than smokers in the pre-contemplation SOC (45.2%), p=.034, (OR=.314, 95%

CI=.123, .802); similarly, smokers in the preparation SOC were less likely to self report a

major change in family reunions during the previous year (14.9%) than smokers in the

pre-contemplation SOC (32.3%), p=.060, (OR=.349, 95% CI=.126, .0967), as is shown in

Table 24.

Table 24 Statistically Significant Differences between Smokers in the Preparation, and

Pre-Contemplation SOC Given Self-Reported Health Status

Univariate Multivariate Controlling by age and

gender Preparation Precontemplation 95% CI

Variable No % No % PFET OR Lower Upper P H2.2 Self Reported Interesting Things in Daily Life Rq2 60 82.19 20 64.52 0.074 2.645 1.000 6.996 0.05 * H2.11 Major Change in Health of Relative in the past Year Rs33c 17 22.97 14 45.16 0.034 0.314 0.123 0.802 0.015 * H2.12 Major Change Family Get-togethers in the Past Year Rs33d 11 14.86 10 32.26 0.060 0.349 0.126 0.967 0.043 *

88

Comparison by self-reported health status among smokers in the pre-contemplation,

contemplation, and preparation SOC

Appendix L 5 describes the socioeconomic characteristics of smokers in

the pre-contemplation, contemplation, and preparation SOC. There were no statistically


Comparison by self-reported health status given perceptions of the likelihood of success

if wanted to quit smoking

Appendix L 6 describes the self-reported health status variables of smokers who

believed they would be likely and unlikely to succeed if they wanted to quit smoking.

The only statistically significant difference was adequate exercise. Smokers who

answered that they were unlikely to succeed if they wanted to quit smoking were less

likely to exercise adequately (17.7%) than those who answered that they were unlikely to

succeed (43.2%), (OR=.242, 95% CI=.603, .929), as is shown in Table 25.

Table 25 Statistically Significant Differences by Likelihood to Succeed

if Wanted to Quit Given Self-Reported Health Status



H2.7 Adequate Exercise – cumex 3 17.65 38 43.18 0.049 0.242 0.603 0.929 0.039 *

89

Comparison by self-reported health status given believes about the likelihood of success

if decided to quit smoking


believe they are likely and unlikely to succeed if they decided to quit smoking. There

were no statistically significant differences.

Comparison by self-reported health status variables given level of comfort asking for

help


felt comfortable and uncomfortable asking for help to quit smoking. There were no

statistically significant differences; however, a larger percentage of smokers who felt

uncomfortable asking for help tend to engage in adequate exercise (51.2%), compared to

those who felt comfortable asking for help (31.7%), p=0.063. When controlling for age

and gender, a similar trend was found, (OR=2.299, 95% CI=.0976, 5.414), as is shown in

Table 26.

Table 26 Statistically Significant Differences by Level of Comfort About Asking

for Help to Quit Smoking Given Self-Reported Health Status

Univariate Multivariate Controlling by age

and gender Uncomfortable Comfortable 95% CI

Variable No % No % P FET OR Lower

Upper P

H2.7 Adequate Exercise – cumex 21 51.22 19 31.67 0 .063 2.299

0.976

5.414

0.057

90

Comparison by self-reported health status variables given level of agreement about the

believe that the only way to stop smoking is through will power

Appendix L 9 describes the self-reported health status characteristics of smokers

who agree and disagree about the belief that the only way to stop smoking is through

their own will power.

Statistically significant differences were found for self-reported healthy, self-

reported major injury or illness during the previous year, and BMI.

A larger percentage of smokers who answered that they agreed that they believe

the only way to stop smoking is through their own will power self-reported healthy status

(72.9%), compared to those who disagree (37.5%), p=.049. A larger percentage of

smokers who answered that they disagreed with the belief that the only way to stop

smoking is through their own will power self-reported suffering a major injury or illness

during the previous year (66.7%), compared to those who agree (20.8%), p=.007,

Similarly, a larger percentage of smokers who answered that they disagreed about the

belief that the only way to stop smoking is through their own will power have a normal

BMI (88.9%), compared to those who agree (22.6%), p<.001.

When controlling for age and gender, smokers who disagree about the belief that

only way to stop smoking is through will power are more likely to report mayor injury or

illness during the previous year than those who agree (OR=5.736, 95% CI=1.216,

27.051); and smokers who disagree with the belief that the only way to stop smoking is

through will power are more likely to have a normal BMI than those who agree


91

Table 27 Statistically Significant Differences by Agreement About Only Way to

Stop Smoking is Through Will Power Given Self-Reported Health Status Univariate


Disagree Agree 95% CI Variable No % No % PFET OR Lower Upper P

H2.1 Self Reported Healthy Rq1 3 37.50 70 72.92 0.049 0.264 0.054 1.286 0.099 H2.9 Self reported Major Injury or illness in the Past Year Rs33a 6 66.67 20 20.83 0.007 5.736 1.216 27.051 0.027 * H2.14 DBMI 8 88.89 21 22.58 0.000 39.402 3.799 408.623 0.002 *

Summary results for hypothesis two

The results for the second hypothesis, differences by self-reported health status,

show that there are significant differences among smokers in the preparation and pre-

contemplation SOC. Smokers in the preparation SOC are less likely to report major

change in the health of relative during the previous year and major change in family

reunions, and are more likely to report interesting things in their daily life than those in


The data support the following subhypotheses:


report interesting things in daily life during the previous month than

Latino former smokers and Latino smokers who are willing to quit

smoking.


self-report major change in health of a family member during the previous

year than Latino former smokers and Latino smokers who are willing to

quit smoking.

92


self-report major change in the number of family get-togethers during the

previous year than Latino former smokers and Latino smokers who are




self-report fair or poor physical health during the previous year than


smoking.


report that they are happy with their personal life during the previous

month than Latino former smokers and Latino smokers who are willing to

quit smoking.


report that they are healthy compare to other people their age than Latino



report injury or illness affecting daily routine during the previous year

than Latino former smokers and Latino smokers who are willing to quit

smoking.

93


report physical activity during the previous week than Latino former



report adequate exercise during the previous week than Latino former



self-report stressful events during the previous month than Latino former



self-report a major personal injury or illness during the previous year than


smoking.


self-report change of residence during the previous year than Latino



report adequate fruit and vegetable consumption during the previous week


smoking.

94

H2.14: Latino smokers who are not willing to quit smoking have a lower BMI


smoking.

Beliefs about smoking variables given smoking status and stages of change

Results of the comparison of beliefs about smoking variables between never

smokers and smokers in the different SOC are presented in Appendices M 1 to 9.

Comparison by beliefs about smoking variables among never smokers and ever smokers

Appendix M 1 shows beliefs about smoking variables of never and ever smokers.


significant differences by beliefs that smoking facilitates friendship, provides pleasure,

relieves stress, can help to focus on activities, helps to lose weight, and there are no

positive aspects of smoking as follows:

A larger percentage of ever smokers (11.2%) believed that smoking facilitates

friendship, compared to never smokers (6%), p=.017. A larger percentage of ever

smokers (40%) believed that smoking provides pleasure, compared to never smokers

(18.3%), p<.001. A larger percentage of ever smokers (48.7%) believed that smoking

relieves stress, compared to never smokers (21.1%), p<.001. A larger percentage of ever

smokers (14.7%) believed that smoking can help focus on activities, compared to never

smokers (8.67%), p=.015. Similarly, a larger percentage of ever smokers (29.3%)

believed that smoking helps to lose weight, compared to never smokers (21.6%), p=.027.

95

A larger percentage of never smokers (59%) believed that there are no positive aspects of

smoking, compared to ever smokers (32.3%), p<.001.

When the comparison was controlled by age and gender, statistically significant

differences were found for beliefs that smoking provides pleasure, relieves stress, that

there are no positive aspects of smoking, and that smoking causes heart disease. Never

smokers are less likely to believe that smoking provides pleasure and that smoking

relieves stress than ever smokers, (OR=.364, 95% CI=.252, .526) and (OR=.278, 95%

CI=.194, .400), respectively. As expected, never smokers were more likely to believe that

there are no positive aspects of smoking (OR=2.600, 95% CI=1.848, 3.660) and that

smoking causes heart disease (OR=2.252, 95% CI=1.175, 4.314). Table 28 describes the

statistically significant differences between never and ever smokers regarding their

beliefs about smoking.

Table 28 Statistically Significant Differences Between

Never and Ever Smokers Given Beliefs About Smoking


and gender Never Ever 95% CI

Variable No % No % PFET OR Lower Upper P H3.1 Smoking Facilitates Friendship Rs34a 34 6.00 26 11.16 0.017 0.641 0.359 1.146 0.134 H3.2 Smoking Provides Pleasure Rs34b 102 18.25 94 40.00 0.000 0.364 0.252 0.526 0.000 * H3.3 Smoking Relieves Stress Rs34c 114 21.07 112 48.70 0.000 0.278 0.194 0.400 0.000 * H3.4 Smoking Can Help focus on activities Rs34d 48 8.63 34 14.66 0.015 0.800 0.477 1.341 0.397 H3.5 Smoking helps to Lose Weight Rs34e 119 21.64 67 29.26 0.027 0.830 0.567 1.214 0.336 H3.6 No Positive Aspects of Smoking Rsmokeben 336 58.95 76 32.34 0.000 2.600 1.848 3.660 0.000 * H3.8 Smoking Causes Heart Disease Rs76c 509 94.09 207 91.19 0.157 2.252 1.175 4.314 0.014 *

Comparison by beliefs about smoking variables among former and current smokers

Appendix M 2 shows beliefs about smoking variables of former and current

smokers.

96

When former smokers were compared to current smokers, there were statistically

significant differences by the beliefs that there are no positive aspects of smoking and

that about smoking there are more harms than benefits. When controlling for age and

gender, former smokers are more likely to believe that there are no positive aspects of

smoking (OR=1.839, 95% CI=1.018, 3.323), and consequently, that with regard to

smoking there are more harms than benefits (OR=6.472, 95% CI=2.044, 20.494), as is

shown in Table 29.

Table 29 Statistically Significant Differences Between

Former and Current Smokers Given Beliefs About Smoking



H3.6 No Positive Aspects of Smoking Rsmokeben 48 37.50 28 26.67 0.092 1.839 1.018 3.323 0.044 * H3.13 About smoking, there are more harms than benefits ds39 123 96.09 89 84.76 0.005 6.472 2.044 20.494 0.001 *

Comparison by beliefs about smoking variables among former smokers in the


smokers no willing to quit, in the pre-contemplation SOC

Appendix M 3 describes the beliefs about smoking variables of former smokers,

in the maintenance SOC, current smokers willing to quit, in the preparation SOC, and

current smokers not willing to quit, in the pre-contemplation SOC.


compared, statistically significant differences were found only for beliefs that about

smoking there are more harms than benefits. A larger percentage of smokers in the

maintenance SOC (96.1%) believed that smoking causes more harms than benefits

97

compared to those in the preparation SOC (83.8%) and in the pre-contemplation

SOC(87.1%), p = .007, as is shown in Table 30.

Table 30 Statistically Significant Differences Between Smokers in the Maintenance,Preparation, and Pre-Contemplation SOC Given Beliefs About Smoking

Maintenance SOC

Preparation SOC


Variable No % No % No % P FET H3.13 About smoking, there are more harms than benefits ds39 123 96.09 62 83.78 27 87.10 0.007 *

Comparison by beliefs about smoking variables among smokers in the preparation and

pre-contemplation SOC

Appendix M 4 shows beliefs about smoking variables of smokers in the



contemplation SOC, there were statistically significant differences by beliefs that

smoking facilitates friendship and provides pleasure. When controlling for age and

gender, smokers in the preparation SOC were less likely to believe that smoking

facilitates friendship (OR=.216, 95% CI=.052, .891) and that smoking provides pleasure

(OR=.373, 95% CI=.150, .930), as is shown in Table 31.


Preparation and Pre-Contemplation SOC Given Beliefs About Smoking Univariate


Preparation Precontemplation 95% CI Variable No % No % PFET OR Lower Upper P

H3.1 Smoking Facilitates Friendship Rs34a 4 5.41 6 19.35 0.061 0.216 0.052 0.891 0.034 * H3.2 Smoking Provides Pleasure Rs34b 27 36.49 17 54.84 0.089 0.373 0.150 0.930 0.034 *

98

Comparison by beliefs about smoking variables among smokers in the pre-contemplation,

contemplation, and preparation SOC

Appendix M 5 describes beliefs about smoking variables of smokers in the

pre-contemplation, contemplation, and preparation SOC. There were no statistically

significant differences between smokers in the pre-contemplation, contemplation, and

preparation SOC.

Comparison by beliefs about smoking variables given perceived likelihood of success if

wanted to quit smoking

Appendix M 6 describes beliefs about smoking of smokers who believe they are

likely and unlikely to succeed if they wanted to quit smoking. There were no statistically


Comparison by beliefs about smoking variables given perceived likelihood of success if

decided to quit smoking

Appendix M 7 describes beliefs about smoking of smokers who believe they are

likely and unlikely to succeed if they decided to quit smoking.

When controlling for age and gender, smokers who answered that they were

unlikely to succeed if they decided to quit smoking are less likely to believe that people

smoke because they want to (OR=.114, 95% CI=.018, .671), as is shown in Table 32.

99


Decided to Quit Smoking Given Beliefs About Smoking Univariate



H3.9 People Smoke because they want to rs35 6 60.00 74 77.89 0.244 0.114 0.018 0.671 0.016 *

Comparison by beliefs about smoking variables given level of comfort asking for help

Appendix M 8 describes the self-reported health status variables of smokers who

felt comfortable and uncomfortable asking for help to quit smoking. There were no

statistically significant differences.

Comparison by beliefs about smoking variables given level of agreement about the belief

that the only way to stop smoking is through will power

Appendix M 9 describes beliefs about smoking by smokers who agree and

disagree about the belief that the only way to stop smoking is through their own will

power.

The only statistically significant difference was for the belief that smoking results

in more harms than benefits. When controlling for age and gender, smokers who disagree

with the belief that the only way to stop smoking is through will power are less likely to

believe that smoking causes more harms than benefits (OR=.200, 95% CI=.040, .991)

than those who agree, as is shown in Table 33.

100

Table 33 Statistically Significant Differences by Agreement About Only Way to Stop

Smoking is Through Will Power Given Beliefs About Smoking Univariate


Variable Disagree Agree 95% CI No % No % P FET OR Lower Upper P

H3.13 About smoking, there are more harms than benefits ds39 5 55.56 84 87.50 0.029 0.200 0.040 0.991 0.049 *

Summary results for hypothesis three

The results for the third hypothesis show that there are significant differences

among former smokers in the maintenance, preparation and pre-contemplation SOC for

the beliefs that smoking facilitates friendship and provides pleasure. Smokers in the

preparation SOC are less likely to believe that smoking facilitates friendship and that

smoking provides pleasure than those in the pre-contemplation SOC.



believe that smoking facilitates friendship than Latino former smokers and



believe that smoking provides pleasure than Latino former smokers and


101



believe that smoking relieves stress than Latino former smokers and



believe that smoking helps to focus on activities than Latino former



believe that smoking helps to lose weight than Latino former smokers and



believe that smoking has positive aspects than Latino former smokers and


H3.7: Latino smokers who are not willing to quit smoking are less

knowledgeable that smoking causes lung cancer than Latino former


H3.8: Latino smokers who are not willing to quit smoking are less

knowledgeable that smoking causes heart disease than Latino former


H3.9: Latino smokers who are not willing to quit smoking are more willing to

believe that people smoke because they want to than Latino former


102


believe that people smoke because it is a habit than Latino former smokers



believe that people who smoke cannot control whether they smoke or not


smoking.


believe that it is okay to smoke as long as you are healthy than Latino



believe that smoking causes more harms than benefits than Latino former


Behaviors about second-hand smoke variables given smoking status and stages of

change

Results of the comparison of behaviors about SHS between never smokers and

smokers in the different SOC are presented in Appendices N 1 to 9.

Comparison by behaviors about SHS variables among never smokers and ever smokers

Appendix N 1 shows behaviors about SHS of never and ever smokers.

103


significant differences by the following behaviors: comfortable with others smoking

around you, living in a house in which someone smokes, riding in a car in which

someone smokes, smoking is not allowed at home, prefer to work where smoking is not

allowed, been exposed to SHS during the previous week, and exposing children under 18

years old to SHS during the previous week.

Controlling for age and gender, never smokers are less likely than ever smokers to

be comfortable with others smoking around them (OR=.234, 95% CI=.155, .353), live in

a house in which someone smokes (OR=.352, 95% CI=.207, .598), ride in a car with

someone who smokes (OR=.382, 95% CI=.256, .572), be exposed to SHS during the

previous week (OR=.392, 95% CI=.277, .557), and to expose children under 18 years old

to SHS during the previous week (OR=.443, 95% CI=.311, .631). Never smokers are

more likely to live in a home in which smoking is not allowed than ever smokers

(OR=3.424, 95% CI=1.992, 5.885), as well as to prefer work where smoking is not

allowed (OR=3.035, 95% CI=2.014, 4.572), as is shown in table 34.

Table 34 Statistically Significant Differences Between Never and Ever Smokers

Given Behaviors About Second-Hand Smoke


and gender Never Ever 95% CI

Variable No % No % P FET OR Lower Upper P H4.1 Comfortable with others smoking around you Rs62 57 10.02 82 35.34 0.000 0.234 0.155 0.353 0.000 * H4.2 House someone smokes Rs64 37 6.49 37 15.75 0.000 0.352 0.207 0.598 0.000 * H4.3 Car someone smokes Rs66 82 14.39 71 30.21 0.000 0.382 0.256 0.572 0.000 * H4.4 smoking not Allowed at home Rs65 538 94.55 194 82.55 0.000 3.424 1.992 5.885 0.000 * H4.7 Prefer works where smoking is not allowed Rs73 352 82.05 122 60.40 0.000 3.035 2.014 4.572 0.000 * H4.8 SHS (1=exposure to shs; 0=no shs) 259 45.44 161 68.51 0.000 0.392 0.277 0.557 0.000 * H4.9 MinorsSHS 188 32.98 105 44.68 0.002 0.443 0.311 0.631 0.000 *

104

Comparison by behaviors about second-hand smoke variables among former smokers

and current smokers

Appendix N 2 shows behaviors about SHS of former and current smokers.


significant differences for the following behaviors: comfortable with others smoking

around you, living in a house in which someone smokes, riding in a car in which

someone smokes, smoking is not allowed at home, prefer to work where smoking is not

allowed, been exposed to SHS during the previous week, and exposing children under 18

years old to SHS during the previous week.

Controlling for age and gender, former smokers are less likely than current

smokers to be comfortable with others smoking around them (OR=.113, 95% CI=.058,

.222), live in a house in which someone smokes (OR=.154, 95% CI=.063, .377), ride in a

car in which someone smokes (OR=.238, 95% CI=.125, .452), be exposed to SHS during

the previous week (OR=.293, 95% CI=.155, .556), and to expose children under 18 years

old to SHS during the previous week (OR=.568443, 95% CI=.324, .995).

Former smokers are more likely to live in a home in which smoking is not

allowed than current smokers (OR=5.837, 95% CI=2.524, 13.497), as well as to prefer

work where smoking is not allowed (OR=4.465, 95% CI=2.350, 8.484), as is shown in

table 35.

105

Table 35 Statistically Significant Differences Between Former and

Current Smokers Given Behaviors About Second-Hand Smoke Univariate



H4.1 Comfortable with others smoking around you Rs62 20 15.87 61 58.65 0.000 0.113 0.058 0.222 0.000 * H4.2 House someone smokes Rs64 9 7.03 27 25.71 0.000 0.154 0.063 0.377 0.000 * H4.3 Car someone smokes Rs66 19 14.84 51 48.57 0.000 0.238 0.125 0.452 0.000 * H4.4 smoking not Allowed at home Rs65 116 90.63 77 73.33 0.001 5.837 2.524 13.497 0.000 * H4.7 Prefer works where smoking is not allowed Rs73 84 77.78 38 41.30 0.000 4.465 2.350 8.484 0.000 * H4.8 SHS (1=exposure to shs; 0=no shs) 72 56.25 87 82.86 0.000 0.293 0.155 0.556 0.000 * H4.9 MinorsSHS 46 35.94 58 55.24 0.004 0.568 0.324 0.995 0.048 *

Comparison by behaviors about second-hand smoke variables among former smokers in

the maintenance SOC, current smokers willing to quit, in the preparation SOC, and

current smokers not willing to quit, in the pre-contemplation SOC

Appendix N 3 describes the beliefs about SHS variables of former smokers, in the


smokers no willing to quit, in the pre-contemplation SOC.


compared, there were found statistically significant differences for the following

behaviors: comfortable with others smoking around you, living in a house in which

someone smokes, riding in a car in which someone smokes, smoking is not allowed at

home, prefer to work where smoking is not allowed, been exposed to SHS during the

previous week, and exposing children under 18 years old to SHS during the previous

week.

A lower percentage of smokers in the maintenance SOC (15.9%) felt comfortable

with others smoking around them, compared to smokers in the preparation SOC (55.4%)

and those in the pre-contemplation SOC (66.7%), p<.001. A lower percentage of smokers

106

in the maintenance SOC (7%) lived in a house in which someone smoked compared to

smokers in the preparation SOC (24.3%) and those in the pre-contemplation SOC (29%),

p<.001. A lower percentage of smokers in the maintenance SOC (14.8%) felt comfortable

riding in a car in which someone smoked compared to smokers in the preparation SOC

(43.2%) and those in the pre-contemplation SOC (61.3%), p<.001. A lower percentage of

smokers in the maintenance SOC (56.3%) had been exposed to SHS, compared to

smokers in the preparation SOC (81.1%) and those in the pre-contemplation SOC

(87.1%), p<.001. A lower percentage of smokers in the maintenance SOC (35.9%) had

exposed their children under 18 years old to SHS, compared to smokers in the

preparation SOC (51.4%) and those in the pre-contemplation SOC (64.5%) p=.006.

A larger percentage of smokers in the maintenance SOC (90.6%) lived in a home

in which smoking is not allowed, compared to smokers in the preparation SOC (71.6%)

and those in the pre-contemplation SOC (77.4%), p=.001. Similarly, a larger percentage

of smokers in the maintenance SOC (77.8%) preferred to work where smoking is not

allowed compared to smokers in the preparation SOC (43.75%) and those in the pre-

contemplation SOC (35.7%), p<.001, as is shown in Table 36.

Table 36

Statistically Significant Differences Between Smokers in the Maintenance, Preparation, and Pre-Contemplation SOC Given Behaviors About

Second-Hand Smoke Maintenance SOC

Preparation SOC


Variable No % No % No % P FET H4.1 Comfortable with others smoking around you Rs62 20 15.87 41 55.41 20 66.67 0.000 * H4.2 House someone smokes Rs64 9 7.03 18 24.32 9 29.03 0.000 * H4.3 Car someone smokes Rs66 19 14.84 32 43.24 19 61.29 0.000 * H4.4 smoking not Allowed at home Rs65 116 90.62 53 71.62 24 77.42 0.001 * H4.7 Prefer works where smoking is not allowed Rs73 84 77.78 28 43.75 10 35.71 0.000 * H4.8 SHS (1=exposure to shs; 0=no shs) 72 56.25 60 81.08 27 87.10 0.000 * H4.9 MinorsSHS 46 35.94 38 51.35 20 64.52 0.006 *

107

Comparison by behaviors about second-hand smoke variables among smokers in the

preparation and pre-contemplation SOC

Appendix N 4 shows beliefs about SHS variables of smokers in the



contemplation SOC, there were no statistically significant differences.

Comparison by behaviors about second-hand smoke variables among smokers in the pre-

contemplation, contemplation, and preparation SOC

Appendix N 5 describes beliefs about SHS variables of smokers in the pre-

contemplation, contemplation, and preparation SOC.

Statistically significant differences were found for riding in a car in which

someone smoked and been exposed to SHS during the previous week. A lower

percentage of smokers in the preparation SOC (37.9%) rode in a car in which someone

smoked during the previous week, compared to smokers in the pre-contemplation SOC

(44.4%) and those in the contemplation SOC (73.3%), p=.007. Also, a lower percentage

of smokers in the preparation SOC (77.6%) had been exposed to SHS during the previous

week compared to smokers in the pre-contemplation SOC (77.8%) and those in the

contemplation SOC (96.7%), p=.048, as is shown in Table 37.

108

Table 37 Statistically Significant Differences Between Smokers in the Preparation, Contemplation, and Pre-Contemplation SOC

Given Behaviors About Second-Hand Smoke Pre-contemplation SOC

Contemplation SOC

Preparation SOC

Variable No % No % No % P FET H4.3 Car someone smokes Rs66 8 44.44 22 73.33 22 37.93 0.007 * H4.8 SHS (1=exposure to shs; 0=no shs) 14 77.78 29 96.67 45 77.59 0.048 *

Comparison by behaviors about second-hand smoke variables given believes about the

likelihood of success if wanted to quit smoking

Appendix N 6 describes beliefs about SHS of smokers who are likely and unlikely

to succeed if they wanted to quit smoking.

Controlling for age and gender, the only statistically significant difference was

living in a house in which someone smoked. Smokers who believed they are unlikely to

succeed if they wanted to quit smoking are more likely to live in a house in which

someone smokes (OR=3.699. 95% CI=1.187, 11.529), as is shown in Table 38.

Table 38 Statistically Significant Differences by Likelihood to Succeed if Wanted to

Quit Smoking Given Behaviors About Second-Hand Smoke Univariate



H4.2 House someone smokes Rs64 8 47.06 19 21.59 0.037 3.699 1.187 11.529 0.024 *

Comparison by behaviors about second-hand smoke variables given believes about the

likelihood of success if decided to quit smoking

Appendix N 7 describes beliefs about SHS of smokers who perceived themselves

to be likely and unlikely to succeed if they decided to quit smoking.

109

The only statistically significant variable was children exposed to SHS during the

previous week; a larger percentage of smokers who perceived themselves to be unlikely

to succeed if they decided to quit smoking exposed their children younger than 18 years

old to SHS (90%) compared to those who perceived themselves likely to succeed

(51.6%), p=.022; however, when the comparison was controlled by age and gender, there

were no statistically significant differences, as is shown in Table 39.

Table 39 Statistically Significant Differences by Likelihood to Succeed if Decided to

Quit Smoking Given Behaviors About Second-Hand Smoke Univariate Multivariate Controlling by age and gender


H4.9 MinorsSHS 9 90.00 49 51.58 0.022 6.841 0.803 58.29 0.079

Comparison by behaviors about second-hand smoke variables given level of comfort

asking for help

Appendix N 8 describes the behavior about SHS variables of smokers who felt

comfortable an uncomfortable asking for help to quit smoking. There were no statistically


Comparison by behaviors about second-hand smoke variables given level of agreement

about the belief that the only way to stop smoking is through will power

Appendix N 9 describes beliefs about SHS variables of smokers who agree and

disagree about the belief that the only way to stop smoking is through their own will

power. There were no statistically significant differences.

110

Summary results for hypothesis four

The results for the fourth hypothesis show that there are significant differences

between former smokers in the maintenance SOC, smokers in the preparation SOC, and

smokers in the pre-contemplation SOC by the following behaviors about SHS:

comfortable with other smoking around you, living in a house in which someone smokes,

riding in a car in which someone smoked, living in a home in which smoking is not

allowed, prefer to work where smoking is not allowed, exposure to SHS, and exposure of

their children younger than 18 years old to SHS during the previous week.

Former smokers in the maintenance SOC tend to be less comfortable with others

smoking around them, do not live in a house in which someone smokes, do not ride in a

car in which someone smokes, be less exposed to SHS, and to less frequently expose

their children under 18 years to SHS during the previous week than smokers in the

preparation and pre-contemplation SOC respectively. Also, they tend to live in a home in

which smoking is not allowed and prefer to work where smoking is not allowed, relative

to smokers in the preparation and pre-contemplation SOC.

Similarly, smokers in the preparation SOC tend to not ride in a car in which

someone smokes and to be less exposed to SHS during the previous week than smokers

in the contemplation SOC and those in the pre-contemplation SOC.

111



feel comfortable when others smoke around them than Latino former



in a house where someone smokes than Latino former smokers and Latino


H4.3: Latino smokers who are not willing to quit smoking are more likely to ride

in a car with a smoker than Latino former smokers and Latino smokers



in a household where smoking is allowed than Latino former smokers and



prefer to work in a workplace where smoking is allowed than Latino



exposed to SHS than Latino former smokers and Latino smokers who are



with a minor exposed to SHS than Latino former smokers and Latino


112



work where someone smokes in their work area than Latino former



work where smoking is allowed in common areas than Latino former


Behaviors about smoking and beliefs about stopping smoking variables given

smoking status and stages of change

Results of the comparison of behaviors about smoking and beliefs about stopping

smoking between never smokers and smokers in the different SOC are presented in

Appendices O 1 to 9.

Comparison by behaviors about smoking and beliefs about stopping smoking variables

among never smokers and ever smokers

Appendix O 1 shows behaviors about smoking and beliefs about stopping

smoking of never and ever smokers.

There were no statistically significant differences between never and ever

smokers by the variable choice or addiction, the only variable answered by never

smokers.

113


among former smokers and current smokers


smoking of former and current smokers.


significant differences by the following behaviors: smoking the first cigarette after been

18 years old and smoking cigarettes regularly after been18 years old. Controlling for age

and gender, former smokers are less likely to have smoked their first cigarette after their

18th birthday (OR=.349, 95% CI=.017, .718), and to have smoked cigarettes regularly

(OR=.419, 95% CI=.235, .745) after their 18th birthday than current smokers, as is

shown in Table 40.

Table 40 Statistically Significant Differences Between Former and Current Smokers

Given Behaviors About Smoking and Beliefs About Stopping Smoking


and gender FS CS 95% CI

Variable No % No % P FET OR Lower Upper P H5.11 Smoked first cigarette after 18 yo Ds50T18yo 19 14.84 28 26.92 0.032 0.349 0.170 0.718 0.004 * 5.12 Smoking cigarettes regularly after 18 yo Ds51R18yo 63 49.22 66 62.86 0.047 0.419 0.235 0.745 0.003 *


among smokers in the maintenance, preparation, and pre-contemplation SOC

Appendix O 3 describes the behaviors about smoking and beliefs about stopping

smoking variables of smokers in the maintenance, preparation, and pre-contemplation

SOC.

114


compared, there were found statistically significant differences by the age at which they

smoked their first cigarette. A lower percentage of smokers in the maintenance SOC

(14.8%) smoked their first cigarette after their 18th birthday, compared to smokers in the

preparation SOC (30.1%) and those in the pre-contemplation SOC (19.4%), p=.037, as is

shown in Table 41.


Maintenance, Preparation, and Pre-Contemplation SOC Given Behaviors About Smoking and Beliefs About Stopping Smoking

Maintenance SOC

Preparation SOC


Variable No % No % No % P FET H5.11 Smoked first cigarette after 18 yo Ds50T18yo 19 14.84 22 30.14 6 19.35 0.037 *


among smokers in the preparation and pre-contemplation SOC


smoking variables of smokers in the preparation and pre-contemplation SOC.


contemplation SOC, the following beliefs about stopping smoking were statistically

significantly different: very likely to succeed if want to stop smoking and very likely to

succeed if decide to stop smoking. When controlling for age and gender, smokers in the

preparation SOC are more likely to believe that they would be very likely to succeed if

they want to stop smoking than those in the pre-contemplation SOC, (OR=5.441, 95%

CI=2.058, 14.384). Similarly, smokers in the preparation SOC are more likely to believe

115

that they would be very likely to succeed if they decide to stop smoking than those in the

pre-contemplation SOC, (OR=3.574, 95% CI=1.424, 8.969). It also appears that a larger

percentage of smokers in the preparation SOC (58.1%), compared to those in the pre-

contemplation SOC (36.7%), does not enjoy smoking p=.057, as is shown in Table 42.

Table 42 Statistically Significant Differences Between Smokers in the Preparation,

and Pre-Contemplation SOC Given Behaviors About Smoking and Beliefs About Stopping Smoking


age and gender

Preparation SOC

Pre-contemplation SOC 95% CI

Variable No % No % P FET OR Lower Upper P H5.6 Does not enjoy smoking rS56 43 58.11 11 36.67 0.054 2.409 0.975 5.954 0.057 H5.7 Very likely to succeed if want to stop smoking rs58 46 62.16 8 25.81 0.001 5.441 2.058 14.384 0.001 * H5.8 Very likely to succeed if decide to stop smoking rs59 52 70.27 12 38.71 0.004 3.574 1.424 8.969 0.007 *


among smokers in the pre-contemplation, contemplation, and preparation SOC

Appendix O 5 describes behaviors about smoking and beliefs about stopping

smoking variables of smokers in the pre-contemplation, contemplation, and preparation

SOC.

Statistically significant differences were found by smoker does not enjoy smoking

and smoking cigarettes regularly after their 18th birthday. A larger percentage of smokers

in the preparation SOC (65.5%) does not enjoy smoking, compared to smokers in the

contemplation SOC (36.64%) and those in the pre-contemplation SOC (29.4%), p=.005.

Also, a larger percentage of smokers in the preparation SOC (72.41%) smoked cigarettes

116

regularly after their 18th birthday compared to smokers in the pre-contemplation SOC

(61.1%) and those in the contemplation SOC (43.3%), p=.030; as is shown in Table 43.


Preparation, Contemplation, and Pre-Contemplation SOC Given Behaviors About Smoking and Beliefs About Stopping Smoking


Contemplation SOC

Preparation SOC

Variable No % No % No % P FET H5.6 Does not enjoy smoking rS56 5 29.41 11 36.67 38 65.52 0.005 * H5.12 Smoking cigarettes regularly after 18 yo Ds51R18yo 11 61.11 13 43.33 42 72.41 0.030 *


given believes about the likelihood of success if wanted to quit smoking


smoking of smokers who are likely and unlikely to succeed if they wanted to quit

smoking.

There were no statistically significant differences.


given perceived likelihood of success if decided to quit smoking


smoking variables of smokers who perceived themselves to be likely and unlikely to

succeed if they decided to quit smoking.

There were no statistically significant differences.

117


given level of comfort asking for help


smoking variables of smokers who felt comfortable an uncomfortable asking for help to

quit smoking.

There were no statistically significant differences


given level of agreement about the belief that the only way to stop smoking is through will

power


smoking variables of smokers who agree and disagree about the belief that the only way

to stop smoking is through their own will power.

The only statistically significant difference was by very comfortable asking for

help to stop smoking. As expected, controlling for age and gender, smokers who disagree

about the belief that the only way to stop smoking is through will power are more likely

to feel very comfortable asking for help to stop smoking than those who agreed


Table 44

Statistically Significant Differences by Agreement About Only Way to Stop Smoking is Through Will Power Given Behaviors About Smoking and Beliefs

About Stopping Smoking


and gender Disagree Agree 95% CI

Variable No % No % P FET OR Lower Upper P H5.9 Very comfortable asking for help to stop smoking rs60 7 77.78 35 38.04 0.032 7.893 1.336 46.641 0.023 *

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Summary results for hypothesis five

The results for the fifth hypothesis show that there are significant differences

among former smokers in the maintenance SOC, smokers in the preparation SOC,

smokers in the contemplation SOC, and smokers in the pre-contemplation SOC by the

following behaviors about smoking and beliefs about stopping smoking variables:

smoked first cigarette after their 18th birthday, smoking cigarettes regularly after 18th

birthday, very likely to succeed if wanted to stop smoking, very likely to succeed if

decided to stop smoking, and does not enjoy smoking.

Formers smokers in the maintenance SOC tend to be less likely to smoke their

first cigarette after their 18th birthday than smokers in the pre-contemplation and

preparation SOC.

Smokers in the preparation SOC are more likely to believe they would be very

likely to succeed if they wanted and decided to stop smoking than smokers in the pre-

contemplation SOC.

Finally, smokers in the preparation SOC are less likely to enjoy smoking

compared to smokers in the contemplation and pre-contemplation SOC. Similarly,

smokers in the preparation SOC are more likely to start smoking cigarettes regularly after

their 18th birthday than smokers in the pre-contemplation and contemplation SOC.

119



enjoy smoking than Latino smokers who are willing to quit smoking.


they would succeed if they want to stop smoking than Latino smokers who



they would succeed if they decided to stop smoking than Latino smokers



report smoking cigarettes regularly at younger age than Latino smokers




perceive smoking as a habit than Latino smokers who are willing to quit

smoking.


smoke every day than Latino smokers who are willing to quit smoking.


smoke the first cigarette within 30 minutes after waking up than Latino


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report that they smoke more when facing stressful events than Latino



comfortable smoking around others than Latino smokers who are willing

to quit smoking.

H5.9: Latino smokers who are not willing to quit smoking are less likely to feel

comfortable asking for help to stop smoking than Latino smokers who are



think the only way they would be able to stop smoking is through they

own will power than Latino smokers who are willing to quit smoking.


have smoked their first cigarette at younger age than Latino smokers who



smoke a larger number of cigarettes daily than Latino smokers who are


H5.14: Latino smokers who are not willing to quit smoking are less likely to quit

smoking for a day or more one or more times during the last year than


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CHAPTER SIX

DISCUSSION AND CONCLUSIONS

The final chapter includes five sections. The first section describes the relevant

findings from the study, which are discussed in the second section. The third section

describes the limitations of the study; the recommendations are shown in the fourth

section. Finally, the fifth section contains the conclusions and recommendations for

future research.

Key findings

Socioeconomic characteristics

The results of the study show that most of the respondents were first generation in

the U.S. (75.7%), younger than 40 years old (mean age 37.9 years), but older than 24

years (87.7%), were married or living in a marriage-like relationship (71.9%), lived with

children (70.7%), completed high school or some level of higher education (61.2%), and

were employed (83.8%). Similarly, the majority of respondents was home country

oriented (mean 3.52 in a scale 1 to 4) and was familiar with the U.S. culture (mean 2.33

in a scale 1 to 4).

The smoking prevalence was 13.3%, similar to the smoking prevalence among

Latinos living in Hennepin County, Minnesota (13.6%) (Hennepin County Human

Services and Public Health Department, 2008), and lower than the general population of

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Minnesota at the time of the survey (18.3%) (CDC, 2007); however, men had a

statistically significant higher smoking prevalence (20.1%) compared to women (6.1%),

p=<.001. Although almost all of the respondents believed that smoking causes cancer

(99.1%) and heart disease (93.2%), almost half of them (48.8%) believed that there are

some positive aspects of smoking, including beliefs that smoking relieves stress (29.3%),

provides pleasure (24.7%), and helps to lose weight (23.9%). Only 18% of respondents

believed that smoking is an addiction; a small percentage (6.5%) believed that it is okay

to smoke as long as the person is healthy, and a similar percentage (7.3%) believed that

the dangers and benefits of smoking are equal. Very few respondents (1.4%) believed

that smoking has more benefits than not smoking.

Although the majority of the respondents (82.7%) felt uncomfortable when others

smoked around them, almost half of the smokers (47%) felt comfortable smoking around

others and more than half (52.2%) of the respondents were exposed to SHS during the

previous week, as well as a significant percentage of their children (36.4%), especially in

the car (19%), at work (16.4%), and at home (9.2%). The majority of Latino smokers

tried their first cigarette (79.5%), and almost half (44.9%) started smoking regularly,

before they were of legal age to smoke.

Smokers reported smoking on average 8 cigarettes per day, above the addiction

threshold of 5 cigarettes per day (Benowitz and Henningfield, 1994), and smoking on

average 9 days per month. The majority of smokers had tried to stop smoking for a day or

more (73%), on average 13.5 times, during the previous year. Regarding former smokers,

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a large majority (87.5%) stopped smoking more than one year before the survey and

29.9% reported that smoking restrictions influenced their decision to stop smoking.

Although the majority of the respondents (75.1%) reported excellent, very good

or good physical health, 38.8% reported that an injury or illness affected their daily

routine during the previous year and 19% reported some degree of stress during the

previous month. These health problems prevented respondents from performing their

usual activities during two days during the previous month. Only 27.8% of the

respondents had a normal BMI. The mean BMI of the respondents was 28.2, probably as

consequence of the reported lack of adequate exercise (35% of respondents reported

exercising adequately during the previous week), and the low consumption of fruits (1.9

servings per day) and vegetables (1.7 servings per day).

Relevant comparisons given socioeconomic status

When never smokers were compared to ever smokers, controlling for age and

gender, there was a likelihood of never smokers to be women (OR=4.859, 95%

CI=3.413, 6.918), and to respond to the survey in Spanish (OR=1.582, 95% CI=1.123,

2.229). Regarding former and current smokers, only marital status was statistically

significant. Former smokers were more likely to be married or living in a marriage-like

relationship (OR=2.879, 95% CI=1.518, 5.460). Maintenance, preparation, and pre-

contemplation SOC data showed that age and marital status were statistically

significantly different; 97.7% of smokers in the maintenance SOC were older than 24

years compared to 86.5% of smokers in the preparation SOC and 77.4% of those in the

124

pre-contemplation SOC, p<.001. When looking at marital status, 79.7% of smokers in the

maintenance SOC were married or living in a marriage-like relationship, compared to

56.8% of smokers in the preparation SOC and 67.7% of those in the pre-contemplation

SOC, p = .002; however, contrary to what was expected, a lower percentage of smokers

in the preparation SOC was married or living in a marriage-like relationship than those in


When smokers in the preparation, contemplation, and pre-contemplation SOC

were compared, age was the only statistically significant difference. A larger percentage

of smokers in the preparation SOC was older than 24 years (91.4%), compared to 83.3%

of smokers in the pre-contemplation and 70% of those in the contemplation SOC, p=.032;

however, contrary to expectations, smokers in the contemplation were younger than those

in the pre-contemplation SOC.

When smokers were compared by their beliefs about quitting smoking,

controlling for age and gender, those who believed they were unlikely to succeed if they

wanted (OR=.270, 95% CI=.089, .0813) or decided (OR=.199, 95% CI=.044, .903) to

quit smoking were less likely to have friends from the same ethnic background than those

who believed they were likely to succeed.

When the comparison was made given the level of comfort asking for help,

controlling for age and gender, the only statistically significant difference was that

smokers who responded that they were uncomfortable asking for help to quit smoking are

more likely to live with children under 18 years old than those who answered they were

comfortable (OR=3.507, 95% CI=1.293, 9.510).

125

Relevant comparisons given self-reported health status

When controlling for age and gender, never smokers were more likely to report

happiness (OR=1.794, 95% CI=1.033, 3.115), less likely to report major injury or illness

during the previous year (OR=.512, 95% CI=.336, .779), and less likely to report a major

change in health of relative in the past year (OR=.609, 95% CI=.420, .884) than never

smokers.

Smokers in the preparation SOC were less likely to report major change in the

health of relative during the previous year (OR=.314, 95% CI=.123, .802) and major

change in family reunions (OR=.349, 95% CI=.126, .0967) than those in the pre-

contemplation SOC, and were more likely to report interesting things in their daily life

(OR=2.645, 95% CI=1.000, 6.995) than those in the pre-contemplation SOC.

When smokers were compared according to their beliefs about quitting smoking,

controlling for age and gender, those who answered they believed they were unlikely to

succeed if they wanted to quit smoking were less likely to exercise adequately than those

who believed they were likely to succeed (OR=.242, 95% CI=.603, .929).

Smokers who disagree about the belief that the only way to stop smoking is

through will power were more likely to report mayor injury or illness during the previous

year (OR=5.736, 95% CI=1.216, 27.051) and to have a normal BMI (OR=39.402, 95%

CI=3.799, 408.623) than those who agree.

126

Relevant comparisons given beliefs about smoking

Controlling for age and gender, never smokers were less likely to believe that

smoking provides pleasure (OR=.364, 95% CI=.252, .526) and that smoking relieves

stress (OR=.278, 95% CI=.194, .400) than ever smokers. Never smokers were more

likely to believe that there are no positive aspects of smoking (OR=2.600, 95% CI=1.848,

3.660) and that smoking causes heart disease (OR=2.252, 95% CI=1.175, 4.314) than

ever smokers. Former smokers were more likely to believe that there are no positive

aspects of smoking (OR=1.839, 95% CI=1.018, 3.323) and, consequently, that smoking

causes more harms than benefits (OR=6.472, 95% CI=2.044, 20.494) than current

smokers.


compared, a larger percentage of smokers in the maintenance SOC (96.1%) believed that

smoking caused more harms than benefits compared to smokers in the preparation SOC

(83.8%) and those in the pre-contemplation SOC (87.1%), p = .007. It was unexpected

that smokers in the preparation SOC had the lower percentage; however, this difference

was no statistically significant when smokers in the preparation SOC were compared to

those in the pre-contemplation SOC. Smokers in the preparation SOC, controlling for age

and gender, were less likely to believe that smoking facilitates friendship (OR=.216, 95%

CI=.052, .891) and that smoking provides pleasure (OR=.373, 95% CI=.150, .930) than

those in the pre-contemplation SOC.

When smokers were compared by their beliefs about quitting smoking,

controlling for age and gender, smokers who believed that they were unlikely to succeed

127

if they decided to quit smoking are less likely to believe that people smoke because they

want to (OR=.114, 95% CI=.018, .671). It was also found that smokers who disagree

with the belief that the only way to stop smoking is through will power were less likely to

believe that smoking causes more harms than benefits (OR=.200, 95% CI=.040, .991)

than those who agree.

Relevant comparisons given behaviors about second-hand smoke

Controlling for age and gender, never smokers were less likely than ever smokers

to be comfortable with others smoking around them (OR=.234, 95% CI=.155, .353), live

in a house in which someone smokes (OR=.352, 95% CI=.207, .598), ride in a car with

someone who smokes (OR=.382, 95% CI=.256, .572), be exposed to SHS during the

previous week (OR=.392, 95% CI=.277, .557), and to expose children under 18 years old

to SHS during the previous week (OR=.443, 95% CI=.311, .631). It also was found that

never smokers were more likely to live in a home in which smoking is not allowed

(OR=3.424, 95% CI=1.992, 5.885) and to prefer work where smoking is not allowed

(OR=3.035, 95% CI=2.014, 4.572) than ever smokers.

Similarly, former smokers were less likely than current smokers to be comfortable

with others smoking around them (OR=.113, 95% CI=.058, .222), live in a house in

which someone smokes (OR=.154, 95% CI=.063, .377), ride in a car in which someone

smokes (OR=.238, 95% CI=.125, .452), be exposed to SHS during the previous week

(OR=.293, 95% CI=.155, .556), and to expose children under 18 years old to SHS during

the previous week (OR=.568443, 95% CI=.324, .995). Former smokers were more likely

128

to live in a home in which smoking is not allowed than ever smokers (OR=5.837, 95%

CI=2.524, 13.497), as well as to prefer work where smoking is not allowed (OR=4.465,

95% CI=2.350, 8.484) than current smokers.

Smokers in the maintenance SOC tended to be less comfortable with others

smoking around them (15.9%), do not live in a house in which someone smokes (7%), do

not ride in a car in which someone smokes (14.8%), be less exposed to SHS (56.3%) and

to expose their children under 18 years less to SHS (35.9%) during the previous week

than smokers in the preparation and pre-contemplation SOC. Consequently, smokers in

the maintenance SOC tended to live in a home in which smoking is not allowed (90.6%)

and prefer to work where smoking is not allowed (77.8%), relative to smokers in the


Similarly, smokers in the preparation SOC tended not to ride in a car in which

someone smokes (37.9%) and to be exposed less to SHS during the previous week

(77.6%) than smokers in the contemplation and pre-contemplation SOC.


controlling for age and gender, the only statistically significant difference was that

smokers who see themselves as unlikely to succeed if they wanted to quit smoking were

more likely to live in a house in which someone smokes (OR=3.699. 95% CI=1.187,

11.529).

129

Relevant comparisons given behaviors about smoking and beliefs about stopping smoking

Controlling for age and gender, former smokers were less likely than current

smokers to have smoked their first cigarette after their 18th birthday (OR=.349, 95%

CI=.017, .718), and to have smoked cigarettes regularly after their 18th birthday

(OR=.419, 95% CI=.235, .745). Smokers in the preparation SOC were more likely to

believe they would be very likely to succeed if they wanted (OR=5.441, 95% CI=2.058,

14.384) and decided to stop smoking (OR=3.574, 95% CI=1.424, 8.969), than smokers in


A larger percentage of smokers in the preparation SOC did not enjoy smoking

(65.5%) compared to smokers in the contemplation (29.4%) and pre-contemplation SOC

(29.4%), p=.005. Smokers in the preparation SOC were more likely to start smoking

cigarettes regularly after their 18th birthday (72.4%) than smokers in the pre-

contemplation (61.1%) and contemplation SOC (43.3%), p=.030.


controlling for age and gender, the only statistically significant difference was by very

comfortable asking for help to stop smoking. As expected, smokers who disagree with

the belief that the only way to stop smoking is through will power were more likely to

feel very comfortable asking for help to stop smoking than those who agreed (OR=7.893,

95% CI=1.336, 46.641).

130

Discussion

Smoking prevalence

The smoking prevalence among Latinos living in Minnesota found in this study

(13.3%) was similar to the prevalence found the same year (2006) among Latinos living

in Hennepin County, Minnesota (13.6%), (Hennepin County Human Services and Public

Health Department, 2008); and tended to be lower than the prevalence among the U.S.

Latino population in the same year (15.2%), (CDC, 2007), and lower than the smoking

prevalence among the adults in Minnesota (18%) (ClearWay Minnesota, Blue Cross and

Blue Shield of Minnesota, and Minnesota Department of Health, 2008). Among Latino

men living in Minnesota, the smoking prevalence was similar to the prevalence among

Latino men in the U.S. (20%); however, the smoking prevalence for Latino women living

in Minnesota (6.1%) was lower than the smoking prevalence of U.S. Latino women

(10.1%) (CDC, 2007). Due to differences in the methodological approaches, several

results could be slightly different than those reported by The Tobacco use in Minnesota:

A quantitative survey of members of Minnesota’s Latino communities (Blue Cross and

Blue Shield of Minnesota, ClearWay Minnesota, Comunidades Latinas Unidas en

Servicio, 2008).

Smoking and socioeconomic variables

Age, married or living in a marriage-like relationship, friends from the same

ethnic background, and language of the survey were the statistically different

131

socioeconomic and acculturation variables found in this study. These findings are

consistent with previous studies as follows:

Age

This study shows that Latino smokers in the maintenance SOC were older than

smokers in the preparation and pre-contemplation SOC, and that smokers in the

preparation SOC tend to be older than those in the contemplation and pre-contemplation

SOC. Previous studies found that smokers tend to quit when they are older because of

their greater amount of concern with health and friendship (Bossé & Rose, 1973). Due to

the sequential nature of the SOC model, it is expected that smokers’ age increases as they

advance through the SOC.

Marital status

This study found that former smokers were more likely to be married or living in

a marriage-like relationship than current smokers. This is consistent with previous studies

that found that the likelihood of smoking is significantly greater for singles (Umberson &

Liu, 2006) and that older, married, and heavy smokers are more likely to quit smoking

(Loon, Tijhuis, Surtees, & Ormel, 2005).

Acculturation

Although diverse authors consider language and years of residence in the U.S. as

proxies to level of acculturation (Bock, Niaura, Neighbors, Carmona-Barros, & Azam,

2005; Crespo, Smit, Carter-Pokras, & Anderson, 2001; and Maher, Boysun, Rohde,

132

Stark, Pizacani, et al. 2005), the DREGAN project also utilized a multidimensional

approach of community to measure the level of acculturation of respondents, modeling

two major constructs and five latent variables to reflect cultural fluency and cultural

orientation (Constantine, Rockwood, Schillo, Castellanos, Foldes, & Saul, 2009). This

study included the variables fluency with home country culture (dfluency2HC) and

friends from the same ethnic background (friendsdorint4f) from the latent variables, in

addition to language of the survey and years living in the U.S., from the DREGAN

project data set (Rockwood, Virnig, Constantine, Miazga, & Turner, 2007). No

statistically significant differences were found between smokers in the maintenance, pre-

contemplation, contemplation, and preparation SOC given language of the survey, years

living in the U.S., fluency with home country culture, and friends from the same ethnic

background, this could be explained by the strong home-country orientation of the

respondents as most of them were first generation immigrants.

It was found that smokers who believed that they were unlikely to succeed if they

wanted or decided to quit smoking were less likely to have friends from the same ethnic

background than those who answered they were likely to succeed. This suggests that

more acculturated Latino smokers are less likely to believe they would succeed if they

want or decide to quit smoking. Several studies show that friendship predicted transition

into current cigarette use (Urberg, Degirmencioglu, & Pilgrim, 1997) and that

acculturation increases the risk of smoking among Latino adolescents and could lead to

an increased risk of experimentation with smoking (Unger, Cruz, Rohrbach, Ribisl, et al.,

2000).

133

Regarding language of the survey, this study found inconsistent results. For

example, respondents who answered the survey in Spanish were more likely to be never

smokers; however, there were no statistically significant differences between current and

former smokers, or between smokers in the different SOC. Some authors report that

acculturation has different effects on smoking behavior by gender (Perez-Stable,

Ramirez, Villareal, Talavera, et al., 2001). Marin (1989) found that smoking prevalence

was higher among less acculturated Latino men and higher among more acculturated

Latino women.

Smoking addiction

This study shows that Latino smokers smoked on average 8 cigarettes per day,

above the addiction threshold of 5 cigarettes per day (Benowitz and Henningfield, 1994);

however, they smoked on average 9 days per month, and had tried to stop smoking on

average 13.5 times during the previous year. This situation would call for the

implementation of smoking cessation programs that address smoking in social situations

and activities, as well educate them about how to modify their environment in order to

successfully quitting smoking (Reitzel, Costello, Mazas, Vidrine, et al, 2009).

The study also found that former smokers were less likely to have smoked their first

cigarette after their 18th birthday than current smokers, and also that former smokers and

smokers in the preparation SOC were less likely to smoke cigarettes regularly after their

18th birthday than current smokers and smokers in the pre-contemplation and

contemplation SOC respectively. The report of the Surgeon General: Preventing tobacco

134

use among young people describes how most smokers start smoking before their 18th

birthday, and that consequently most adolescent smokers became addicted to nicotine

(Elders, Perry, Eriksen, & Giovino, 1994), a situation that could make quitting smoking

more difficult. Breslau and Peterson (1996) found that a deferral to the initiation of

smoking might contribute to the reduction of smoking-related mortality and morbidity by

increasing the potential for quitting smoking.

Exposure to SHS behavior

Although never and former smokers are less likely to be exposed and exposed

their children to SHS, the present study found that a significant percentage of Latino

smokers and non smokers were exposed and exposed their children to SHS, particularly

in the car, at work, and at home. Similarly, data from the 1994 National Health Interview

Survey and Year 2000 Objectives supplement showed that 35% of children under 18

years old were exposed to SHS at homes where residents or visitors smoke on a regular

basis (Schuster, Franke, & Pham, 2002).

This is a very important cause of concern because the large number of

publications about the harms of SHS exposure, including that SHS exposure of children,

and particularly of single mothers, is associated with increased level of cotidine and

polycyclic aromatic hydrocarbon-albumin (PAH), a recognized carcinogen, in their

peripheral blood (Crawford, Mayer, Santella, Cooper, Ottman, et al., 1994). In addition,

various authors have found that exposure to SHS increases the risk for respiratory

infections in children (Kum, Meloy, & Herrod, 2006), and the numerous publications

135

about morbidity and mortality associated with smoking and exposure to SHS (U. S.

Department of Health, Education, and Welfare. Public Health Service, 1964; Department

of Health and Human Services, 1988; U. S. Department of Health and Human Services,

2006; CDC, 2005; & OEHHA, 2005).

The present study found that never and former smokers were less likely to be

comfortable with others smoking around them than ever and current smokers

respectively. Similarly, it was found that never smokers and former smokers were less

likely to live in a house in which someone smokes than ever and current smokers;

however, there were no statistically significant differences among smokers in the pre-

contemplation, contemplation, and preparation SOC. As some authors recommend,

tobacco control interventions should promote group as well as individual smoking

cessation efforts and encourage smoke-free home initiatives. (DiClemente, Delahanty, &

Fiedler, 2010).

Never and former smokers were also more likely to live in a home in which

smoking is not allowed and to prefer to work where smoking is not allowed than ever and

current smokers. Smokers who believed they were unlikely to succeed if they wanted to

quit smoking were more likely to live in a house in which someone smokes. Also, it was

found that never smokers and smokers in the maintenance and preparation SOC were less

likely to ride in a car with someone who smokes than ever, current, and smokers in the

contemplation and pre-contemplation SOC respectively. Previous studies found that the

presence of nonsmoking adults and children was associated with smoking restrictions in

the homes of inner-city smokers (Okah, Choi, Okuyemi, & Ahluwalia, 2002) and that

136

smoking bans were less likely among Mexican-Americans who live with smokers

(Martinez-Donate, Hovell, Hofstetter, González-Pérez, et al, 2007).

In general, the study found that never and former smokers were less likely to be

exposed to SHS during the previous week than ever and current smokers, as well as

smokers in the preparation and pre-contemplation SOC tended to be less exposed to SHS

during the previous week than smokers in the contemplation SOC. Similarly, never and

former smokers were less likely to expose their children under 18 years old to SHS

during the previous week than ever and current smokers. In addition, this study shows

that Latino smokers who felt uncomfortable asking for help to quit smoking were more

likely to live with children under 18 years old than those who answered they were

comfortable.

Smoking beliefs and behaviors

The study found that about half of the respondents believed that there are some

positive aspects of smoking, including the beliefs that smoking relieves stress, helps for

lose weight, and provides pleasure. Also, a small percentage believed that it is okay to

smoke as long as the person is healthy and a similar percentage believed that the dangers

and benefits of smoking are equal. These results help us to understand some of the

reasons for Latino to smoke, which it is necessary to plan adequate smoking cessation

interventions (Leventhal & Avis, 1976)

As expected, it was found that never and former smokers were more likely to

believe that there are no positive aspects of smoking than ever and current smokers; it

137

was also found that never smokers and smokers in the preparation SOC were less likely

to believe that smoking provides pleasure than ever smokers and those in the pre-

contemplation SOC. Similarly, smokers in the preparation SOC were less likely to

believe that smoking facilitates friendship than those in the pre-contemplation SOC; and

smokers who answered that they were unlikely to succeed if they decided to quit smoking

were less likely to believe that people smoke because they want to.

Never smokers were more likely to believe that smoking causes heart disease than

ever smokers, and never smokers were less likely to believe that smoking relieves stress

than ever smokers. Former smokers were more likely to believe that there are more harms

than benefits to smoking than current smokers. However, smokers who disagree about the

belief that the only way to stop smoking is through will power were less likely to believe

that smoking causes more harms than benefits. Ivings and Khardaji (2007) found that

most smokers report beliefs in the benefits of smoking, which should be modified to

encourage smoking cessation. Some authors recommend that smoking cessation

interventions should emphasize and help smokers to acknowledge that smoking causes

serious diseases (Chapman, Wong, & Smith, 1993).

The only behavior that was found statistically significantly different was enjoying

smoking. A larger percentage of smokers in the preparation SOC did not enjoy smoking

compared to smokers in the contemplation and pre-contemplation SOC.

These beliefs and behaviors about smoking contrast with the large percentage of

respondents who believed that smoking causes lung cancer and heart disease. This is an

example of cognitive dissonance as showed by Halpern (1994) that should be included in

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smoking cessation efforts and interventions to educate the Latino population about the

short-and long-term health consequences of smoking and exposure to SHS, especially for

their children.

Smoking and stressful events

A strong relationship between stressful events and smoking was found in this

study. Never smokers were more likely to report happiness than ever smokers, and less

likely to report stressful events than current smokers. Never smokers and smokers in the

preparation SOC were less likely to report stressful events than ever smokers and

smokers in the pre-contemplation SOC respectively; never smokers and smokers in the

preparation SOC were less likely to report major change in health of relative during the

previous year than ever smokers and smokers in the pre-contemplation SOC. Similarly,

smokers in the preparation SOC are less likely to report a major change in family

reunions than smokers in the pre-contemplation SOC, and smokers in the preparation

SOC were more likely to report interesting things in their daily life than those in the pre-

contemplation SOC. Similarly, some authors have reported that smokers have a higher

level of stress (Parrot, 1999) and that smoking could help to relax and reduce stress

(Kassel, Stroud, & Paronis, 2003). Another study found that a successful long-term

cessation program should individualize the approach and identify interesting and or

pleasurable motivations to replace smoking (Moghaddam, & Ferguson, 2007).

Never smokers were less likely to report major injury or illness than ever

smokers; in contrast, smokers who disagree about the belief that the only way to stop

139

smoking is through will power were more likely to report major injury or illness during

the previous year. Similar results were reported by Mody and Smith (2003 and 2006),

who found that current smokers were more likely to report poor general health status than

non smokers and former smokers. Lee and Markides (1991) found that younger Mexican-

American men who smoke more than 10 cigarettes per day were more likely to report

greater activity limitation due to poor health, and that non-smoking middle-age men and

women generally reported better health than lighter smokers.

Expectations about quitting and confidence to succeed

As was found in a previous study (DiClemente, C., Delahanty, J., & Fiedler, R.

2010), the expectations about quitting smoking and the confidence about succeeding were

statistically significantly higher among smokers in the preparation SOC than those in the

pre-contemplation SOC. The study also found that smokers who disagree about the belief

that the only way to stop smoking is through will power were more likely to feel very

comfortable asking for help to stop smoking than those who agreed. Some authors found

that the intention to quit and the personal rating of the likelihood of success could be

predictors of smoking cessation. (Twigg, Moon, Szatkowski, & Iggulden, 2009).

The present study found that smokers who answered that they were unlikely to

succeed if they wanted or decided to quit smoking were less likely to exercise adequately

than those who answered they were likely to succeed. As some researches described, it is

possible that a negative body image could reduce the intention to quit smoking (King,

Matacin, White, Marcus, 2005). It was also reported that former smokers significantly

140

increased physical activity after quitting (Perkins, Rohay, Meilahn, Wing, Matthews, &

Kuller, 1993).

Quitting smoking and smoking restrictions

The majority of former smokers stopped smoking more than one year before the

survey and 30% reported that smoking restrictions influenced their decision to stop

smoking. These data support the importance of legislation to ban smoking in public

places and the adoption of prohibition of smoking at home and work to encourage

smokers to quit, as has been published by Shields (2007).

Limitations

The present study has some limitations. The most important is that as secondary

data analysis it has the same limitations as the original survey, which was not designed to

address the stages of change of Latino smokers living in Minnesota.

As in previous studies, recall bias and social desirability could have some effects

in the data (Gilpin & Pierce, 1994); however, self-reported smoking status has been

found to be valid in general population studies (Vartiainen, Seppala, Lillsunde, & Puska,

2002).

The present analysis suffers from a lack of statistical power resulting from the low

sample size for some of the groups included in the analysis.

141

Recommendations

The results of the present study demonstrate the need for tobacco control

interventions to educate the Latino population about the harms of smoking and SHS

exposure, especially for their children. Educational interventions should be implemented

to eliminate exposure to SHS, taking into account the cognitive dissonance that affects

smokers and non-smokers exposed to SHS. Tobacco control interventions and smoking

cessation programs should be culturally and linguistically appropriate as it is

recommended by the U.S. Department of Health and Human Services (1998) and the

CDC (1999, 2007).

Smoking cessation intervention should encourage young Latino smokers to quit,

especially those who do not report interesting things in their daily life and report stressful

events in their family. Such interventions should educate them about the long term

consequences of smoking and exposure to SHS such as the increased risk of

cardiovascular disease and cancer for their children.

The results show that smokers in the pre-contemplation SOC have more friends

from their same ethnic and cultural background. For this reason it is necessary to address

the impact of friendship on smoking behaviors, especially among recent immigrants.

Smoking cessation programs should engage smokers and their friends who smoke to quit

smoking. Some authors suggest that tobacco control initiatives may be more effective if

they promote group and individual smoking cessation efforts and promote smoke-free

home initiatives (DiClemente, Delahanty, & Fiedler, 2010).

142

Intervention efforts should also be directed to educating less acculturated Latino

smokers, especially those living with children about how individual and group smoking

cessation programs and nicotine replacement therapies could increase their chance to

succeed quitting smoking.

Smoking cessation programs should develop messages to eliminate SHS exposure

among Latino children at home and in the car.

Smoking bans at home, in cars, and at work places should be implemented to

protect non-smokers from exposure to SHS, encourage smokers to quit, and to prevent

children from trying their first cigarette.

Smoking cessation programs should emphasize healthy nutrition, particularly

increasing the consumption of fruits and vegetables, and adequate exercise, to prevent

smokers who quit from gaining weight. This would help to reduce the percentage of

relapsing smokers.

Stress and happiness should be addressed in smoking cessation interventions.

Latino smokers should be educated about relaxation techniques and mental health

programs to reduce their level of stress. In addition, smoking cessation programs should

address interesting and/or pleasurable incentives to replace smoking.

Expectations about quitting smoking should be addressed. Positive expectations

must be reinforced and negative expectations need to be changed in order to increase the

possibilities for success.

143

Understanding the motivational and volitional processes to quit smoking could

increase the effectiveness of smoking cessation programs, although research to better

understand the stages of change among Latino smokers is needed.

Although all health care providers should advise and educate their patients about

smoking cessation and elimination of SHS exposure, pharmacists are in a privileged

position to implement this practice (Tyc, Hovell, & Winickoff, 2008). In addition, as

some authors recommend for practitioners (Zimmerman, Olsen, & Bosworthan, 2000),

smoking cessation brief counseling sessions should be incorporated as a routine practice

among pharmacists.

A comprehensive literature review (Dent, Harris, & Noonan, 2007), demonstrated

that pharmacists are effective in providing smoking cessation interventions because they

are the most accessible health care professional and are in an ideal position to deliver

tobacco cessation services on-site, where nicotine replacement drugs are dispensed. In

addition, pharmacists should receive training in smoking cessation interventions and

should be motivated and reimbursed to provide these services.

Cipolle, Strand, and Morley (2004), included history of tobacco dependence

assessment in their comprehensive Pharmaceutical Care Practice: The Clinician Guide.

They recognize smoking as one of the common causes of drug therapy problems that

must be documented in the current medication record of the patient, and recommend

smoking cessation interventions as part of the preventive pharmacotherapy that positively

impact one of the most important common problems treated in primary care.

144

Conclusions

The results show that Latino smokers living in Minnesota share some of the

characteristics described by previous studies, including: A high level of exposure to SHS,

the trend to quit smoking when they are older, tendency to smoke and unwillingness to

quit when they are exposed to stressful events, the beliefs that smoking facilitates

friendship and provides pleasure, enjoyment of smoking and negative expectations for

successfully quitting smoking. These hypotheses should be tested in prospective

intervention studies using the SOC algorithm, taking into account the smoking prevalence

differences between women and men and the cause of smoking. As Prochaska and

DiClemente recognized in 1986, “The days of searching for simple solutions to complex

problems should be behind us. The complexities of changing addictive behaviors require

multivariate rather than univariate solutions” (Prochaska, DiClemente, 1986).

As the most accessible health care practitioner, pharmacists are in a privileged

position to provide smoking cessation interventions and to promote the elimination of

SHS exposure, especially to Latino recent immigrants who do not know how to navigate

the complex health care systems in the U.S. By learning the unique characteristics of

Latino smokers, pharmacists will be able to address their needs and increase the

possibilities for successful outcomes.

145

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APPENDICES

160

Appendix A

U.S Smoking Status By Selected Demographic Variables 1965 - 2006 Smoking Status Total Population

1965 1970 1974 1978 1980 1983 1985 1987 1990 1993 1995 1997 1999 2001 2002 2003 2004* 2006 Current 42.4 37.4 37.1 34.1 33.2 32.1 30.1 28.8 25.5 25 24.7 24.7 23.5 22.8 22.5 21.6 20.9 20.8 Former 13.6 18.5 19.5 20.8 21.3 21.8 24.2 22.8 24.6 24.6 23.3 22.8 23.1 22.2 22.6 21.8 21.4 21 Never 44 44.2 43.4 45 45.5 46.1 45.8 48.4 49.9 50.5 52 52.4 53.5 55 54.9 56.6 57.7 58.2

Sex Male 1965 1970 1974 1978 1980 1983 1985 1987 1990 1993 1995 1997 1999 2001 2002 2003 2004* 2006 Current 51.9 44.1 43.1 38.1 37.6 35.1 32.6 31.2 28.4 27.7 27 27.6 25.7 25.2 25.2 24.1 23.4 23.9 Former 19.8 26.3 27.7 28.3 28.1 28.3 30.9 28.9 30.3 29.9 27.5 27 27.3 26.4 26.4 25.2 24.8 24.5 Never 28.3 29.6 29.2 33.6 34.4 36.6 36.5 39.9 41.3 42.4 45.5 45.4 47 48.5 48.4 50.7 51.7 51.6 Female 1965 1970 1974 1978 1980 1983 1985 1987 1990 1993 1995 1997 1999 2001 2002 2003 2004* 2006 Current 33.9 31.5 32.1 30.7 29.3 29.5 27.9 26.5 22.8 22.5 22.6 22.1 21.5 20.7 20 19.2 18.5 18 Former 8 11.6 12.7 14.2 15.1 15.9 18.1 17.4 19.5 19.7 19.5 19 19.2 18.3 19.1 18.7 18.3 17.8 Never 58.1 56.9 55.2 55.2 55.5 54.6 54 56 57.7 57.8 57.9 58.9 59.3 61.1 60.9 62.1 63.2 64.2

Race§ White (Non-Hispanic)

1965 1970 1974 1978 1980 1983 1985 1987 1990 1993 1995 1997 1999 2001 2002 2003 2004* 2006 Current 42.1 37 36.4 33.9 32.9 31.8 29.6 28.5 25.6 24.9 24.8 24.8 23.7 23.4 22.9 21.8 22.2 21.9 Former 14.2 19.4 20.5 21.9 22.2 22.8 25.5 24.2 25.9 26.2 24.9 24.6 24.9 24.1 24.3 23.3 24.7 24.6 Never 43.8 43.6 43.1 44.3 44.9 45.3 44.9 47.3 48.5 48.9 50.3 50.7 51.5 52.5 52.8 54.9 53.1 53.5

Black (Non-Hispanic) Current 45.8 41.4 44 37.7 36.9 35.9 34.9 32.9 26.2 26.1 25.7 26.8 24.3 22.3 22.5 21.8 20.5 23 Former 8.4 10.7 10.8 13.3 13.8 14.2 15.9 14.8 16.7 15.7 14.4 13.6 15.4 14.5 15.5 14.3 12.9 12.6 Never 45.8 47.8 45.3 49 49.4 49.9 49.2 52.3 57.1 58.2 59.9 59.6 60.3 63.2 62 64 66.7 64.5 Hispanic 1965 1970 1974 1978 1980 1983 1985 1987 1990 1993 1995 1997 1999 2001 2002 2003 2004* 2006 Current N/A N/A N/A 31.6 30 25.3 25.9 23.6 23 20.4 18.3 20.4 18.1 16.7 16.7 16.4 15 15.2 Former N/A N/A N/A 15.6 15.1 15.7 17.2 16.1 17 16.2 16.5 14.9 14.7 14.3 15 12.9 13.2 12.7 Never N/A N/A N/A 52.9 54.9 59 56.9 60.4 60 63.4 65.2 64.7 67.2 69.1 68.4 70.8 71.7 72.1

Non-Hispanic Current N/A N/A N/A 34.3 33.4 32.6 30.3 29.2 25.7 25.4 25.4 25.2 24.1 23.6 23.2 22.3 21.7 N/A Former N/A N/A N/A 21.1 21.6 22.2 24.6 23.4 25.3 25.2 24.1 23.7 24 23.1 23.5 23.1 22.6 N/A Never N/A N/A N/A 44.6 45 45.3 45.1 47.5 49 49.4 50.6 51.1 51.9 53.3 53.2 54.6 55.7 N/A

Asian/Pacific Islander Current N/A N/A N/A 24.2 24.1 20.7 21.8 14.3 16.4 18.2 16.6 16.5 15 12.4 13.3 11.8 11.3 10.4 Former N/A N/A N/A 14 15.4 14.6 12.6 10.7 14.4 15.6 13.8 14.6 11.7 9.6 11.8 13.9 12.1 11.1 Never N/A N/A N/A 61.8 60.5 64.7 65.7 75 69.2 66.3 69.6 68.9 73.3 78 74.9 74.3 76.6 78.4

American Indian/Alaska Native Current N/A N/A N/A 45.2 60.1 39.6 32.6 37.4 38.4 38.7 36.3 32.1 41.2 32.7 40.8 39.7 33.4 32.4 Former N/A N/A N/A 22.7 20.9 22.6 20.8 23.9 20.7 20.9 19.6 21.1 17 20.5 20.6 14.3 21.2 25.6 Never N/A N/A N/A 32.1 19.1 37.8 46.6 38.8 40.9 40.4 44.2 46.8 41.8 46.8 38.7 46 45.4 42

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Appendix A

U.S Smoking Status By Selected Demographic Variables 1965 – 2006 (Continuation)

Age (years) 18-24 1965 1970 1974 1978 1980 1983 1985 1987 1990 1993 1995 1997 1999 2001 2002 2003 2004* 2006 Current 45.5 38 37.8 34.4 33.3 34.2 29.3 27.1 24.5 25.8 24.8 28.7 27.9 26.9 28.5 23.9 23.6 23.9 Former 6.9 9.2 9.5 9.2 10.5 9.3 10.1 8 9.5 7.2 8.6 7.3 7.6 7.8 7.5 7.1 7 5.9 Never 47.6 52.8 52.7 56.4 56.2 56.5 60.6 64.9 66 67 66.6 64 64.5 65.4 64 69 69.4 70.2 25-44 1965 1970 1974 1978 1980 1983 1985 1987 1990 1993 1995 1997 1999 2001 2002 2003 2004* 2006 Current 51.2 44.6 44.5 39.3 37.8 36.3 34.8 33.2 29.7 29.2 28.6 28.6 27.3 25.9 25.7 25.6 23.8 23.5 Former 13.6 18.8 18.4 19.5 19.8 19 21.4 19.6 20 18.6 17.5 15.9 15.4 14.5 15 14.2 13.4 13.7 Never 35.3 36.6 37.1 41.2 42.5 44.7 43.8 47.2 50.3 52.2 53.8 55.5 57.3 59.7 59.3 60.2 62.8 62.8 45-64 1965 1970 1974 1978 1980 1983 1985 1987 1990 1993 1995 1997 1999 2001 2002 2003 2004* 2006 Current 41.6 38.6 37.7 36.7 35.6 33.3 31.6 30.9 27 26 25.5 24.4 23.3 23.8 22.7 22 22.4 21.8 Former 16.1 21.7 24.8 26.1 26.6 28.8 31.2 29.9 32.9 33.9 30.9 31.2 31 29.4 29.4 28 27.9 26.9 Never 42.3 39.7 37.5 37.3 37.9 37.9 37.3 39.3 40.1 40.1 43.5 44.3 45.7 46.9 47.9 50 49.8 51.3 >=65 1965 1970 1974 1978 1980 1983 1985 1987 1990 1993 1995 1997 1999 2001 2002 2003 2004* 2006 Current 17.9 16.1 17.3 16.3 17.2 16.7 16 15.2 12.8 11.8 13 12 10.6 10.2 9.3 9.1 8.8 10.2 Former 15 21.3 23.3 28.1 27.9 30.7 34 34.1 36.6 38.4 37.7 38.6 40.6 39.3 40.5 40 39.3 37.9 Never 67.2 62.6 59.4 55.6 54.9 52.6 50 50.7 50.6 49.8 49.3 49.4 48.8 50.6 50.3 50.9 51.9 52

Footnotes

* Persons > = 18 years of age. † Current smokers reported smoking > = 100 cigarettes and currently smoked. Former smokers reported smoking > = 100 cigarettes and did not currently smoke. Never smokers reported that they had smoked < 100 cigarettes. § Questions assessing race/ethnicity changed in 1997 and Asian/Pacific Islanders from 1997 through 2004 are limited to persons who reported their race as Chinese, Filipino, or Asian Indians.

Data on education are presented for persons > = 25 years of age.

N/A Data not available. Source: National Health Interview Surveys: 1965, 1970, 1974, 1978, 1980, 1983, 1985, 1987, 1990, 1993, 1995, 1997, 1999, 2001-2006. Note: For any year, 95% confidence intervals do not exceed ±1.2% for the total population, ±1.8% for men, ±1.4% for women, ±3.9% for whites, ±4.7% for blacks, ±4.7% for Hispanics, ±7.8% for Asian/Pacific Islanders, ±14.8% for American Indian/Alaska Natives, ±2.7% for persons ages 18-24 years, ±1.8% for person ages 25-44 years, ±2.5% for persons ages 45-64 years, ±2.1% for persons ages >= 65 years, ±3.3% for < 8 years of education, ±2.8% for 9-11 years of education, ±1.9% for 12 years of education, ±3.1% for 13-15 years of education, ±2.9% for >= 16 years of educations, ±1.0% for persons at or above the poverty level, ±2.7% for persons below the poverty level, and ±3.5% for persons with unknown poverty level.

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Appendix B

DREGAN Phone Bilingual Survey DREGAN PHONE STUDY INTRO SCRIPT: Hello. My name is _____ and I’m calling from the University of Minnesota, School of Public Health. I am calling because we are conducting a study about health and health behaviors throughout the state of Minnesota. You may have received a letter about this study in the last week or two.

Hola. Mi nombre es y le estoy llamando desde la Escuela de Salud Pública de la Universidad de Minnesota. En estos momentos estamos llevando a cabo un estudio sobre salud y hábitos de salud a través de todo el estado de Minnesota. Es probable que haya recibido por correo una carta relacionada a este estudio hace una o dos semanas atrás.

Your household was selected at random from households throughout the state. The results from the study will help various organizations in the state to understand important issues related to health and community.

Su hogar ha sido seleccionado al azar entre todos los hogares del estado. Los resultados de este estudio ayudarán a varias organizaciones del estado a entender asuntos importantes relacionados con la salud y la comunidad.

We’re talking to people 18 years of age and older. The person we talk to within each household is the person who will have the next birthday. Would that be you or would that be someone else? (WE INTERVIEW WHOEVER HAS THE NEXT BIRTHDAY TO MAKE THE CHOICE TOTALLY RANDOM.)

1 RESPONDENT (CONSENT AND BEGIN INTERVIEW) 2 SOMEONE ELSE ---------May I speak to that person?

PERSON AVAILABLE ----------(EXPLAIN STUDY, CONSENT RESPONDENT AND INTERVIEW) PERSON NOT AVAILABLE ----------- When would be a good time to call back? Estamos hablando con personas que tengan 18 años o más. La persona con la cual hablamos en cada hogar es aquella que tenga el cumpleaños más próximo. ¿Esa persona sería usted o alguien más?

(ENTREVISTAMOS A AQUELLAS PERSONAS CON EL CUMPLEAÑOS MÁS PRÓXIMO PARA QUE LA SELECCIÓN SEA TOTALMENTE AL AZAR)

163

1. ENTREVISTADO: (SOLICITE CONSENTIMIENTO Y COMIENCE LA

ENTREVISTA) 2. OTRA PERSONA: ¿Podría hablar con esa persona?

PERSONA DISPONIBLE: (EXPLIQUE, CONSIENTA Y COMIENCE ENTREVISTA)

PERSONA NO DISPONIBLE: ¿Cuándo sería un buen momento para encontrar a esta persona? CONSENT: CONSENTIMIENTO: This study takes between 5-6 minutes. Your participation is voluntary. In any reports we write about this study, we will not reveal information that would allow anyone to identify who took part. There aren’t any direct benefits to you, but the information will help us understand more about the health of people in Minnesota. Este estudio toma entre 5 a 6 minutos. Su participación es totalmente voluntaria. Cualquier informe que preparemos en relación a este estudio no incluirá ningún tipo de información que permita identificar a las personas que participaron. No hay beneficios directos; sin embargo, esta información nos ayudará entender un poco más acerca de la salud de la gente en Minnesota. Before we start, let me tell you that everything you say will be kept confidential. Your name or phone number will not be linked to your answers. Your answers will be combined with those of other people in Minnesota and only researchers doing the study will have access to the interview data.

Antes de comenzar, permítame informarle que todo lo que usted diga es totalmente confidencial. Su nombre y número de teléfono no estarán asociados con sus respuestas. Sus respuestas serán combinadas con las de las otras personas que participen en el estudio y solamente los investigadores tendrán acceso a los datos obtenidos.

The researcher in charge of this study is Dr. Todd Rockwood and you may have his phone number if you wish (612/624-7437). He would be able to answer any questions you have, or if you have questions now, I can answer them for you. If you would like to contact someone at the Research Subjects’ Advocates line, I can give you that number too (612/625-1650). El investigador a cargo de este estudio lo es el Dr. Todd Rockwood. Si usted desea le puedo dar su número de teléfono (612/624-7437). Él podrá contestar cualquier duda o pregunta que usted tenga acerca del estudio. De igual manera, si usted tiene alguna pregunta o duda en este momento yo podría contestarla o si usted desea contactar a la

164

Línea de Defensores para Sujetos de Investigación, también le puedo dar ese número de teléfono (612/625-1650).

LIFESTYLE ITEMS GENDER (OBSERVE, ASK IF UNKNOWN)

1 MALE 2 FEMALE

GÉNERO (OBSERVE, PREGUNTE SI DESCONOCE)

1 MASCULINO 2 FEMENINO

1 During the past 12 months, would you say your physical health was…

1 Excellent

2 Very good

3 Good

4 Fair

5 Poor 1 Durante los últimos 12 meses, ¿diría usted que su salud física ha sido: (MN)

Excelente

Muy Buena

Buena

Regular

Mala 2 Has your daily life been full of things that were interesting to you during the past month?

1 Most of the time 2 Some of the time 3 A little of the time 4 None of the time

165

2 Durante el pasado mes, ¿ha estado su vida diaria llena de cosas interesantes para

usted?

Gran parte del tiempo Parte del tiempo Un poco del tiempo o Ninguna parte del tiempo

3 How happy or pleased have you been with your personal life during the past month?

1 Very Happy 2 Somewhat Happy 3 Somewhat Unhappy 4 Very Unhappy

3 Durante el último mes, ¿Qué tan feliz o complacido(a) ha estado usted con su

vida personal?

Muy Feliz Algo Feliz Algo Infeliz Muy Infeliz

4 Now thinking about your race or ethnicity, which of the following do you

consider yourself to be? [MAY SELECT MORE THAN ONE]

1 Asian (GO TO Q4a)

2 Hispanic or Latino (GO TO Q5) [INCLUDES MESTIZO, CHICANO, MORENO(A), TRIGUENO(A), ETC.]

3 American Indian or Alaskan Native (GO TO Q5) 4 Black or African American (GO TO Q5) 5 White (GO TO Q5) 6 Native Hawaiian or Other Pacific Islander (GO TO Q5) 7 Some other race (GO TO Q5)

166

4 Pensando en su raza o etnia, ¿de qué raza o etnia se considera usted? (Similar to HA)

[PUEDE SELECCIONAR MÁS DE UNA]

Asiático(a) (GO TO Q4a)

Hispano(a) o Latino(a) (GO TO Q5) [INCLUYE MESTIZO(A), CHICANO(A), MORENO(A), TRIGUEÑO(A), ETC]

Indio(a) Americano(a) o Nativo(a) de Alaska (GO TO Q5)

Negro(a) o Afro-americano(a) (GO TO Q5)

Blanco(a) (GO TO Q5)

Isleño(a) nativo(a) de Hawaii o de otra isla del Pacífico. (GO TO

Q5)

Alguna otra raza (GO TO Q5)

4a. [ASIAN]. Which of the following do you consider yourself to be? [MAY SELECT MORE THAN ONE]

1 Hmong 2 Vietnamese 3 Cambodian 4 Laotian 5 Chinese 6 Korean 7 Japanese 8 Other Asian Nation (SPECIFY): __________________________

IF MORE THAN ONE SELECTED FOR Q4a, ASK Q4b

4a. [ASIÁTICO]. ¿Cuál de las siguientes mejor lo describe a usted? (HA) [PUEDE SELECCIONAR MÁS DE UNA]

Hmong Vietnamita Laosiano(a) Camboyano(a) Chino(a) Coreano(a) Japonés(a) Otro Asiático (ESPECIFIQUE): __________________________

167

4b Which of these <FILL>, do you identify with most closely?

1 Hmong 2 Vietnamese 3 Cambodian 4 Laotian 5 Latino/Hispanic

4b ¿Con cuál de las siguientes <FILL>, usted mejor se identifica?

1 Hmong 2 Vietnamita 3 Camboyano 4 Laosiano 5 Latino/Hispano

SCREENING ITEMS

5 What country were you born in? _________________________ COUNTRY

IF US GO TO Q8 5 ¿En qué país nació usted? (MN) _________________________ PAÍS IF US GO TO Q8 6 What country were you living in prior to coming to the U.S.? _________________________ COUNTRY 6 ¿En qué país vivía antes de llegar a los Estados Unidos? _________________________ PAÍS

168

7 What year did you come to the U.S. to live? Interviewer Alternatives: When did you come to the U.S. How long ago did you come to U.S. ________ (Year) GO TO NEW QUESTION CHECKPOINT 7 ¿En qué año llegó a vivir a los Estados Unidos? Alternativas para el Entrevistador: ¿Cuándo vino a vivir a los Estados Unidos?

(HA) ¿Hace cuánto tiempo llegó a vivir a los Estados

Unidos? ________ (Año) GO TO Q11 8 Were both of your parents born in the United States?

1 Yes GO TO 11 2 No 7 DK GO TO 11 9 REF GO TO 11

8 ¿Nacieron sus dos padres en los Estados Unidos? (MN)

1 Sí GO TO 11 2 No 7 No sabe GO TO 11 9 REF GO TO 11

9 In what country was your mother born?

________ COUNTRY IF US, GO TO Q10

7 DK 9 REF

169

9 ¿En qué país nació su madre? (MN) ________ PAÍS IF US, GO TO Q10

NO SABE REHUSÓ

9a What year did she come to the US?

________ YEAR

7 DK 9 REF

9a. ¿En qué año llegó ella a los Estados Unidos?

________ AÑO NO SABE REHUSÓ

10 In what country was your father born? ________ COUNTRY IF US, GO TO NEW QUESTION

CHECKPOINT 7 DK 9 REF

10 ¿En qué país nació su padre? (MN) ________ PAÍS IF US, GO TO NEW QUESTION CHECKPOINT

NO SABE REHUSÓ

10a What year did he come to the US?

________ YEAR

7 DK 9 REF

170

GO TO NEW QUESTION CHECKPOINT

10a. ¿En qué año llegó él a los Estados Unidos?

________ AÑO NO SABE REHUSÓ

GO TO NEW QUESTION CHECKPOINT 11 Were any of your grandparents born outside of the US?

1 Yes GO TO 11a

2 No 7 DK GO TO NQ CHECKPOINT 9 REF

11. ¿Alguno de sus abuelos nació fuera de los Estados Unidos?

1 Sí GO TO 11a

2 No 7 DK GO TO NQ CHECKPOINT 9 REF

11a Where were they born? How about your mother’s mother? What country was she born in?

____________ COUNTRY 11b And your mother’s father?

____________ COUNTRY

171

11c And where was your father’s mother born? ____________ COUNTRY 11d And your father’s father?

____________ COUNTRY

11a. ¿Dónde nacieron?

Qué tal su abuela materna, ¿en qué país nació? (LA MAMÁ DE SU

MAMÁ) ________ PAÍS 11b. ¿Y su abuelo materno? (EL PAPÁ DE SU MAMÁ) ________ PAÍS

11c. ¿Dónde nació su abuela paterna? (LA MAMÁ DE SU PAPÁ)

________ PAÍS

11d. ¿Y su abuelo paterno? (EL PAPÁ DE SU PAPÁ)

________ PAÍS

NEW QUESTION CHECKPOINT

IF Q4 is not LATINO and Q4a is not HMONG, VIETNAMESE, CAMBODIAN, or LAOTIAN, ask new questions. Otherwise, GO TO Q12 Si Q4 no es LATINO y Q4 no es HMONG, VIETNAMITA, CAMBOYANO o LAOSIANO pregunte las nuevas preguntas. De otro modo, GO TO Q12

172

NQ1 Would either of your parents consider themselves to be one of the following?

A Hmong 1 YES 2 NO 7 DK 9 REF B Vietnamese 1 YES 2 NO 7 DK 9 REF C Cambodian 1 YES 2 NO 7 DK 9 REF D Laotian 1 YES 2 NO 7 DK 9 REF E Latino/Hispanic 1 YES 2 NO 7 DK 9 REF

IF ONE YES GO TO Q12 (marital status) IF MORE THAN ONE YES GO TO NQ2 IF ALL NO GO TO NQ3

NQ1 ¿Cualquiera de sus padres se considera a sí mismo alguno de los siguientes?

A Hmong 1 SÍ 2 NO 7 DK 9 REF B Vietnamita 1 SÍ 2 NO 7 DK 9 REF C Camboyano 1 SÍ 2 NO 7 DK 9 REF D Laosiano 1 SÍ 2 NO 7 DK 9 REF E Latino/Hispano 1 SÍ 2 NO 7 DK 9 REF

IF ONE YES GO TO Q12 (marital status) IF MORE THAN ONE YES GO TO NQ2 IF ALL NO GO TO NQ3

NQ2 Which of these, <FILL> and <FILL> and <FILL> do you identify with most closely? (CHOOSE ONLY ONE)


173

NQ2 ¿Con cuál de las siguientes, <FILL> y <FILL>, mejor se identifica usted?

(ESCOJA SÓLO UNA OPCIÓN)


NQ3 Would any of your grandparents have considered themselves to be one of the following?

A Hmong 1 YES 2 NO 7 DK 9 REF B Vietnamese 1 YES 2 NO 7 DK 9 REF C Cambodian 1 YES 2 NO 7 DK 9 REF D Laotian 1 YES 2 NO 7 DK 9 REF E Latino/Hispanic 1 YES 2 NO 7 DK 9 REF

IF ONE YES GO TO Q12 (marital status) IF MORE THAN ONE YES GO TO NQ4 IF ALL NO GO TO Q12

NQ3 ¿Cualquiera de sus abuelos se consideraría alguno de los siguientes?

A Hmong 1 SÍ 2 NO 7 DK 9 REF B Vietnamita 1 SÍ 2 NO 7 DK 9 REF C Camboyano 1 SÍ 2 NO 7 DK 9 REF D Laosiano 1 SÍ 2 NO 7 DK 9 REF E Latino/Hispano 1 SÍ 2 NO 7 DK 9 REF

IF ONE YES GO TO Q12 (marital status)

174

IF MORE THAN ONE YES GO TO NQ4 IF ALL NO GO TO Q12

NQ4 Which of these, <FILL> and <FILL> and <FILL> do you identify with most

closely? (CHOOSE ONLY ONE)


NQ4 ¿Con cuál de las siguientes, <FILL> y <FILL>, mejor se identifica usted?

(ESCOJA SÓLO UNA OPCIÓN)


12 Are you currently

1 Married GO TO Q13

2 Living in a Marriage Like

Relationship

3 Separated

GO TO Q14 4 Divorced 5 Widowed, or have you6 Never been married

175

12. ¿Actualmente, está usted (MN)

1 Casado (a) GO TO Q13

2 Viviendo con su pareja como si

estuviese casado(a)

3 Separado(a)

GO TO Q14 4 Divorciado(a) 5 Viudo(a) o 6 Nunca se ha casado

13 Does your spouse/partner consider themselves to be of Latino/Hispanic,

Vietnamese, Cambodian, Laotian, or Hmong origin? code responses:

1 Hmong 2 Vietnamese 3 Cambodian 4 Laotian 5 Other Asian 6 Latino/Hispanic 7 None of the above

13. ¿Su esposo(a)/pareja se considera a si mismo de origen Latino/Hispano,

Vietnamita, Camboyano, Laosiano o Hmong?

code responses:

Vietnamita

Camboyano(a)

Laosiano(a)

Hmong

Otro GrupoAsiático

Latino(a)/Hispano(a)

Ninguno de los anteriores

176

IF R doesn’t screen in any other way, and Q13 has more than 1 answer, ask Q13b

13b Which of these <FILL>, do you identify with most closely

1 Hmong 2 Vietnamese 3 Cambodian 4 Laotian

IF R doesn’t screen in any other way, and Q13 has more than 1 answer, ask

Q13b 13b ¿Con cuál de las siguientes, <FILL> y <FILL>, mejor se identifica

usted?

1 Hmong 2 Vietnamita 3 Camboyano 4 Laosiano

IF SELF-IDENTIFY AS ‘NON-QUALIFYING’ RACE/ETHNICITY: While you don’t self-identify as a <FILL ETHNICITY>, the research we are conducting is focused on people who are of <FILL ETHNICITY> heritage, and we want to include you in the study.

A. DECISION RULE FOR INCLUSION INTO STUDY – LATINO:

If Self-Identify is not Latino (Q4 ne2)

THEN R DOES NOT MEET SCREEN

If Parent Identify is not Latino (NQ1E is NO) If Grandparent identify is not Latino (NQ3E is NO)

177

IF MARRIED TO SEASIAN: Since your spouse is <FILL ETHNICITY>, we want to include you in the study.

B. DECISION RULE FOR INCLUSION INTO STUDY – SEAsian:

If Self-Identify is not SEAsian (Q4 ne 1-4)

THEN R DOES NOT MEET SCREEN

If Parent Identify is not SEAsian (NQ1A-D are all NO) If Grandparent identify is not SEAsian (NQ3A-D are all NO) If Spouse is not SEAsian (Q13 ne 1-4)

TERMINATION STATEMENT IF SCREEN NOT MET: Okay. That is my last question. Thank you so much for taking part in our study. Esta ha sido mi última pregunta. Muchas gracias por tomar parte de nuestro estudio.

FLUENCY 14 How well do you understand each of the following: 14. Qué tan bien entiende usted cada uno de los siguientes: a How about U.S. Holidays such as Thanksgiving and 4th of July?

1 Very Well 2 Somewhat Well 3 Not Very Well 4 Not At All

178

a Celebraciones de los Estados Unidos tales como el Día de Acción de Gracias o el 4 de Julio.

Muy Bien

Algo Bien

No Muy Bien

Para Nada Bien

b And how about the Minnesota Nice Celebration?


b Y qué tan bien entiende usted la celebración del “Minnesota Nice”? (“MINNESOTA AGRADABLE”)

Muy Bien

Algo Bien

No Muy Bien

Para Nada Bien 15 If you attended a wedding or funeral based on <FILL> traditions, how well would

you understand what is going on? NOTE: if US born Latino use “Latino traditions” instead of “traditions from <FILL>


179

15. Si usted asistiera a una boda o funeral basado en tradiciones <FILL PAÍS>, ¿Qué tan bien entendería lo que está pasando?

NOTE: if US born Latino use “Latino traditions” instead of “traditions from <FILLCOUNTRY>

Muy Bien

Algo Bien

No Muy Bien

Para Nada Bien 16 Do you agree or disagree with the following statement? 16 ¿Está usted de acuerdo o en desacuerdo con lo siguiente?

a I understand <FILL> ways very well.

1 Agree GO TO a1 2 Disagree GO TO a2

a Entiendo muy bien las tradiciones de <FILL PAÍS>.

De

Acuerdo

GO TO a1

En

Desacuerdo

GO TO a2 a1 Do you strongly agree or somewhat agree?

1 STRONGLY AGREE 2 SOMEWHAT AGREE

a1 ¿Diría usted que está muy de acuerdo o algo de acuerdo?

MUY DE ACUERDO

ALGO DE ACUERDO

180

a2 Do you strongly disagree or somewhat disagree?

1 STRONGLY DISAGREE 2 SOMEWHAT DISAGREE

a2 ¿Diría usted que está algo en desacuerdo o bastante en desacuerdo?

ALGO EN DESACUERDO

MUY EN DESACUERDO

ORIENTATION 17 How important is it to you that <FILL> ways are practiced in your home?

1 Not at All Important 2 A Little Important 3 Somewhat Important 4 Very Important

IMMIGRANTS (IF Q5 IS NOT US) 17 ¿Qué tan importante es para usted que las costumbres de <FILL PAÍS> sean

practicadas en su hogar? (Options from MN)

No es importante

Un poco importante

Algo más importante o

Muy importante IMMIGRANTS (IF Q5 IS NOT US) 18a How many of your neighbors are from the same ethnic background as you?

Would you say none, a few, some, a lot or almost all of them?

1 NONE 2 A FEW 3 SOME 4 A LOT 5 ALMOST ALL

181

18a ¿Cuántos de sus vecinos son del mismo grupo étnico que usted? ¿Diría usted que ninguno, unos pocos, algunos, muchos o casi todos? (Options from MN)

NINGUNO

UNOS POCOS

ALGUNOS

MUCHOS

CASI TODOS 18b How many of your close friends are from the same ethnic background as you?

Would you say none, a few, some, a lot or almost all of them?

1 NONE 2 VERY FEW 3 SOME 4 A LOT 5 ALMOST ALL

18b ¿Cuántos de sus amigos cercanos son del mismo grupo étnico que usted? ¿Diría

usted que ninguno, unos pocos, algunos, muchos o casi todos?

NINGUNO

MUY POCOS

ALGUNOS

MUCHOS

CASI TODOS 19 Do you think you are similar or different to <a-b>: 19 ¿Cree usted que es parecido(a) o diferente a <a-b>:

a People who live in <FILL> (country)

1 Similar GO TO a1 2 Different GO TO a2

a La gente que vive en <FILL> (país)

Parecido(a) GO TO a1

Diferente GO TO a2

182

a1 How similar are you? Are you a little similar, somewhat similar, or very similar?

1 A LITTLE SIMILAR 2 SOMEWHAT SIMILAR 3 VERY SIMILAR

a1 ¿Qué tan parecido(a) es usted? ¿Es usted un poco parecido(a), algo

parecido(a) o muy parecido(a)?

POCO PARECIDO(A)

ALGO PARECIDO(A)

MUY PARECIDO(A)

a2 How different are you? Are you a little different, somewhat different, or very different?

1 A LITTLE DIFFERENT 2 SOMEWHAT DIFFERENT 3 VERY DIFFERENT

a2 ¿Qué tan diferente es usted? ¿Es usted un poco diferente, algo diferente o

muy diferente?

UN POCO DIFERENTE

ALGO DIFERENTE

MUY DIFERENTE b Typical White Minnesotan

1 Similar GO TO b1 2 Different GO TO b2

b El típico habitante blanco de Minnesota

Parecido(a) GO TO b1

Diferente GO TO b2

183

b1 How similar are you? Are you a little similar, somewhat similar, or very similar?


b1 ¿Qué tan parecido(a) es usted? ¿Es usted un poco parecido(a), algo

parecido(a) o muy parecido(a)?

UN POCO PARECIDO(A)

ALGO PARECIDO(A)

MUY PARECIDO(A)

b2 How different are you? Are you a little different, somewhat different, or very different?


b2 ¿Qué tan diferente es usted? ¿Es usted un poco diferente, algo diferente o

muy diferente?

UN POCO DIFERENTE

ALGO DIFERENTE

MUY DIFERENTE 20 Which of the following would you say best describes you:

1 <FILL> 2 <FILL> American 3 An American

20 ¿Cuál de las siguientes diría usted que mejor le describe?

<FILL>

<FILL> Americano

Un Americano

184

RANDOMLY SELECTED PHONE ONLY SAMPLE. ALL OTHERS GO TO Q26 Ask Q21-25 AND DEMOGRAPHICS. DO NOT SCHEDULE FOR FACE-TO-FACE INTERVIEW. 21 Have you ever smoked a cigarette, even 1 or 2 puffs?

1 Yes 2 No 21a Not even one or two puffs? 1 Yes CONTINUE 2 No GO TO Q 26

7 DK CONTINUE

9 REF RANDOMLY SELECTED PHONE ONLY SAMPLE. Ask Q47-51 AND DEMOGRAPHICS. DO NOT SCHEDULE FOR FACE-TO-FACE INTERVIEW. 21. Q40 (OPCIÓN 1): ¿Alguna vez ha fumado un cigarillo, bien sea una probadita? (ALGUNA VEZ EN LA

VIDA) (OPCIÓN 2): ¿Alguna vez ha fumado un cigarillo, bien sea una o dos pitadas? (CDC-GYTS) (ALGUNA VEZ EN LA

VIDA)

1 Sí 2 No 21a ¿Ni siquiera una pitada (una probadita)? 1 Sí CONTINUE 2 No GO TO Q 26

7 DK CONTINUE

9 REF 22 Do you consider yourself a smoker?

1 Yes 2 No 7 DK 9 REF

185

22 ¿Se considera usted un(a) fumador(a)?

1 Sí 2 No 7 DK 9 REF

23 Have you smoked at least 100 cigarettes in your entire life?

1 Yes 2 No GO TO Q 26

7 DK CONTINUE

9 REF 23 ¿Ha fumado al menos 100 cigarrillos en toda su vida? (MN)

1 Sí 2 No GO TO Q 26

7 DK CONTINUE

9 REF 24 Have you smoked a cigarette, even a puff in the last 6 months?

1 Yes 2 No GO TO Q 26

7 DK CONTINUE

9 REF 24 ¿En los últimos 6 meses ha fumado un cigarillo, aunque sea una probadita? (una

pitada)? 1 Sí 2 No GO TO Q 26

7 DK CONTINUE

9 REF

186

25 Do you now smoke cigarettes every day, some days, or not at all?

1 Everyday 2 Some Days 3 Not At All

25 Fuma usted actualmente cigarillos todos los días, algunos días o ningún día?

(MN)

Todos los días

Algunos días

Ningún día Finally, I have a few questions about you which will help our staff interpret the results. Finalmente, tengo algunas preguntas acerca de usted que ayudarán nuestro personal a interpretar los resultados. 26 What is your age? _______ YEARS 26 ¿Cuántos años tiene usted? _______ EDAD

IF REFUSED 27 What age group are you in?

1 Less than 20 2 20 – 29 3 30 – 39 4 40 – 49 5 50 – 59 6 60 – 69 7 70 or over

IF REFUSED

187

27. ¿Si le menciono algunas categorías de edades, diría que su grupo de edad es:

Menos de 20 20 a 29 30 a 39 40 a 49 50 a 59 60 a 69 70 o más

28 What is the highest grade or level of school you have completed? (DO NOT

READ CHOICES)

1 NO FORMAL EDUCATION 2 COMPLETED ELEMENTARY SCHOOL (GRADES 1-6) 3 COMPLETED JUNIOR HIGH SCHOOL (GRADES 7-9) 4 HIGH SCHOOL GRADUATE OR GED 5 TECHNICAL, VOCATIONAL TRAINING, OR BUSINESS SCHOOL 6 SOME COLLEGE (INCLUDES TECH SCHOOL/AA DEGREES) 7 COLLEGE GRADUATE (BA/BS DEGREE) 8 POST GRADUATE/PROFESSIONAL SCHOOL 9 OTHER, SPECIFY: ____________________________________________

97 DK 99 REF IF NOT IN PHONE ONLY STRATA

GO TO SCHEDULE

188

28 ¿Hasta qué grado o nivel escolar completó? (NO LEA LAS OPCIONES) (MN)

Ninguna educación formal (HA)

Completó la escuela primaria/elemental (Grados 1 – 6) (DS)

Completó la escuela secundaria (Grados 7 – 9) (DS)

Se graduó de la Escuela secundaria o GED (11 A 12 AÑOS DE

ESCUELA/COLEGIO) (MN)

Adiestramiento Técnico o Vocacional o Escuela de Comercio

Algo de Universidad (Incluye escuela técnica/Grado Asociado)

(MN)

Título Universitario (BA/BS)

Título de Pos-grado

Otro, Especifíque:

______________________________________________

No Sabe

Rehusó IF NOT IN PHONE ONLY STRATA GO TO SCHEDULE

PHONE GROUP ONLY Q29 In studies like this, households are often grouped according to income. What was

the total income for your household over the past year, including salaries or other earnings, interest, retirement and so on, for all household members combined?

, DOLLARS

7 DK 9 REF

Q29 En estudios de este tipo, las unidades familiares frecuentemente se agrupan según

sus ingresos. ¿Cuánto sumó el ingreso total de todas las personas de su unidad familiar durante el año pasado, incluyendo salarios y otros ingresos, intereses, jubilación, etc.? (MN)

, DÓLARES

NO SABE REHUSÓ

189

IF R REFUSES OR CANNOT ESTIMATE INCOME: Q30 How about if I give you some categories? Would you say it was more or less than

$25,000 a year?

1 LESS

2 MORE

7 DK 9 REF

IF R REFUSES OR CANNOT ESTIMATE INCOME: Q30 ¿Qué le parece si le menciono algunas categorías? ¿Podría decir que los ingresos

totales de su familia eran mayors o menores de $25,000 por año? (MN)

MENOR

Q30a 1 Less than $5,000 2 $5,001 to $10,000 3 $10,001 to $15,000 4 $15,001 to $20,000 5 $20,001 to $25,000

Q30b 1 $25,001 to $30,000 2 $30,001 to $35,000 3 $35,001 to $40,000 4 $40,001 to $75,000 5 Over $75,000

Q30a 1 Menos de$5,000 2 $5,001 a $10,000 3 $10,001 a $15,000 4 $15,001 a $20,000 5 $20,001 a $25,000

190

MAYOR

NO SABE REHUSÓ

TERMINATION STATEMENT FOR RANDOMLY SELECTED ‘SMOKING” PHONE ONLY GROUP: Okay. That was my last question. I really appreciate your help with our study. TERMINATION STATEMENTFOR RANDOMLY SELECTED ‘SMOKING’ PHONE

ONLY GROUP:

Bueno, esta ha sido mi última pregunta. Muchísimas gracias por su participación y su ayuda.

Q30b 1 $25,001 a $30,000 2 $30,001 a $35,000 3 $35,001 a $40,000 4 $40,001 a $75,000 5 Más de $75,000

191

Appendix C DREGAN Face to Face Bilingual Survey

Q1 Compared to other people your age, do you consider your health to be excellent,

very good, good, fair, or poor?

Excellent

Very Good

Good

Fair

Poor Q1 En comparación con otras personas de su edad, ¿considera que su salud es

excelente, muy buena, buena, regular o mala?

Excelente

Muy buena

Buena

Regular

Mala Q2 During the past 12 months has injury or illness caused you to cut down on the

things you usually do?

Not at all

A little bit or

A lot Q2 Durante los últimos 12 meses, ¿se ha visto limitado(a) en las cosas que

normalmente hace por alguna lesión o enfermedad? Diría Ud. que…

Nada

Un poco; o

Muy

ID # _____________

192

Q3 Do you think that a typical white Minnesotan would think that you are Latino, Asian or Southeast Asian, White, African American, American Indian, or from some other racial ethnic background?

Latino/Hispanic

Asian

Southeast Asian

White

African American

American Indian

Other (SPECIFY): _______________________________________________

Q3 ¿Cree usted que un típico habitante blanco de Minnesota pensaría que usted es latino/a, Hispano(a), asiático/a, o, asiático/a del sudeste, blanco/a, afro-americano/a, indio/a americano/a o de algún otro grupo racial o étnico?

Latino/a/Hispano/a

Asiático/a

Asiático del sudeste/a

Blanco/a

Afro americano/a

Indio/a americano/a

Otro (Por favor ESPECIFIQUE):

_______________________________________________

FLUENCY Q4 What was the first language you learned to speak? (IF R LEARNED TWO LANGUAGES AT ONCE, CODE BOTH) A. _______________________________ B. _______________________________

193

Q4 ¿Cuál fue el primer idioma que aprendió a hablar? (IF R LEARNED TWO LANGUAGES AT ONCE, CODE BOTH) A. _______________________________ B. _______________________________ Q5 And what other languages do you know? ______________________________

______________________________

Q5 ¿qué otros idiomas habla u? ______________________________

______________________________

Q6 (ASK OF SECOND LANGUAGE ONLY)

NOT AT

ALL

NOT VERY WELL

SOMEWHAT WELL

VERY WELL

a How comfortable are you communicating in <FILL>

PRIORITY LIST ENGLISH NATIVE LANGUAGE (KHMER, ETC.) LATINO: PORTUGUESE VIET: FRENCH

194

Q6 (Solamente PREGUNTE ACERCA DEL SEGUNDO IDIOMA)

NADA NO MUY

BIEN ALGO BIEN

MUY BIEN

a ¿Qué tan cómodo(a) se siente comunicándose en <FILL>?

PRIORITY LIST ENGLISH NATIVE LANGUAGE (KHMER, ETC.) LATINO: PORTUGUESE VIET: FRENCH Q7 How well do you understand each of the following:

Q7a U.S. sport events such as the Super Bowl or Stanley Cup playoffs?

Very Well

Somewhat Well

Not Very Well

Not At All

DON’T FOLLOW SPORTS Q7 Qué tan bien entiende usted lo siguiente:

Q7a ¿Eventos deportivos de los EE.UU. como el Súper Tazón (SUPER BOWL) o la copa Stanley?

Muy bien

Bien

No muy bien

Nada

NO SIGO DEPORTES

195

Q7b How well do you understand the legend of Paul Bunyan and Babe the Blue Ox?

Very Well

Somewhat Well

Not Very Well

Not At All

Q7b ¿Qué tan bien entiende la leyenda de Paul Bunyan y Bebé, el buey azul?

Muy bien

Algo bien

No muy bien

Para nada bien

Q7c And how well do you understand the Boston Tea Party?

Very Well

Somewhat Well

Not Very Well

Not At All

Q7c Y ¿Qué tan bien entiende la (MOTÍN DEL TÉ DE BOSTON)?

Muy bien

Algo bien

No muy bien

Para nada bien

196

Q8 If you attended a wedding or funeral based on <FILL> traditions, how well would you understand what is going on?

NOTE: if US born Latino use “Latino traditions” instead of “traditions from <FILL>

Very Well

Somewhat Well

Not Very Well

Not At All Q8 Si usted asistiera a una boda o a un funeral basado en tradiciones < FILL >, ¿Qué

tan bien entendería lo que está pasando? NOTE: if US born Latino use “Latino traditions” instead of “traditions from <FILL>

Muy bien

Bien

No muy bien

Nada Q9 Do you agree or disagree with each of the following: Q9a I understand <FILL> traditions very well

Agree

Disagree

Q9a1 Do you strongly agree or somewhat agree? 9 STRONGLY AGREE 9 SOMEWHAT AGREE

Q9a2 Do you strongly disagree or somewhat disagree? 9 STRONGLY DISAGREE 9 SOMEWHAT DISAGREE

197

Q9 ¿Está usted de acuerdo o en desacuerdo con cada una de las siguientes afirmaciones?

Q9a Entiendo muy bien las tradiciones <FILL>

De

acuerdo

En

desacuerdo

Q9b I understand American ways very well

Agree

Disagree

Q9b1 Do you strongly agree or somewhat agree? 9 STRONGLY AGREE 9 SOMEWHAT AGREE

Q9b2 Do you strongly disagree or somewhat disagree? 9 STRONGLY DISAGREE 9 SOMEWHAT DISAGREE

Q9a1 ¿Está usted muy de acuerdo o algo de acuerdo? 9 MUY DE ACUERDO

9 ALGO DE ACUERDO

Q9a2 ¿Está usted muy en desacuerdo o algo en desacuerdo? 9 MUY EN DESACUERDO 9 ALGO EN DESACUERDO

198

9b Entiendo muy bien las costumbres americanas

De

acuerdo

En

desacuerdo

ORIENTATION

Q10 How important is it to you that <FILL> ways are practiced in your home?

Not at All Important

A Little Important

Somewhat Important

Very Important

Q10 ¿Qué tan importante es para usted que las costumbres <FILL> sean seguidas en su casa? (MN Needs)

No es importante

Poco importante

Importante

Muy importante CHECKPOINT

1 U.S. BORN GO TO Q15

2 IMMIGRANT

Q9b1 ¿Está usted muy de acuerdo o algo de acuerdo? 9 MUY DE ACUERDO 9 ALGO DE ACUERDO

Q9b2 ¿Está usted muy en desacuerdo o algo en desacuerdo? 9 MUY EN DESACUERDO 9 ALGO EN DESACUERDO

199

Since moving to the U.S., how much has changed for each of the following: Q11 How about the language you speak at home, has there been no change at all, a

little change, some change or a lot of change?

NO CHANGE AT ALL

VERY LITTLE CHANGE

SOME CHANGE

A LOT OF CHANGE Desde que llegó a los EE.UU., qué tanto ha cambiado en cada uno de los siguientes

aspectos: Q11 El idioma que usted habla en casa, ¿no ha cambiado, ha cambiado muy poco, ha

cambiado algo o ha cambiado mucho? (DESDE QUE LLEGÓ A LOS EE.UU.)

NO HA CAMBIADO

MUY POCO

ALGO

MUCHO

Q12 And how about the sports or sporting teams you follow, no change, a little, some or a lot of change?

NO CHANGE AT ALL

VERY LITTLE CHANGE

SOME CHANGE

A LOT OF CHANGE

DON’T FOLLOW SPORTS

Q12 Y que tal los deportes o equipos deportivos que sigue de cerca, ¿no ha cambiado, ha cambiado muy poco, ha cambiado algo o ha cambiado mucho? (DESDE QUE LLEGÓ A LOS EE.UU.)

NO HA CAMBIADO

MUY POCO

ALGO

MUCHO

NO SIGO DEPORTES

200

Q13 How about the food you eat. Would you say there has been no change, a little, some or a lot of change?

NO CHANGE AT ALL

VERY LITTLE CHANGE

SOME CHANGE

A LOT OF CHANGE

Q13 Y que tal la comida que usted come. ¿No ha cambiado, ha cambiado muy poco, ha cambiado algo o ha cambiado mucho? (DESDE QUE LLEGÓ A LOS EE.UU.)

NO HA CAMBIADO

MUY POCO

ALGO DE

MUCHO

Q14 And how about the music you listen to. Has there been no change, a little, some

or a lot of change?

NO CHANGE AT ALL

VERY LITTLE CHANGE

SOME CHANGE

A LOT OF CHANGE Q14 Y que tal la música que usted escucha. ¿No ha cambiado, ha cambiado muy poco,

ha cambiado algo o ha cambiado mucho? (DESDE QUE LLEGÓ A LOS EE.UU.)

NO HA CAMBIADO

MUY POCO

ALGO DE

MUCHO

201

Q15 Thinking about a typical white Minnesotan, are you similar or different to them for each of the following:

Q15a The music you listen to

Similar

Different Q15 Pensando en un típico habitante blanco de Minnesota, ¿es usted parecido/a o

diferente en cada uno de los siguientes aspectos? Q15a La música que usted escucha

Parecido/a

Diferente

Q15a1 How similar are you? Are you a little similar, somewhat similar, or very similar?


Q15a2 How different are you? Are you a little different, somewhat different, or very different?


Q15a1 ¿Qué tan parecido/a es usted? ¿es usted poco parecido/a, algo parecido/a o muy parecido/a?

9 POCO PARECIDO/A 9 ALGO PARECIDO/A 9 MUY PARECIDO/A

Q15a2 ¿Qué tan diferente es usted? ¿es usted poco diferente, algo diferente, o muy diferente?

9 POCO DIFERENTE 9 ALGO DIFERENTE 9 MUY DIFERENTE

202

Q15b The food you eat

Similar

Different

Q15b La comida que usted come

Parecido/a

Diferente

Q15b1 How similar are you? Are you a little similar, somewhat similar, or very similar?


Q15b2 How different are you? Are you a little different, somewhat different, or very different?


Q15b1 ¿Qué tan parecido/a es usted? ¿es usted poco parecido/a, algo parecido/a o muy parecido/a?


Q15b2 ¿Qué tan diferente es usted? ¿es usted poco diferente, algo diferente, o muy diferente?


203

Q15c Expressions you use when you speak (slang)

Similar

Different Q15c Expresiones que usted utiliza al hablar (como por ejemplo jerga)

Parecido/a

Diferente

Q15c1 How similar are you? Are you a little similar, somewhat similar, or very similar?


Q15c2 How different are you? Are you a little different, somewhat different, or very different?

9 A LITTLE DIFFERENT 9 SOMEWHAT DIFFERENT

9 VERY DIFFERENT

Q15c1 ¿Qué tan parecido/a es usted? ¿es usted poco parecido/a, algo parecido/a o muy parecido/a?


Q15c2 ¿Qué tan diferente es usted? ¿es usted poco diferente, algo diferente, o muy diferente?


204

Q15d The sport or sporting teams you follow

Similar

Different

Q15d Deportes o equipos deportivos que usted sigue de cerca

Parecido/a

Diferente

Q15d1 How similar are you? Are you a little similar, somewhat similar, or very similar?


Q15d2 How different are you? Are you a little different, somewhat different, or very different?


Q15d1 ¿ Qué tan parecido/a es usted? ¿es usted poco parecido/a, algo parecido/a o muy parecido/a?


Q15d2 ¿Qué tan diferente es usted? ¿es usted poco diferente, algo diferente, o muy diferente?


205

Q16 Thinking overall, how similar or different are you to a Typical White Minnesotan

Similar

Different Q16 En lo general, ¿qué tan parecido/a o diferente es usted a un típico habitante blanco

de Minnesota?

Parecido/a

Diferente

Q16a How similar are you? Are you a little similar, somewhat similar, or very similar?


Q16b How different are you? Are you a little different, somewhat different, or very different?

9 A LITTLE DIFFERENT 9 SOMEWHAT DIFFERENT

9 VERY DIFFERENT

Q16a1 ¿Qué tan parecido/a es usted? ¿es usted poco parecido/a, algo parecido/a o muy parecido/a?


Q16a2 ¿Qué tan diferente es usted? ¿es usted poco diferente, algo diferente, o muy diferente?


206

Q17 How many of your casual friends or acquaintances are from the same ethnic background as you? Would you say none, a few, some, a lot or almost all of them?

NONE

A FEW

SOME

A LOT

ALMOST ALL Q17 ¿Cuántos de sus amigos casuales o conocidos son de su grupo étnico? ¿diría que

ninguno, muy pocos, algunos, muchos, o casi todos?

NINGUNO

MUY POCOS

ALGUNOS

MUCHOS

CASI TODOS Q18 Which of the following would you say best describes you:

<FILL>

<FILL> American

An American IF R IS NOT SEAsian AND SPOUSE IS SEAsian ASK “YOUR SPOUSE” Q18 ¿Cuál de las siguientes palabras lo describiría mejor?:

<FILL>

<FILL> Americano/a

Americano/a IF R IS NOT SEAsian AND SPOUSE IS SEAsian ASK “YOUR SPOUSE”

207

Q19 How strongly do you identify with your/your spouse’s <FILL 1> background?

Not at All

A Little

Somewhat

A Lot IF R IS NOT SEAsian AND SPOUSE IS SEAsian ASK “YOUR SPOUSE” Q19 ¿Qué tanto se identifica usted con sus raices <FILL1>/las raices <FILL 1> de su

esposo/a?

Nada

Poco

Algo

Mucho IF R IS NOT SEAsian AND SPOUSE IS SEAsian ASK “YOUR SPOUSE” Q20 How important do you feel it is to keep in touch with or learn about your/your

spouse’s <FILL 1> ethnic or cultural background?

Not at All

A Little

Somewhat

A Lot Q20 ¿Qué tan importante es para usted mantenerse en contacto o aprender sobre sus

raices étnicas o culturales o las de su esposo/a?

Nada

Poco

Algo

Muy

208

Q21 Now thinking about the conversations that you have at home with other family members, friends or guests, are more of those conversations in <FILL> than English, more in English than <FILL> or are they about the same?

More <FILL> than English

More English than <FILL>

About the same Q21 Pensando en las conversaciones que usted tiene en casa con otros miembros de su

familia, amigos o visitas, ¿son estas conversaciones más en <FILL> que inglés, más en inglés que en <FILL> o más o menos igual en ambos idiomas?

Más <FILL> que inglés

Más inglés que <FILL>

Más o menos iguales en ambos idiomas Q22 How important are each of the following to keeping ones identity as a <FILL 1>: Q22a Speak <LANGUAGE FILL>

Very Important

Somewhat Important

Not Very Important

Not at All Important Q22 ¿Qué tan importante para usted es mantener su identidad como <FILL 1> en cada

uno de los siguientes aspectos? Q22a Hablar < LANGUAGE FILL >. Es…

Muy importante

Algo importante

No muy importante

No es importante

209

Q22b Raise children as a <FILL>

Very Important

Somewhat Important

Not Very Important


Q22b Criar los niños como <FILL> Es…

Muy importante

Algo importante

No muy importante

No es importante

Q22c Take on as few American ways as possible

Very Important

Somewhat Important

Not Very Important


Q22c Adoptar el menor número posible de costumbres estadounidenses. Es…

Muy importante

Algo importante

No muy importante

No es importante

Q22d Be born in <FILL>

Very Important

Somewhat Important

Not Very Important


210

Q22d Haber nacido en <FILL> Es…

Muy importante

Algo importante

No muy importante

No es importante

Q22e View themselves as a <FILL> first and an American second

Very Important

Somewhat Important

Not Very Important


Q22e Verse primero como <FILL> y segundo como americano(a). Es…

Muy importante

Algo importante

No muy importante

No es importante

Q22f Spend time mainly with others who are from the same ethnic background

Very Important

Somewhat Important

Not Very Important


Q22f Pasar la mayor parte del tiempo con personas que tienen las mismas raices étnicas. Es…

Muy importante

Algo importante

No muy importante

No es importante

211

Q22g Marry someone who shares the same cultural background

Very Important

Somewhat Important

Not Very Important


Q22g Casarse con alguien que tenga las mismas raices culturales. Es…

Muy Importante

Algo Importante

No Muy Importante

No es Importante

Q22h Follow events in <FILL – COUNTRY>

Very Important

Somewhat Important

Not Very Important


Q22h Seguir los eventos en <FILL – PAÍS> Es…

Muy Importante

Algo Importante

No Muy Importante

No es Importante Q22i Caring for children in traditional <FILL> ways

Very Important

Somewhat Important

Not Very Important


212

Q22i El criar a los niños de la manera tradicional <FILL>. Es...

Muy Importante

Algo Importante

No Muy Importante

No es Importante Q2 My next questions are about physical activities that you did in the past 7 days,

including activities that you did at work, as part of your house and yard work, to get from place to place, or in your spare time for recreation, exercise or sports.

During the past 7 days, have you done any physical activity, that is any activity that caused you to breathe at least a little harder than normal?

Yes

GO TO Q24

No

GO TO Q28, Next page Q23 Las siguientes preguntas son sobre aquellas actividades físicas que usted llevó a

cabo durante los últimos 7 días. Estas incluyen actividades que hizo en su trabajo, como parte de las tareas de su hogar, o jardín, aquellas que hizo para ir de un lugar a otro o en su tiempo libre por motivos recreacionales, de ejercicio o deportivos.

¿Durante los pasados 7 días, ha hecho alguna actividad física? Es decir, cualquier

actividad que le haya hecho respirar al menos un poco más fuerte que lo común.

SÍ

GO TO Q24

NO

GO TO Q28, Próxima página Q24 The next few questions are about moderate activity you may have done in the past

7 days. Moderate physical activities are those activities that make you breathe just a little harder than normal. Examples are carrying light loads, bicycling at a regular pace or walking.

213

During the past 7 days, on how many days did you do moderate physical activities for more than 10 minutes at a time?

# DAYS PER WEEK

Q24 Las siguientes preguntas son acerca de aquellas actividades físicas moderadas que

pudo haber hecho durante los pasados 7 días. Actividades físicas moderadas son aquellas en las que usted tiene que respirar un poco más fuerte que lo normal. Por ejemplo, llevar cargas livianas, andar en bicicleta o caminar.

En los pasados 7 días, durante cuántos días llevó a cabo actividades físicas

moderadas por más de 10 minutos en cada ocasión? _______ # DÍAS POR SEMANA

Q25 On the most recent day that you did moderate physical activity, how long did you do this for? How many minutes or hours?

MINUTES/HOURS Q25 El último día que realizó alguna actividad física moderada, ¿Durante cuánto

tiempo la realizó? ¿Cuántos minutos u horas? _______ MINUTOS/HORAS Q26 Now think about vigorous physical activities you may have done in the past 7

days. These are activities such as heavy lifting, digging or fast running that cause you to breathe much harder than normal.

During the past 7 days, on how many days did you do vigorous physical activities

for more than 10 minutes at a time?

# DAYS PER WEEK Q26 Ahora, piense en actividades físicas vigorosas que usted haya hecho en los

últimos 7 días. Estas son actividades que lo hacen respirar mucho más fuerte que

lo normal; tales como levantar cosas pesadas, excavar o correr.

214

En los pasados 7 días, ¿durante cuántos días llevó a cabo actividades físicas vigorosas por más de 10 minutos en cada occasión?

# DÍAS POR SEMANA

Q27 On the most recent day that you did vigorous physical activity, how long did you

do this for? MINUTES/HOURS

Q27 El día más reciente en el cual llevó a cabo alguna actividad física vigorosa, ¿Por

cuánto tiempo? MINUTOS/HORAS Q28 The next question concerns the foods you usually eat. Thinking back over the

past 7 days, how many servings of fruit did you usually eat in a day? A serving would be half a cup of fruit or fruit juice or a medium piece of fruit.

SERVINGS PER DAY INTERVIEW INSTRUCTION: A cup is about a handful Q28 Las siguientes preguntas son acerca de los alimentos que usualmente come.

Pensando en los últimos 7 días, ¿cuántas porciones de fruta, por lo general, comió en un día? Una porción sería media taza de fruta o de jugo de fruta o un pedazo mediano de fruta.

SERVINGS PER DAY INTERVIEW INSTRUCTION: Una taza es un puñado. Q29 Over the past 7 days, how many servings of vegetables did you usually eat in a

day? A serving would be half a cup of cooked vegetables or one cup of raw vegetables.

SERVINGS PER DAY INTERVIEW INSTRUCTION: A cup is about a handful

215

Q29 Pensando en los últimos 7 días, ¿cuántas porciones de vegetales, por lo general, comió en un día? Una porción sería media taza de vegetales cocidos o una taza de vegetales crudos.

PORCIONES POR DÍA INTERVIEW INSTRUCTION: Una taza es un puñado

Q30 During the past 30 days, for about how many days did stress, poor physical health, or depression keep you from doing your usual activities?

(IF NEEDED: USUAL ACTIVITIES SUCH AS TAKING CARE OF YOURSELF, WORK OR RECREATION?)

ENTER NUMBER OF DAYS (1 - 30) Q30 Durante los pasados 30 días, ¿Durante cuántos días el estrés, la mala salud física,

o la depresión le impidieron llevar a cabo sus actividades usuales? (DE SER NECESARIO: ACTIVIDADES USUALES TALES COMO EL CUIDAR DE SÍ MISMO(A) TRABAJAR O ACTIVIDADES RECREACIONALES)

ENTRE EL NÚMERO DE DÍAS (1 – 30) Q31 Now thinking about your physical health, which includes physical illness and

injury, for how many days during the past 30 days was your physical health not good?

ENTER NUMBER OF DAYS (1 - 30) Q31 Pensando en el aspecto físico, el cual incluye cualquier enfermedad física o

lesiones. ¿Durante cuántos días, en los últimos 30 días, no se encontró bien de salud? (~DS)

ENTRE EL NÚMERO DE DÍAS (1 – 30) Q32 Have you been anxious, worried, or upset during the past month?

Extremely

Quite A Bit

Some

A Little

Not At All

216

Q32 Durante el mes pasado, ¿ha estado ansioso(a), preocupado(a) o molesto(a)?

Muchísimo

Bastante

Algo

Muy poco

Nada Q33 For each of the following events or situations please indicate if they have

occurred in your life in the last year. YES NO

Death of a spouse or close family member

Change in where you live

Major change in health or behavior of a family member

Major change in the number of family get-togethers

Q33 Para cada uno de los siguientes eventos o situaciones, por favor indique si le ha

ocurrido en su vida durante el pasado año. SÍ NO

Muerte de esposo/a o familiar cercano

Cambios en el lugar que vive

Cambio significativo en la salud o conducta de un miembro de la familia

Cambio significativo en el número de reuniones familiares.

SMOKING My next questions are about smoking. Q34a Do you think smoking can help a person make friends?

Yes

No

217

Las siguientes preguntas son acerca del fumar. Q34a ¿Cree usted que fumar puede ayudarle a una persona a hacer amigos?

SÍ

NO Q34b Do you think it provides pleasure?

Yes

No Q34b ¿Cree que causa placer?

SÍ

NO Q34c Does it relieve stress and anxiety?

Yes

No Q34c ¿Alivia el estrés y la ansiedad?

SÍ

NO Q34d Do you think smoking can help a person focus on activities such as work, chores

or other tasks?

Yes

No Q34d ¿Cree que el fumar puede ayudarle a una persona a concentrarse en el trabajo,

tareas domésticas, o en otras actividades?

SÍ

NO

Q34e And do you think it helps to lose weight?

Yes

No Q34e ¿Y cree que ayuda a perder peso?

SÍ

NO

218

For each of the next statements, please tell me if you strongly agree, somewhat agree, somewhat disagree or strongly disagree. Q35 People who smoke do so because they want to.

STRONGLY AGREE

SOMEWHAT AGREE

SOMEWHAT DISAGREE

STRONGLY DISAGREE Para cada una de las siguientes afirmaciones, por favor dígame si está acuerdo, algo de

acuerdo, algo en desacuerdo o en desacuerdo.

Q35 La gente que fuma lo hace porque quiere. Está...

DE ACUERDO

ALGO DE ACUERDO

ALGO EN DESACUERDO

DESACUERDO Q36 People who smoke do so because it is a habit.

Strongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree Q36 La gente que fuma lo hace porque es un hábito. Está...

de acuerdo

Algo de acuerdo

Algo en desacuerdo

en desacuerdo

219

Q37 People who smoke cannot control whether they smoke or not.

Strongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree Q37 La gente que fuma no puede controlar si fuma o no. Está...

de acuerdo

Algo de acuerdo

Algo en desacuerdo

en desacuerdo Q38 As long as you are healthy, it is ok to smoke.

Strongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree Q38 Mientras se esté saludable, está bien fumar. Está...

de acuerdo

Algo de acuerdo

Algo en desacuerdo

en desacuerdo Q39 Which of the following best describes your beliefs about smoking:

There are more benefits than harms

There are more harms than benefits

The harms and benefits are about equal Q39 ¿Cuál de las siguientes frases describe mejor lo que usted opina sobre fumar?

Hay más beneficios que daños.

Hay más daños que beneficios

No hay diferencia.

220

TOBACCO BEHAVIOR QUESTIONS

Q40 Have you ever smoked a cigarette, even 1 or 2 puffs? Yes

No Q40a Not even one or two puffs?

Yes CONTINUE

No GO TO Q62 Q40 (OPCIÓN 1): ¿Alguna vez ha fumado un cigarillo, bien sea una

probadita/fumadita? (ALGUNA VEZ EN LA VIDA) (OPCIÓN 2): ¿Alguna vez ha fumado un cigarillo, bien sea una o dos

probaditas/fumaditas? (CDC-GYTS) (ALGUNA VEZ EN LA VIDA)

Sí

No Q40a ¿Ni siquiera una (una

probadita/fumadita)?

Sí CONTINÚE

No GO TO Q62 Q41 Do you consider yourself a smoker?

Yes

No Q41 ¿Se considera usted un/a fumador/a?

Sí

No Q42 Have you smoked at least 100 cigarettes in your entire life?

Yes

No GO TO Q62 Q42 ¿Ha fumado al menos 100 cigarrillos en toda su vida? (MN)

Sí

No GO TO Q62

221

Q43 Have you smoked a cigarette, even a puff in the last 6 months? Yes

No GO TO Q48 (BLUE SECTION) Q43 ¿En los últimos 6 meses ha fumado un cigarillo aunque sea una probadita? (una

fumadita)?

Sí

No GO TO Q48 (SECCIÓN AZUL) Q44 Do you now smoke cigarettes every day, some days, or not at all?

Everyday

Some Days

Not At All

Q45 On average, about how many cigarettes a day do you smoke?

CIGARETTES GO TO Q50

Q46 During the past 30 days, on how many days did you smoke cigarettes?

# OF DAYS Q47 On average, on days when you smoked during

the past 30 days, how many cigarettes did you smoke a day?

CIGARETTES 9 LESS THAN ONE A DAY 9 DON’T KNOW 9 REFUSED GO TO Q50

GO TO Q48 (BLUE SECTION)

222

Q44 Fuma usted actualmente cigarillos todos los días, algunos días o no fuma? (MN)

Todos los

días

Algunos

días

Ningún día

Q45 ¿Cuántos cigarrillos, en promedio, fuma diariamente? (MN)

CIGARRILLOS GO TO Q50

GO TO Q48 (SECCIÓN AZUL)

Q46 Durante los últimos 30 días, ¿cuántos fueron los días en los que fumó cigarrillos/cigarros? (MN)

# DE DÍAS Q47 En los días que fumó durante los últimos 30

días, ¿cuántos cigarillos/cigarros, en promedio, fumó al día? (MN)

CIGARRILLOS 9 MENOS DE UN CIGARRILLO AL DÍA 9 NO SABE

9 REHUSÓ

223

FORMER SMOKERS

Q48 About how long has it been since you last smoked cigarettes regularly?

“REGULARLY” IS WHATEVER “REGULARLY” MEANS TO THE RESPONDENT

NEVER SMOKED REGULARLY

WITHIN THE PAST MONTH (1 MONTH OR LESS)

WITHIN THE PAST 3 MONTHS (> 1 MONTH BUT LESS THAN 3

MONTHS AGO)

WITHIN THE PAST 6 MONTHS (> 3 MONTHS BUT LESS THAN 6

MONTHS AGO)

WITHIN THE PAST YEAR (> 6 MONTHS BUT LESS THAN 1 YEAR

AGO)

WITHIN THE PAST 5 YEARS (> 1 YEAR BUT LESS THAN 5 YEARS

AGO)

WITHIN THE PAST 10 YEARS (> 5 YEARS BUT LESS THAN 10 YEARS

AGO)

10 OR MORE YEARS AGO Q48 ¿Desde hace cuánto tiempo dejó de fumar cigarrillos/cigarros regularmente?

“REGULARLY” IS WHATEVER “REGULARLY” MEANS TO THE RESPONDENT

NUNCA FUMÉ REGULARMENTE

DURANTE DEL MES PASADO (1 MES O MENOS)

DURANTE LOS ÚLTIMOS 3 MESES (> 1 MES PERO MENOS DE 3

MESES ATRÁS)

DURANTE LOS ÚLTIMOS 6 MESES (> 3 MESES, PERO MENOS DE 6

MESES ATRÁS)

DURANTE EL AÑO PASADO (> 6 MESES, PERO MENOS DE 1 AÑO

ATRÁS)

DURANTE LOS ‘ULTIMOS 5 AÑOS (> 1 AÑO, PERO MENOS DE 5

AÑOS ATRÁS)

DURANTE LOS ÚLTIMOS 10 AÑOS (> 5 AÑOS, PERO MENOS DE 10

AÑOS ATRÁS)

HACE 10 O MÁS AÑOS

224

Q49 How much did smoking restrictions at home, work or anywhere else affect your decision to quit smoking?

None

A Little

Some

A Lot Q49 ¿Qué tanto le afectaron en su decisión de dejar de fuma, las restricciones de fumar

ya sea en casa, el trabajo, o cualquier otro lugar?

Nada

Muy poco

Algo

Mucho Q50 How old were you the first time you smoked a cigarette? AGE

Q50 ¿Cuántos años tenía la primera vez que fumó un cigarillo? EDAD Q51 How old were you when you first started to smoke cigarettes regularly? AGE NEVER SMOKED REGULARLY Q51 ¿Cuántos años tenía cuando comenzó a fumar cigarillos regularmente? EDAD NUNCA FUMÓ REGULARMENTE

225

Q52 On the days that you smoke, how soon after you wake up do you have your first cigarette?

Within 5 minutes

6 – 30 minutes

31 – 60 minutes

More than 60 minutes Q52 En los días que fuma, ¿Qué tan pronto fuma su primer cigarrillo después de

levantarse?

Dentro de los primeros 5 minutos

De 6 – 30 minutos

De 31 – 60 minutos

Más de 60 minutos Q53 When you are facing stressful events or situations, do you smoke…

A lot more

A little more

The same amount

A little less

A lot less

Q53 Cuando se enfrenta a eventos o situaciones estresantes, usted fuma...

Mucho más

Un Poco más

La misma cantidad

Un poco menos

Mucho menos

226

Q54 How comfortable are you smoking around other <FILL>?

Very comfortable

Somewhat comfortable

Somewhat uncomfortable

Very uncomfortable Q54 ¿Qué tan cómodo/a se siente al fumar cerca de otros <FILL>?

Muy cómodo/a

Algo cómodo/a

Algo incómodo/a

Muy incómodo/a Q55 How many times in the past 12 months did you quit smoking for a day or more? TIMES Q55 ¿ Durante los últimos 12 meses cuántas veces dejó de fumar por un día o más? VECES Q56 Which of the following statements best describes how you feel?

I really enjoy smoking

I enjoy smoking

I don’t like smoking

I really don’t like smoking Q56 ¿Cuál de las siguientes afirmaciones mejor describe lo que usted siente?

Disfruto mucho fumar

Disfruto fumar

No me gusta mucho fumar

Realmente no me gusta fumar

227

Q57 Which of the following best describes how you feel?

I don’t think about stopping smoking

I don’t want to stop smoking

I would like to stop smoking, but don’t want to go through the process

I want to stop smoking

I WOULD LIKE TO STOP FOR SOME OTHER REASON

<INTERVIEWER: IF VOLUNTEERED “DO NOT WANT TO STOP FOR SOME OTHER REASON” CODE BUT DO NOT OFFER AS RESPONSE>

Q57 ¿Cuál de las siguientes afirmaciones describe mejor lo que usted siente?

No pienso en dejar de fumar

No quiero dejar de fumar

Me gustaría dejar de fumar, pero no quiero pasar por el proceso

Quiero dejar de fumar

QUISIERA DEJAR DE FUMAR POR ALGUNA OTRA RAZÓN

<INTERVIEWER: IF VOLUNTEERED “DO NOT WANT TO STOP FOR SOME OTHER REASON” CODE BUT DO NOT OFFER AS RESPONSE>

Q58 If you wanted to stop smoking, how likely do you think you would be to succeed?

Very likely

Somewhat likely

Somewhat unlikely

Very unlikely Q58 Si usted quisiera dejar de fumar, ¿Qué tan probable es que tuviera éxito?

Muy probable

Algo probable

Algo improbable

Muy improbable

228

Q59 If you decided to stop smoking, how likely do you think you would be to succeed?

Very likely

Somewhat likely

Somewhat unlikely

Very unlikely Q59 Si usted decidiera dejar de fumar, ¿Qué tan probable es que tuviera éxito?

Muy probable

Algo probable

Algo improbable

Muy improbable Q60 How comfortable would you be asking for help to stop smoking?

Very comfortable



Very uncomfortable Q60 ¿Qué tan cómodo/a se sentiría usted al pedir ayuda para dejar de fumar?

Muy cómodo/a

Algo cómodo/a

Algo incómodo/a

Muy incómodo/a Q61 For this next statement, please tell me if you strongly agree, somewhat agree,

somewhat disagree or strongly disagree: The only way I would be able to stop smoking is through my own will power.

STRONGLY AGREE

SOMEWHAT AGREE

SOMEWHAT DISAGREE

STRONGLY DISAGREE

229

Q61 Por favor dígame si Ud. está de acuerdo, algo de acuerdo, algo en desacuerdo o en desacuerdo con las siguientes afirmaciones: Sólo dejaría de fumar sin ayuda. DE ACUERDO ALGO DE ACUERDO

ALGO EN DESACUERDO EN DESACUERDO

Q62 How comfortable are you when other <FILL> smoke around you?

Very comfortable



Very uncomfortable Q62 ¿Qué tan cómodo/a se siente cuando otros <FILL> fuman cerca de usted?

cómodo/a

Algo cómodo/a

Algo incómodo/a

incómodo/a

Q63 Now I would like to ask you about other forms of tobacco. In the last 6 months, have you used <FILL a – h>

YES NO

a. Pipe

b. Water pipe (ASK OF SEAsians ONLY)

c. Cigar

d. Cigarillo (small cigars Spanish)

e. Chewing Tobacco (with nuts for Hmong) or snuff

f. Bidis

g. Kreteks or Clove Cigarettes

h. Any other (What would that be?)

230

Q63 Ahora, me gustaría preguntarle acerca de otras formas de tabaco. En los últimos 6 meses, ha usado <FILL a – h>

SÍ NO a. Una pipa

B. UNA PIPA DE AGUA (SÓLO A SEASIANS )

c. (PURO/HABANO)

d. Purito (PURO PEQUEÑO)

e. Tabaco para mascar (CON NUECES PARA PERSONAS HMONG) o Rapé

f. Bidis

g. Kreteks o cigarrillos de clavo de olor

h. Algún otro tipo de tabaco (¿Cuál?)

Q64 During the past 7 days has anyone smoked anywhere inside your home?

Yes

No Q64 Durante los últimos 7 días, ¿ alguien ha fumado dentro de su casa?

Sí

No

231

Q65 Which statement best describes the rules about smoking inside your home. (Inside does not include places such as decks, garages, or porches.)

Smoking is not allowed anywhere in the house

Smoking is allowed some places in the house

People can smoke anywhere

Or is there some other rule

Q65 ¿Cuál de los siguientes afirmaciones describe mejor las reglas existentes en su hogar en cuanto a fumar dentro de su casa? (Dentro de su casa no incluye áreas tales como balcones, garajes y pórticos)

Fumar no está permitido en ningún lugar de la casa.

Está permitido fumar en ciertas áreas dentro de

la casa.

La gente puede fumar donde desee

Existe alguna otra regla

Q65a What is that? 9 People can smoke in certain places 9 Certain people can smoke 9 People can smoke on some occasions 9 Other (SPECIFY): _________________

Q65a ¿Cuál?

9 La gente puede fumar en ciertas áreas de la casa

9 Ciertas personas pueden fumar

9 La gente puede fumar en ciertas ocasiones

9 Otra (ESPECIFIQUE): ______________

232

Q66 In the past 7 days, have you been in a car with someone else who was smoking?

Yes

No Q66 En los últimos 7 días, ¿ha estado en un carro con alguien que estuviera fumando?

Sí

No Q67 Are you currently employed for wages or are you self employed?

Employed for wages (Work for someone else)

Self-Employed

Don’t Work for

Wages

SKIP TO Q75 Q67 Actualmente, ¿está empleado con pagos o trabaja por cuenta propia?

Empleado por pagos (Trabaja para alguien más)

Trabaja por cuenta propia

No trabaja por pagos SKIP TO Q75 Q68 How many different jobs do you have?

ONE JOB

TWO JOBS

THREE OR MORE JOBS

Q68a Are you indoors or outdoors most of the time? 9 INDOORS GO TO Q69 9 OUTDOORS GO TO Q73

233

Q68 ¿Cuántos empleos tiene usted?

UN

TRABAJO

DOS TRABAJOS

TRES O MÁS

TRABAJOS

Q68b Now I want to ask you some questions about smoking at the place you work the most or your primary job. While working at your main job, are you indoors or outdoors most of the time?

9 INDOORS 9 OUTDOORS GO TO Q73

Q68a ¿Pasa la mayor parte del tiempo en áreas interiores o exteriores?

9 INTERIORES GO TO Q69 9 EXTERIORES GO TO Q73

Q68b Ahora me gustaría hacerle algunas preguntas sobre el fumar en su sitio principal de trabajo. ¿Pasa la mayor parte del tiempo en áreas interiores o exteriores?

9 INTERIORES 9 EXTERIORES GO TO Q73

234

Q69 What best describes where your primary or main job is? ( READ IF NECESSARY) YES NO A. A CLASSROOM

B. A HOSPITAL

C. AN OFFICE OR OFFICE BUILDING

D. YOUR HOME

E. A PLANT OR FACTORY

F. A RETAIL OR CONVENIENCE STORE OR WAREHOUSE

G. A RESTAURANT

DOES IS SERVE ALCOHOL?

H. BAR OR TAVERN

I. HOTEL OR MOTEL

J. VEHICLE

K. SOME OTHER PLACE

235

Q69 ¿Cuál de los siguientes lugares decribe mejor su sitio principal de trabajo?

(LEA DE SER NECESARIO) SÍ NO A. UN SALÓN DE CLASES

B. UN HOSPITAL

C. UNA OFICINA EN UN COMPLEJO DE OFICINAS

D. SU CASA

E. UNA PLANTA O FÁBRICA

F. UNA TIENDA O UN ALMACÉN

G. UN RESTAURANTE

¿SIRVEN BEBIDAS ALCOHÓLICAS?

H. UNA BARRA O TAVERNA

I. UN HOTEL O MOTEL

J. UN VEHÍCULO

K. ALGÚN OTRO LUGAR:

Q70 In the past 7 days, has anyone smoked in your work area?

Yes

No Q70 En los últimos 7 días, ¿ alguien fumó en su área de trabajo?

Sí

No

236

Q71 Thinking of your primary or main job, which of the following best describes the official smoking policy for indoor public or common areas, such as lobbies, rest rooms, and lunchrooms?

Smoking is not allowed in any common areas

SKIP TO Q73, YELLOW PAGE

Smoking is allowed

in common areas Q71 Pensando en su sitio principal de trabajo, ¿cuál de las siguientes frases describe

mejor la política oficial sobre el fumar en áreas interiores, públicas o comunes, como los vestíbulos, baños y comedores?

Fumar no está permitido en ninguna área común

SKIP TO Q73, YELLOW PAGE

Fumar está permitido en

áreas comunes

Q72 Is it allowed in….. All common areas Some common areas

WORKPLACE HAS NO INDOOR AREAS (DO NOT READ/DOES NOT APPLY)

Q72 Está permitido en… Todas las áreas comunes Algunas áreas comunes

EL LUGAR DE TRABAJO NO TIENE ÁREAS INTERIORES (NO LEA/NO APLICA)

237

Q73 Do you prefer to work where smoking is allowed, not allowed or does it make no difference?

Allowed

Not Allowed

No Difference

Q73 ¿Prefiere usted trabajar en lugares donde se permite fumar, donde no se permite

fumar o le es indiferente?

PERMITIDO

NO PERMITIDO

LE ES INDIFERENTE

CHECKPOINT

1 R HAS ONE JOB GO TO Q75

2 R HAS MORE THAN ONE JOB CHECKPOINT

1 R HAS ONE JOB GO TO Q75

2 R HAS MORE THAN ONE JOB

Q74 In the past 7 days, has anyone smoked in your work area at your other job?

9 YES 9 NO

Q74 En su otro lugar de trabajo, ¿ alguien ha fumado en los últimos 7 días?

9 SÍ 9 NO

238

Q75 In the past 7 days, has anyone smoked near you at any other place besides your home, workplace or in a car?

Yes

No Q75 En los últimos 7 días, ¿ alguien ha fumado cerca de usted en algún otro sitio que

no sea su casa, trabajo o en el carro?

Si

No Q76 Do you think smoking causes: YES NO Lung Cancer

Poor Vision

Heart Disease

Arthritis

Q76 Piensa usted que el fumar causa:

SÍ NO Cáncer del pulmón

Mala visión

Enfermedades del corazón

Artritis

239

REFUGEE (SE Asian ONLY) Q77 Were you or your parents in a refugee camp before entering the U.S.?

Yes GO TO Q77a No GO TO Q78

Q77 ¿Estuvieron sus padres o usted en un campamento para refugiados antes de entrar

a los Estados Unidos? Sí GO TO Q77a No GO TO Q78

Q77a Who was that?

Me Parents Both

Q77b How long were you in the refugee camp? YEARS

GO TO Q78

Q77c How long were they in the refugee camp? YEARS

GO TO Q78

Q77b How long were you in the refugee camp? YEARS Q77c And how long were they in the refugee camp? YEARS GO TO Q78

240

Q77a ¿Quién estuvo?

Yo Padres Ambos

DEMOGRAPHIC Q78 Including yourself, how many people live in your house? # OF PEOPLE Q78 Incluyéndole a usted, ¿cuántas personas viven en su casa? (Similar MN) # DE PERSONAS Q79 How many are over 18 years of age? # OVER 18

Q77b ¿Durante cuánto tiempo estuvo en el campamento para refugiados?

YEARS

Q77c ¿Durante cuánto tiempo estuvieron ellos en el

campamento para refugiados? YEARS

Q77b ¿Durante cuánto tiempo estuvo en el campamento para refugiados?

YEARS Q77c ¿Durante cuánto tiempo estuvieron ellos en el

campamento para refugiados? YEARS GO TO Q78

241

Q79 ¿Cuántas de estas personas son mayores de 18 años? # MAYORES DE 18 Now I would like to ask a few questions about the people who are over 18 years old who live in the household Ahora, me gustaría hacerle algunas preguntas sobre las personas mayores de 18 años que viven en su hogar.

Q80 Starting with yourself, how old are you? Q80 Comenzando con usted, ¿qué edad tiene? (HA)

And are you male or female? (OBSERVE, ASK IF NEEDED) ¿Y es usted hombre o mujer? (PREGUNTE SÓLO DE SER NECESARIO)

(MN) And what is the age of the next person? ¿Qué edad tiene la siguiente persona? (HA) Is that person male or female? ¿Es esta persona hombre o mujer? (HA) Does that person smoke cigarettes? ¿Esta persona fuma cigarillos? Does that person use any other form of tobacco? ¿Esta persona utiliza alguna otra forma de tabaco? And what is the age of the next person etc. etc.

242

¿Qué edad tiene la siguiente persona? etc. etc. (HA) Person Age Sex Smoke Other Tobacco

RESPONDENT 1

M / F

2

M / F Y / N Y / N

3

M / F Y / N Y / N

4

M / F Y / N Y / N

5

M / F Y / N Y / N

6

M / F Y / N Y / N

7

M / F Y / N Y / N

8

M / F Y / N Y / N

9

M / F Y / N Y / N

Persona Edad Sexo Fuma Otro Tabaco

ENTREVISTADO 1 M /

F

2 M /

F S / N S / N

3 M /

F S / N S / N

4 M /

F S / N S / N

5 M /

F S / N S / N

6 M /

F S / N S / N

7 M /

F S / N S / N

8 M /

F S / N S / N

9 M /

F S / N S / N

243

Q81 What is your religion or religious orientation? ____________________________________ Q81 ¿Cuál es su religion u orientación religiosa? ____________________________________ Q82 What County do you live in? ____________________________________ Q82 ¿En qué condado vive usted? (MN) ____________________________________ Q83 In studies like this, households are often grouped according to income. What was

the total income for your household over the past year, including salaries or other earnings, interest, retirement and so on, for all household members combined?

, DOLLARS

DON’T KNOW REFUSED

IF R REFUSES OR CANNOT ESTIMATE INCOME: Q83 En estudios de este tipo, las unidades familiares frecuentemente se agrupan según

sus ingresos. ¿Cuánto sumó el ingreso total de todas las personas de su unidad familiar durante el año pasado, incluyendo salarios y otros ingresos, intereses, jubilación, etc.? (MN)

, DÓLARES

NO SABE REHUSÓ

IF R REFUSES OR CANNOT ESTIMATE INCOME:

244

Q84 How about if I give you some categories? Would you say it was more or less than $25,000 a year?

LESS

MORE

DON’T KNOW REFUSED

Q84 ¿Qué le parece si le menciono algunas categorías? ¿Podría decir que los ingresos

totales de su familia eran mayores o menores a$25,000 por año? (MN)

MENOR

MAYOR

NO SABE REHUSÓ

Q84a 1 Less than $5,000 2 $5,001 to $10,000 3 $10,001 to $15,000 4 $15,001 to $20,000 5 $20,001 to $25,000

Q84b 6 $25,001 to $30,000 7 $30,001 to $35,000 8 $35,001 to $40,000 9 $40,001 to $75,000 10 Over $75,000

Q84a 1 Menos de $5,000 2 $5,001 a $10,000 3 $10,001 a $15,000 4 $15,001 a $20,000 5 $20,001 a $25,000

Q84b 6 $25,001 a $30,000 7 $30,001 a $35,000 8 $35,001 a $40,000 9 $40,001 a $75,000 10 Más de $75,000

245

Appendix D Study Variables

246

Appendix D 1

Dependent Variables Dependent Variables Type Value Source Ever smokers Dichotomous Never smokers = 0; Ever smokers = 1 Created from DREGAN data set

Dfs Dichotomous former smokers = 0; Current smokers = 1 Created from DREGAN data set

Fwtq Trichotomous (fsmoker=1)=0 (Maintenance); (wtqsum= < 6)=1 (Preparation) ; (wtqsum>6)=2 (Precontemplation)

Created from DREGAN data set

Wtq Dichotomous (wtqsum= < 6)=1 (Preparation) ; (wtqsum>6)=2 (Precontemplation)

Created from DREGAN data set

s573G Trichotomous 1 and 2 = 0 (Precontemplation); 3 = 1 (Contemplation); 4 and 5 = 2 (Preparation)

Recoded from DREGAN data set

s582GT (WanttoQuit) Dichotomous 3 and 4 = 0; 1 and 2 = 1 Recoded from DREGAN data set

s592GT (DecidetoQuit) Dichotomous 3 and 4 = 0; 1 and 2 = 1 Recoded from DREGAN data set

s602GT (AskingforHelp) Dichotomous 3 and 4 = 0; 1 and 2 = 1 Recoded from DREGAN data set

rs61 (Willpower) Dichotomous 3 and 4 = 0; 1 and 2 = 1 Recoded from DREGAN data set

Appendix D 2 Hypothesis 1 Independent Variables

Independent Variables Type Value Source H1.1 Gender male Dichotomous 1= Male; 2=Female DREGAN data set

H1.2 Dage25 Dichotomous 1=>25 Years old Dummy variable

H1.3 Marital Status dq12 M Dichotomous 0=Not Married; 1=Married or marriage like DREGAN data set

H1.4 Dminors 1=18yo 0r <; 0=>18yo

Dichotomous Dminors<=18=1 Recoded from DREGAN data set

H1.5 dq28 Level of education Dichotomous 1=Completed High School or higher education DREGAN data set

H1.6 rs67 Employed Dichotomous rs67Employed=1 Recoded from DREGAN data set

H1.7 Dincome Dichotomous 1=More than $25,000 per household Dummy variable

H1.8 Place of residence Urban1 Dichotomous 1= Urban; 0=rural DREGAN data set

H1.9 Survey's language LangSurveySp

Dichotomous 0=English; 1=Spanish DREGAN data set

H1.10 Years living in the U.S. >5 YrUsa6

Dichotomous 0=Less than 6 years; 1=6 or more years living in the USA

DREGAN data set

H1.11 Fluency 2 HC dfluency2hc Dichotomous 0=USA oriented, Fluency2 0 to 2; 1=Home country oriented, Fluency2 2.1 to 4

DREGAN data set

H1.12 Orientation 4 Friends Dorient4f

Dichotomous 0=Friends little similar ethnicity, Orientation 4 0 to 2.5; 1=Friends very similar ethnicity, Orientation 2.6 to 5

DREGAN data set

247


Dependent Variables Type Value Source H2.1 Self Reported Healthy Rq1 Dichotomous 0=fair or poor health status;

1=excellent, very good, or good health status Dummy variable

H2.2 Self Reported Interesting Things in Daily Life Rq2

Dichotomous 0=A little or none of the time; 1=Most or some of the time

Dummy variable

H2.3 Self Reported Happiness Rq3 Dichotomous 0=Somewhat or very unhappy; 1=Somewhat or very happy

Dummy variable

H2.4Self Reported Healthy Compare to Other People Rs1

Dichotomous 0=fair or poor health status; 1=excellent, very good, or good health status

Dummy variable

H2.5 Self Reported Injury or Illness affecting daily routine during the past 12 months Rs2

Dichotomous 0=Not at all; 1=A little bit or a lot Dummy variable

H2.6 Physical Activity Past Week Rs23 Dichotomous 0=No; 1=Yes Dummy variable H2.7 Adequate Exercise – cumex Dichotomous 0=No; 1=Yes Dummy variable H2.8 Self Reported Stressful Events During the past month Rs32.

Dichotomous 0=No; 1=Yes Dummy variable

H2.9 Self reported Major Injury or illness in the Past Year Rs33a


H2.10 Change Residence in the Past Year Rs33b


H2.11 Major Change in Health of Relative in the past Year Rs33c


H2.12 Major Change Family Get-togethers in the Past Year Rs33d


H2.13 5 + fav dfav Dichotomous 0=Less than 4 servings of fruits and vegetables per day; 1=5 or more servings of fruits and vegetables per day

Dummy variable

H2.14 DBMI Dichotomous 0=Less than 18 or More than 24.9; 1=Normal (from 18 to 24.9)

Dummy variable

Appendix D 4

Hypothesis 3 Independent Variables Independent Variables Type Value Source H3.1 Smoking Facilitates Friendship Rs34a Dichotomous 0=No; 1=Yes Dummy variable H3.2 Smoking Provides Pleasure Rs34b Dichotomous 0=No; 1=Yes Dummy variable H3.3 Smoking Relieves Stress Rs34c Dichotomous 0=No; 1=Yes Dummy variable H3.4 Smoking Can Help focus on activities Rs34d Dichotomous 0=No; 1=Yes Dummy variable H3.5 Smoking helps to Lose Weight Rs34e Dichotomous 0=No; 1=Yes Dummy variable H3.6 No Positive Aspects of Smoking Rsmokeben Dichotomous 0=No; 1=Yes Dummy variable H3.7 Smoking Causes Lung Ca Rs76a Dichotomous 0=No; 1=Yes Dummy variable H3.8 Smoking Causes Heart Disease Rs76c Dichotomous 0=No; 1=Yes Dummy variable H3.9 People Smoke because they want to rs35 Dichotomous rs35 want=1 Dummy variable H3.10 People smoke because it is a habit rs36 Dichotomous rs36 habit = 1 Dummy variable H3.11 People who smoke cannot control they smoke or not rs37 Dichotomous rs37 no control = 1 Dummy variable H3.12 As long as you are healthy, it is OK to smoke rs38 Dichotomous rs38 healthy ok=1 Dummy variable H3.13 About smoking, there are more harms than benefits ds39 Dichotomous ds39 harms>ben=1 Dummy variable

Appendix D 5

Hypothesis 4 Independent Variables Independent Variables Type Value Source H4.1 Comfortable with others smoking around you Rs62 Dichotomous 0=No; 1=Yes Dummy variable H4.2 House someone smokes Rs64 Dichotomous 0=No; 1=Yes Dummy variable H4.3 Car someone smokes Rs66 Dichotomous 0=No; 1=Yes Dummy variable H4.4 smoking not Allowed at home Rs65 Dichotomous 0=No; 1=Yes Dummy variable H4.5 Someone smokes in work area Rs70 Dichotomous 0=No; 1=Yes Dummy variable H4.6 Smoking not permitted at work's common areas Rs71. Dichotomous 0=No; 1=Yes Dummy variable H4.7 Prefer works where smoking is not allowed Rs73 Dichotomous 0=No; 1=Yes Dummy variable H4.8 SHS (1=exposure to shs; 0=no shs) Dichotomous Exposed to SHS=1 Dummy variable H4.9 MinorsSHS Dichotomous Minors exposed to SHS=1 Dummy variable

248


Dependent Variables Type Value Source H5.1 Rchoadic Dichotomous Addiction=1 Choise=0 H5.2 Smoke cigarettes every day rs44 Dichotomous 0=No; 1=Yes Dummy variable H5.3 First cigarette smoked within 30 minutes after waking up rs52 Dichotomous 0=No; 1=Yes Dummy variable H5.4 Smoking more when facing stressful events rs53 Dichotomous 0=No; 1=Yes Dummy variable H5.5 Comfortable smoking around others rs54 Dichotomous 0=No; 1=Yes Dummy variable H5.6 Does not enjoy smoking rS56 Dichotomous 0=No; 1=Yes Dummy variable H5.7 Very likely to succeed if want to stop smoking rs58 Dichotomous 0=No; 1=Yes Dummy variable H5.8 Very likely to succeed if decide to stop smoking rs59 Dichotomous 0=No; 1=Yes Dummy variable H5.9 Very comfortable asking for help to stop smoking rs60 Dichotomous 0=No; 1=Yes Dummy variable H5.10 Ability to stop smoking through own will power rs61 Dichotomous 0=No; 1=Yes Dummy variable H5.11 Smoked first cigarette after 18 yo Ds50T18yo Dichotomous 0=No; 1=Yes Dummy variable H5.12 Smoking cigarettes regularly after 18 yo Ds51R18yo Dichotomous 0=No; 1=Yes Dummy variable H5.13 smokes= >5 cigarettes/day rs45 Dichotomous 0= smokes<5 cigarettes;

1= smokes= >5cigarettes/day

DREGAN data set

H5.14 Quitting smoking for a day or more in the past year Ds55 Dichotomous Ds55Quit=1 DREGAN data set

249

Appendix E Demographic Characteristics of the Sample

250

Appendix E 1 Demographic Characteristics of the Sample

Categorical Variables Categorical Variables N % Total Sample 805 100.00 Gender

Male 413 51.30 Female 392 48.70 Total 805 100.00

Marital Status of Respondents q12 Married 446 56.00 Marriage like 127 15.90 Separated 45 5.60 Divorced 51 6.40 Widowed 19 2.40 Never married 109 13.70 Total 797 100.00

Self-identify Ethnicity cq20 Latino / Hispanic 476 60.33 Latino / Hispanic-American 218 27.63 American 95 12.04 Total 789 100.00

Country of Origin Mexico 443 55.4 United States 194 24.3 Ecuador 29 3.6 El Salvador 27 3.4 Guatemala 23 2.9 Colombia 17 2.1 Puerto Rico 15 1.9 Peru 10 1.3 Honduras 8 1.0 Dominican Republic 5 .6 Argentina 4 .5 Cuba 4 .5 Nicaragua 4 .5 Spain 4 .5 Chile 3 .4 Costa Rica 3 .4 Venezuela 3 .4 Belize 1 .1 Cyprus 1 .1 Philippines 1 .1 Uruguay 1 .1 Total 800 100.0 Language of the survey

English 267 33.25 Spanish 536 66.75 Total 803 100.00

First Language Learned s4a English 113 14.00 Spanish 681 84.60 Other 11 1.40 Total 805 100.00

Living whit minors 18 years old or younger 0 236 29.30 1 569 70.70 Total 805 100.00

Type of Employment s67 For Wages 560 69.74 Self Employed 71 8.84 Do Not Work for Wages 172 21.42 Total 803 100.00

251


Categorical Variables (Continuation) Categorical Variables N % Number of Current Jobs

1 527 83.80 2 89 14.10 3 13 2.10 Total 629 100.00

Primary Job Indoors 525 83.60 Outdoors 103 16.40 Total 628 100.00

Secondary Job Indoors 86 85.10 Outdoors 15 14.90 Total 101 100.00

Location of Primary Job Plant or Factory 148 28.20 Office or office building 91 17.40 Restaurant 83 15.80

Restaurant that serves alcohol 44 5.50* Some other place 57 10.90 Retail, convenient store, or warehouse 43 8.20 Home 40 7.60 Classroom 27 5.20 Hospital 20 3.80 Hotel or Motel 12 2.30 Vehicle 2 0.40 Bar or tavern 1 0.20 Total 568 100.00

* Included in Restaurants Level of Education

No formal education 18 2.30 Completed elementary school 150 18.80 Completed junior high school 141 17.70 High school graduate or GED 204 25.60 Technical, vocational training, or business school 53 6.60 Some college 107 13.40 College graduate BA/BS degree 84 10.50 Post graduate / professional school 40 5.00 Other 1 0.10 Total 798 100.00

Religion Catholic 547 68.20 Other Christian 189 23.57 Other Religion 9 1.12 None 53 6.61 Agnostic / Atheist 4 0.50 Total 802 100.00

County of Residence Hennepin 245 32.70 Ramsey 115 15.40 Rice 65 8.70 St. Louis 62 8.30 Olmsted 60 8.00 Polk 25 3.30 Steele 21 2.80 Clay 20 2.70 Anoka 19 2.50 Washington 18 2.40 Blue Earth 16 2.10 Other 83 11.10 Total 749 100.00

252


Categorical Variables (Continuation) Categorical Variables N % Household Income Distribution

Less than $5,000 19 2.55 $5,001 to $10,000 55 7.37 $10,001 to $15,000 83 11.13 $15,001 to $20,000 76 10.19 $20,001 to $25,000 87 11.66 $25,001 to $30,000 84 11.26 $30,001 to $35,000 59 7.91 $35,001 to $40,000 50 6.70 $40,001 to $75,000 140 18.77 Over $75,000 93 12.47 Total 746 100.00


Continuous Variables Continuous Variables N Mean Minimum Maximum SD

Age (q26) (s801) 805 37.91 18 91 12.58 Age of Entry to the US (q7) 594 23.82 0 63 9.87 Immigrant's Years Living in the US (q7) 594 12.66 0 90 10.33 Year Migrated to US 594 1,993 1,916 2,006 10.33 Years living in the US 594 12.66 0 90 10.33 Household Last Year Income (q29) 218 54,860.50 1,200 500,000 58,014.54 Number of People Living in Household (s78) 805 4.09 1 15 1.86 Number of Adults Living in Household (s79) 805 2.49 1 10 1.24

253

Appendix F Self-Reported Health Status, Physical Activity, and Stress

254

Appendix F 1 Self-Reported Health Status, Physical Activity, and Stress

Categorical Variables Categorical Variables N % Health S1 Self Reported Health Status Compared to Other People of Respondent's Age

Excellent 161 20.02 Very good 179 22.26 Good 264 32.84 Fair 178 22.14 Poor 22 2.74 Total 804 100.00

q1 Self Reported Physical Health Excellent 116 14.50 Very good 144 18.00 Good 274 34.25 Fair 218 27.25 Poor 48 6.00 Total 800 100.00

S2 Self Reported Injury or Illness Affecting Daily Routine During the Past 12 Months

Not at all 493 61.20 A little bit 252 31.30 A lot 60 7.50 Total 805 100.00

Physical Activity S23 Self Reported Physical Activity During the Past Seven Days

Yes 607 75.50 No 197 24.50 Total 804 100.00

TESTVIG Behavioral Risk Factor Surveillance System (BRFSS)~ Meets Definition of Adequate Moderate Exercise (At Least Five Times a Week for a Minimum of 30 Minutes per Time)

0 679 84.35 1 126 15.65 Total 805 100.00

TESTVIG Behavioral Risk Factor Surveillance System (BRFSS)~ Meets Definition of Adequate Vigorous Exercise (At Least Three Times a Week for a Minimum of 20 Minutes per Time)

0 585 72.70 1 220 27.30 Total 805 100.00

BRFSS Standard for Adequate Exercise (Moderate or Vigorous) in a Week

0 523 65.00 1 282 35.00 Total 805 100.00

BMI 18.5 – 24.9 207 27.8 <18.5 and = or >25 538 72.2 Total 745 100.00

Stress S32 Self Reported Stress During the Past Month

Extremely 64 7.95 Quite a bit 74 9.19 Some 226 28.07 A little 288 35.78 Not at all 153 19.01 Total 805 100.00

255

Appendix F 1 Self-Reported Health Status, Physical Activity, and Stress

Categorical Variables (Continuation) Categorical Variables N % S33a Self Reported Major Injury/Illness In the Past Year

Yes 130 16.20 No 673 83.80 Total 803 100.00

S33b Change Residence in the Past Year Yes 134 16.60 No 671 83.40 Total 805 100.00

S33c Major Change in Health/Behavior of a Family member in the Past Year

Yes 197 24.50 No 608 75.50 Total 805 100.00

S33d Major Change in the Number of Family Get-togethers in the Past Year

Yes 163 20.30 No 641 79.70 Total 804 100.00

RECODE: Number of Stressful Events in the Past Year 0 417 51.80 1 226 28.10 2 106 13.20 3 38 4.70 4 18 2.20 Total 805 100.00

Q2 Number of Interesting Things in Daily Life During the Past Month Most of the time 345 43.51 Some of the time 282 35.56 A little of the time 136 17.15 None of the time 30 3.78 Total 793 100.00

Q3 Self Reported Happiness with Personal Life During the Past Month Very happy 382 47.90 Somewhat happy 342 42.90 Somewhat unhappy 61 7.70 Very unhappy 12 1.50 Total 797 100.00

256

Appendix F 2 Summary of Health, Nutrition, Physical Activity and BMI

Continuous Variables Continuous Variables N Mean Minimum Maximum SD Health

s30=During the past 30 days, for about how many days did stress, poor physical health, or depression keep you from doing your usual activities? 799 2.42 0 30 6.24

s31=Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? 804 3.05 0 30 6.78 Physical Activity

Minutes Exercised During Most Recent Time - Moderate Exercise -S25 584 79.54 5 180 60.84

Days of Vigorous Exercise for at Least 10 Minutes the Past Seven Days (S26) 398 3.36 1 7 1.86 Minutes Exercised During Most Recent Time - Vigorous Exercise -S27 395 77.49 5 180 61.70 Nutrition

S28 Servings of Fruits Eaten Per Day over the Past Seven Days 804 1.92 0 14 1.49

S29 Servings of Vegetables Eaten Per Day over the Past Seven Days 782 1.65 0 10 1.21

Total Servings Fruits and Vegetables in last Day S28 804 3.53 0 20 2.23 BMI = Body Mass Index 745 28.17 16.1 61.2 5.22

S31c=Height Inches 750 64.79 55 78 3.97 S31b=Weight Pounds 800 166.27 90 341 34.08

257

Appendix G

Summary of Acculturation Categorical Variables Fluency N % Understanding of US Holidays q14a

Very well 578 72.30 Somewhat well 185 23.20 Not very well 28 3.50 Not at all 8 1.00 Total 799 100.00

Understanding of the "Minnesota Nice Celebration" q14b Very well 157 21.10 Somewhat well 141 19.00 Not very well 134 18.00 Not at all 311 41.90 Total 743 100.00

Understanding of Traditional Latino Weddings and Funerals Q15 Very well 530 66.00 Somewhat well 195 24.30 Not very well 55 6.80 Not at all 23 2.90 Total 803 100.00

Very Good Understanding of Latino Traditions q16 Strongly agree 489 61.20 Somewhat agree 246 30.80 Somewhat disagree 38 4.80 Strongly disagree 26 3.30 Total 799 100.10

S7a Understanding of US Sport Events Very well 202 25.10 Somewhat well 189 23.50 Not very well 184 22.90 Not at all 191 23.70 Do not follow sports 39 4.80 Total 805 100.00

S7b Understanding of US Legends Very well 119 14.90 Somewhat well 160 20.00 Not very well 117 14.60 Not at all 404 50.50 Total 800 100.00

S7c Understanding of the Boston Tea Party Very well 160 20.00 Somewhat well 168 21.00 Not very well 105 13.10 Not at all 368 45.90 Total 801 100.00

Very Good Understanding of American Ways -CS9B Strongly agree 335 42.10 Somewhat agree 251 31.60 Somewhat disagree 167 21.00 Strongly disagree 42 5.30 Total 795 100.00

Importance of Practicing Latino Ways at Home q17 Not at all 55 6.90 A little 113 14.10 Somewhat 204 25.50 Very 428 53.50 Total 800 100.00

258

Appendix G Summary of Acculturation Categorical Variables

Orientation N % Neighbors from the Same Ethnic Background - q18a

None 303 38.60 A few 219 27.90 Some 151 19.20 A lot 54 6.90 Almost all 58 7.40 Total 785 100.00

Close Friends from the Same Ethnic Background -Q18b N % None 86 10.80 A few 211 26.50 Some 184 23.10 A lot 135 16.90 Almost all 181 22.70 Total 797 100.00

S17 Casual Friends or Acquaintances from the Same Ethnic Background None 70 8.70 A few 210 26.10 Some 194 24.10 A lot 147 18.30 Almost all 183 22.80 Total 804 100.00

Self Reported Similarity to People Who Live in Country of Origin or Latin America –CQ19A Very similar 197 24.69 Somewhat similar 188 23.56 A little similar 85 10.65 A little different 86 10.78 Somewhat different 125 15.66 Very different 117 14.66 Total 798 100.00

CQ19B Self Reported Similarity to Typical White Minnesotan Very similar 89 11.40 Somewhat similar 120 15.40 A little similar 63 8.10 A little different 101 13.00 Somewhat different 162 20.80 Very different 244 31.30 Total 779 100.00

S19a Strong Identification with Latino Background Not at all 10 1.20 A little 83 10.30 Somewhat 198 24.70 A lot 512 63.80 Total 803 100.00

S20a Importance of Keeping in Touch With/Learning About Ethnic/Cultural Background Not at all 17 2.10 A little 73 9.10 Somewhat 214 26.60 A lot 501 62.20 Total 805 100.00

S21 Language of Conversations at Home More Spanish than English 436 54.20 More English than Spanish 157 19.50 About the same 212 26.30 Total 805 100.00

s22a Importance of Speaking Spanish to Keep Latino Identity Very important 517 64.38 Somewhat important 219 27.27 Not very important 52 6.48 Not at all important 15 1.87 Total 803 100.00

259


Orientation N % S22b Importance of Raising Children as Latinos to keep Latino Identity

Very important 474 59.00 Somewhat important 246 30.60 Not very important 59 7.30 Not at all important 25 3.10 Total 804 100.00

S22c Importance of Incorporating As Few American Ways As Possible to Keep Latino Identity Very important 231 29.20 Somewhat important 317 40.00 Not very important 142 17.90 Not at all important 102 12.90 Total 792 100.00

s22d Importance of Being Born in a Latino Country to Latino Identity Very important 405 50.80 Somewhat important 186 23.30 Not very important 107 13.40 Not at all important 100 12.50 Total 798 100.00

s22e Importance of Viewing Self Identity First As Latino, Second As an American to Keep Latino Identity Very important 396 49.60 Somewhat important 216 27.10 Not very important 92 11.50 Not at all important 94 11.80 Total 798 100.00

S22f Importance of Spending Time Primarily with Others of Same Ethnic Background To Keep Latino Identity

Very important 281 35.04 Somewhat important 302 37.66 Not very important 140 17.46 Not at all important 79 9.85 Total 802 100.00

S22g Importance of Marrying Someone of Same Cultural Background to Keep Latino Identity Very important 281 35.00 Somewhat important 194 24.20 Not very important 165 20.60 Not at all important 162 20.20 Total 802 100.00

s22h Importance of Following Events in Latin America to Keep Latino Identity Very important 296 36.86 Somewhat important 292 36.36 Not very important 125 15.57 Not at all important 90 11.21 Total 803 100.00

s22i Importance of Caring for Children in Traditional Latino Ways to Keep Latino Identity Very important 369 46.00 Somewhat important 293 36.50 Not very important 97 12.10 Not at all important 43 5.40 Total 802 100.00

S11 Change in the Language Spoken at Home since Moving to US No change at all 233 38.10 Very little change 155 25.40 Some change 135 22.10 A lot of change 88 14.40 Total 611 100.00

s12 Change in Sports Team Allegiance Since Moving to US A lot of change 240 39.30 Some change 124 20.30 Very little change 96 15.70 No change at all 88 14.40 Do not follow sports 63 10.30 Total 611 100.00

260


Orientation N % S13 Change in Food Eaten at Home since Moving to US

No change at all 139 22.70 Very little change 165 27.00 Some change 163 26.70 A lot of change 144 23.60 Total 611 100.00

S14 Change in Music Listened to since Moving to US No change at all 228 37.30 Very little change 130 21.30 Some change 151 24.70 A lot of change 102 16.70 Total 611 100.00

Similarity of Music Listened to Compared to a Typical White Minnesotan CS15A Very similar 109 13.64 Somewhat similar 90 11.26 A little similar 52 6.51 A little different 106 13.27 Somewhat different 169 21.15 Very different 273 34.17 Total 799 100.00

Similarity of Food Eaten Compared to a Typical White Minnesotan -CS15B Very similar 93 11.60 Somewhat similar 97 12.10 A little similar 62 7.70 A little different 112 13.90 Somewhat different 137 17.10 Very different 302 37.60 Total 803 100.00

Similarity of Verbal Expressions Used Compared to a Typical White Minnesotan CS15C Very similar 92 11.57 Somewhat similar 111 13.96 A little similar 56 7.04 A little different 107 13.46 Somewhat different 167 21.01 Very different 262 32.96 Total 795 100.00

Similarity of Sports Team Allegiance Compared to a Typical White Minnesotan CS15D Very similar 165 21.30 Somewhat similar 117 15.10 A little similar 77 9.90 A little different 100 12.90 Somewhat different 111 14.30 Very different 205 26.50 Total 775 100.00

s4a First Language Learned English 113 14.04 Spanish 681 84.60 Hmong 1 0.12 Filipino 1 0.12 Maya 2 0.25 Quechua 2 0.25 South American dialects 4 0.50 Other 1 0.12 Total 805 100.00

s4_b If Multiple First Languages - First Language Learned English 19 50.00 Spanish 17 44.74 Quechua 1 2.63 South American dialects 1 2.63 Total 38 100.00

261


Orientation N % s5_a Other Languages

English 534 66.50 Spanish 83 10.34 French 3 0.37 Portuguese 2 0.25 German 1 0.12 Italian 1 0.12 Chinese 1 0.12 Filipino 1 0.12 Catalan 1 0.12 Quechua 1 0.12 Other 3 0.37 No other language 172 21.42 Total 803 100.00

S5_B Other Languages English 10 10.90 American sign language 4 4.30 Spanish 2 2.20 French 25 27.20 Portuguese 5 5.40 German 6 6.50 Italian 8 8.70 Greek 1 1.10 Chinese 1 1.10 Other 3 3.30 No other 27 29.30 Total 92 100.00

Phenotype Self Reported Ethnicity Q20

Latino/Hispanic 440 74.07 Latino/Hispanic-American 131 22.05 American 23 3.87 Total 594 100.00

Self Reported Ethnicity Best Describes Respondents -Q20b Latino 36 18.50 Chicano 35 17.90 Hispanic 52 26.70 American 72 36.90 Total 195 100.00

Phenotype s3 Self Reported Perceived Ethnicity from the Perspective of a Typical White Minnesotan

Latino/Hispanic 660 86.60 Asian 6 0.80 Southeast Asian 1 0.10 White 77 10.10 African American 2 0.30 American Indian 16 2.10 Total 762 100.00

262

Appendix H Smoking Beliefs

Variables N % S34a Smoking Facilitate Friendship Yes 60 7.50 No 740 92.50 Total 800 100.00 s34b Smoking Provides Pleasure Yes 196 24.69 No 598 75.31 Total 794 100.00 s34c Smoking Relieves Stress/Anxiety Yes 226 29.31 No 545 70.69 Total 771 100.00 s34d Smoking Can Help a Person Focus Yes 82 10.41 No 706 89.59 Total 788 100.00 ps34e Smoking Helps to Lose Weight Yes 186 23.88 No 593 76.12 Total 779 100.00 RECODE: Number of Positive Aspects of Smoking (MAX=5) s34a-e 0 412 51.18 1 178 22.11 2 120 14.91 3 59 7.33 4 25 3.11 5 11 1.37 Total 805 100.00 S76 a Belief that Smoking Causes Lung Cancer Yes 794 99.13 No 7 0.87 Total 801 100.00 s76 c Belief that Smoking Causes Heart Disease Yes 716 93.23 No 52 6.77 Total 768 100.00 s35 People Smoke Because they Want to Strongly agree 435 54.17 Somewhat agree 182 22.67 Somewhat disagree 75 9.34 Strongly disagree 111 13.82 Total 803 100.00 s36 People Smoke Because it Is a Habit Strongly agree 463 57.66 Somewhat agree 177 22.04 Somewhat disagree 65 8.09 Strongly disagree 98 12.20 Total 803 100.00 s37 People Who Smoke Cannot Control whether They Smoke or not Strongly agree 250 31.33 Somewhat agree 201 25.19 Somewhat disagree 164 20.55 Strongly disagree 183 22.93 Total 798 100.00 S38 As Long As You Are Healthy, It Is OK to Smoke Strongly agree 21 2.62 Somewhat agree 31 3.86 Somewhat disagree 76 9.46 Strongly disagree 675 84.06 Total 803 100.00

263

Appendix H

Smoking Beliefs (Continuation) Variables N % s39 Beliefs About Smoking's Harms/Benefits There are more benefits than harms 11 1.37 There are more harms than benefits 735 91.3 The harms and benefits are about equal 59 7.33 Total 805 100

264

Appendix I Second-Hand Smoke Behaviors

Variables N % S62 Comfort Level When Other Latinos Smoke Around You

Very comfortable 72 8.99 Somewhat comfortable 67 8.36 Somewhat uncomfortable 161 20.10 Very uncomfortable 501 62.55 Total 801 100.00

s64 Smoking Inside Home During the Past 7 Days Yes 74 9.19 No 731 90.81 Total 805 100.00

s66 Been in a Car With Someone Who Was Smoking in the Past Seven Days Yes 153 19.01 No 652 80.99 Total 805 100.00

s65 Statement Best Describing Smoking Rules at Home Smoking is not allowed anywhere 732 91.04 Smoking is allowed some places 40 4.98 People can smoke anywhere 17 2.11 Other rule 15 1.87 Total 804 100.00

s70 Smoking in Work Area in the Past Seven Days Yes 86 16.38 No 439 83.62 Total 525 100.00

s71 Smoking Policy in Primary Job Facilities Smoking is not allowed in any common areas 441 84.48 Smoking is allowed in common areas 81 15.52 Total 522 100.00

s73 Work Place Preference Regarding Smoking Allowed 9 1.43 Not allowed 474 75.12 No difference 148 23.45 Total 631 100.00

Number of SHS Exposures In Past 7 Days (MAX=5.) 0 385 47.83 1 263 32.67 2 111 13.79 3 38 4.72 4 8 0.99 Total 805 100.00

Minors of 18 yo exposed to SHS Yes 293 36.40 No 512 63.60 Total 805 100.00

265

Appendix J

Smoking Behaviors Variables N % Choice Vs. Addiction Scale -Choice=2 Addiction=8 -s36-37

2 102 12.81 3 102 12.81 4 147 18.47 5 302 37.94 6 73 9.17 7 37 4.65 8 33 4.15 Total 796 100.00

rs44 Smoke cigarettes every day Yes 55 51.40 No 52 48.60 Total 107 100.00

S52 Minutes Between Waking and First Cigarette Within 5 minutes 6 5.70 6 - 30 minutes 12 11.30 31 - 60 minutes 16 15.10 More than 60 minutes 72 67.90 Total 106 100.00

s53 Amount of Smoking When Facing Stress A lot 16 14.95 A little more 37 34.58 The same amount 38 35.51 A little less 6 5.61 A lot less 10 9.35 Total 107 100.00

s54 Level of Comfort Smoking Around Other Latinos Very comfortable 20 19.23 Somewhat comfortable 29 27.88 Somewhat uncomfortable 31 29.81 Very uncomfortable 24 23.08 Total 104 100.00

s56 Feelings About Smoking I really enjoy smoking 7 6.60 I enjoy smoking 44 41.51 I don't like smoking 47 44.34 I really don't like smoking 8 7.55 Total 106 100.00

s57 Feelings About Quitting Smoking I don't think about stopping smoking 12 11.32 I don't want to stop smoking 6 5.66 I would like to stop smoking, but don't want to go through the process 30 28.30 I want to stop smoking 56 52.83 I would like to stop for some other reason 2 1.89 Total 106 100.00

S58 Belief About Ability to Stop Smoking if Wanted Very likely 54 51.43 Somewhat likely 34 32.38 Somewhat unlikely 9 8.57 Very unlikely 8 7.62 Total 105 100.00

s59 Belief About Ability to Stop Smoking if Decided Very likely 64 60.95 Somewhat likely 31 29.52 Somewhat unlikely 6 5.71 Very unlikely 4 3.81 Total 105 100.00

266

Appendix J Smoking Behaviors (Continuation)

Variable N % S60 Level of Comfort Asking for Help to Stop Smoking Very comfortable 42 41.58 Somewhat comfortable 18 17.82 Somewhat uncomfortable 27 26.73 Very uncomfortable 14 13.86 Total 101 100 S61 Will Power is the Only Way I Would Stop Smoking Strongly agree 81 77.14 Somewhat agree 15 14.29 Somewhat disagree 2 1.9 Strongly disagree 7 6.67 Total 105 100 ds50T18yo Tried the first cigarette after 18 yo Yes 48 20.51 No 186 79.49 Total 234 100 ds51R18yo Smoked regularly after 18 yo Yes 130 55.56 No 105 44.87 Total 234 100.43 rs45 Smokes 5 or more cigarettes daily Yes 35 63.64 No 20 36.36 Total 55 100 ds55quit Quitting smoking per a day or more during the last year Yes 74 73.27 No 27 26.73 Total 101 100

267

Appendix K Group Comparisons Given Socioeconomic Status

268

Appendix K 1

Never and Ever Smokers Given Socioeconomic Status Univariate


Never Ever 95% CI Variable No % No % P FET OR Lower Upper P

H1.1 Gender Male 233 40.88 180 76.60 0.000 4.859 3.413 6.918 0.000 * H1.2 Dage 25 (Older than 24 yo) 491 86.14 215 91.49 0.044 1.122 0.608 2.073 0.713 H1.3 Marital Status dq12 M (married) 407 71.40 166 70.84 0.864 1.221 0.850 1.754 0.281 H1.4 Dminors 1=18yo 0r <; 0=>18yo 422 74.04 147 62.55 0.002 0.908 0.622 1.323 0.614 H1.5 dq28 Level of education (=>HS) 342 60.32 147 63.64 0.423 0.911 0.647 1.283 0.593 H1.6 rs67 Employed 429 75.53 202 85.96 0.001 0.745 0.460 1.205 0.229 H1.7 Dincome (>$25,000) 277 53.27 149 65.93 0.001 0.738 0.519 1.050 0.091 H1.8 Place of residence Urban1 366 64.21 148 62.98 0.747 0.979 0.693 1.384 0.906 H1.9 Survey's language LangSurveySp 403 70.70 133 56.60 0.000 1.582 1.123 2.229 0.009 * H1.10 Years living in the U.S. >5 YrUsa6 340 77.63 129 82.69 0.209 0.963 0.563 1.645 0.889 H1.11 Fluency 2 HC dfluency2hc 414 72.76 179 76.17 0.333 0.781 0.535 1.141 0.201 H1.12 Orientation 4 Friends Dorient4f 357 62.63 127 54.04 0.027 1.106 0.788 1.552 0.559

Appendix K 2 Former and Current Smokers Given Socioeconomic Status



Variable No % No % P FET OR Lower Upper P H1.1 Gender Male 97 75.78 82 78.10 0.756 1.026 0.536 1.963 0.939 H1.2 Dage 25 (Older than 24 yo) 125 97.66 88 83.81 0.000 3.256 0.834 12.720 0.089 H1.3 Marital Status dq12 M (married) 102 79.69 63 60.00 0.001 2.879 1.518 5.460 0.001 * H1.4 Dminors 1=18yo 0r <; 0=>18yo 74 57.81 72 68.57 0.103 0.944 0.519 1.717 0.849 H1.5 dq28 Level of education (=>HS) 83 66.40 63 60.58 0.408 1.393 0.782 2.480 0.261 H1.6 rs67 Employed 108 84.38 92 87.62 0.572 1.482 0.610 3.600 0.385 H1.7 Dincome (>$25,000) 86 70.49 62 60.78 0.156 1.819 0.996 3.323 0.052 H1.8 Place of residence Urban1 79 61.72 67 63.81 0.786 1.347 0.742 2.447 0.327 H1.9 Survey's language LangSurveySp 71 55.47 61 58.10 0.693 0.967 0.558 1.677 0.906 H1.10 Years living in the U.S. >5 YrUsa6 69 85.19 59 79.73 0.403 0.866 0.339 2.214 0.764 H1.11 Fluency 2 HC dfluency2hc 97 75.78 80 76.19 1.000 0.982 0.519 1.861 0.956 H1.12 Orientation 4 Friends Dorient4f 61 47.66 64 60.95 0.048 0.701 0.403 1.218 0.207

Appendix K 3 Smokers in the Maintenance, Preparation,

and Pre-Contemplation SOC Given Socioeconomic Status Maintenance SOC Preparation SOC


Variable No % No % No % P FET H1.1 Gender Male 97 75.78 57 77.03 25 80.65 0.884 H1.2 Dage 25 (Older than 24 yo) 125 97.66 64 86.49 24 77.42 0.000 * H1.3 Marital Status dq12 M (married) 102 79.69 42 56.76 21 67.74 0.002 * H1.4 Dminors 1=18yo 0r <; 0=>18yo 74 57.81 48 64.86 24 77.42 0.119 H1.5 dq28 Level of education (=>HS) 83 66.40 41 56.16 22 70.97 0.246 H1.6 rs67 Employed 108 84.37 64 86.49 28 90.32 0.748 H1.7 Dincome (>$25,000) 86 70.49 43 59.72 19 63.33 0.292 H1.8 Place of residence Urban1 79 61.72 45 60.81 22 70.97 0.623 H1.9 Survey's language LangSurveySp 71 55.47 44 59.46 17 54.84 0.851 H1.10 Years living in the U.S. >5 YrUsa6 69 85.19 43 79.63 16 80.00 0.636 H1.11 Fluency 2 HC dfluency2hc 97 75.78 59 79.73 21 67.74 0.406 H1.12 Orientation 4 Friends Dorient4f 61 47.66 47 63.51 17 54.84 0.095

269

Appendix K 4

Smokers in the Preparation and Pre-Contemplation SOC Given Socioeconomic Status

Univariate

Multivariate Controlling by age

and gender Preparation

SOC Pre-contemplation

SOC 95% CI Variable No % No % P FET OR Lower Upper P H1.1 Gender Male 57 77.03 25 80.65 0.799 1.133 0.391 3.283 0.819 H1.2 Dage 25 (Older than 24 yo) 64 86.49 24 77.42 0.259 0.888 0.222 3.558 0.867 H1.3 Marital Status dq12 M (married) 42 56.76 21 67.74 0.383 0.565 0.222 1.439 0.231 H1.4 Dminors 1=18yo 0r <; 0=>18yo 48 64.86 24 77.42 0.253 0.608 0.223 1.654 0.330 H1.5 dq28 Level of education (=>HS) 41 56.16 22 70.97 0.191 0.539 0.215 1.352 0.188 H1.6 rs67 Employed 64 86.49 28 90.32 0.751 0.883 0.198 3.941 0.871 H1.7 Dincome (>$25,000) 43 59.72 19 63.33 0.295 0.949 0.382 2.360 0.911 H1.8 Place of residence Urban1 45 60.81 22 70.97 0.378 0.807 0.294 2.217 0.678 H1.9 Survey's language LangSurveySp 44 59.46 17 54.84 0.671 1.241 0.523 2.944 0.625 H1.10 Years living in the U.S. >5 YrUsa6 43 79.63 16 80.00 1.000 0.664 0.168 2.626 0.559 H1.11 Fluency 2 HC dfluency2hc 59 79.73 21 67.74 0.214 1.957 0.735 5.209 0.179 H1.12 Orientation 4 Friends Dorient4f 47 63.51 17 54.84 0.511 1.629 0.676 3.927 0.277

Appendix K 5 Smokers in the Preparation, Contemplation,

and Pre-Contemplation SOC Given Socioeconomic Status Pre-contemplation SOC

Contemplation SOC

Preparation SOC

Variable No % No % No % P FET H1.1 Gender Male 14 77.78 23 76.67 45 77.59 1.000 H1.2 Dage 25 (Older than 24 yo) 15 83.33 21 70.00 53 91.38 0.032 * H1.3 Marital Status dq12 M (married) 13 72.22 14 46.67 36 62.07 0.197 H1.4 Dminors 1=18yo 0r <; 0=>18yo 13 72.22 18 60.00 41 70.69 0.582 H1.5 dq28 Level of education (=>HS) 14 77.78 19 63.33 32 54.39 0.190 H1.6 rs67 Employed 15 83.33 27 90.00 51 87.93 0.846 H1.7 Dincome (>$25,000) 12 70.59 17 58.62 34 59.65 0.730 H1.8 Place of residence Urban1 10 55.56 23 76.67 35 60.34 0.220 H1.9 Survey's language LangSurveySp 10 55.56 15 50.00 36 62.07 0.551 H1.10 Years living in the U.S. >5 YrUsa6 11 91.67 17 73.91 31 79.49 0.581 H1.11 Fluency 2 HC dfluency2hc 16 88.89 19 63.33 46 79.31 0.117 H1.12 Orientation 4 Friends Dorient4f 8 44.44 21 70.00 36 62.07 0.206

270

Appendix K 6

Likelihood to succeed if Wanted to Quit Smoking Given Socioeconomic Status


and gender Unlikely Likely 95% CI

Variable No % No % P FET OR Lower Upper P H1.1 Gender Male 14 82.35 68 77.27 0.759 0.739 0.192 2.845 0.660 H1.2 Dage 25 (Older than 24 yo) 14 82.35 74 84.09 1.000 1.009 0.180 5.639 0.992 H1.3 Marital Status dq12 M (married) 10 58.82 53 60.23 1.000 0.895 0.302 2.652 0.841 H1.4 Dminors 1=18yo 0r <; 0=>18yo 13 76.47 59 67.05 0.573 1.645 0.476 5.680 0.432 H1.5 dq28 Level of education (=>HS) 10 58.82 53 60.23 1.000 0.919 0.317 2.663 0.877 H1.6 rs67 Employed 15 88.24 77 87.50 1.000 0.894 0.156 5.106 0.900 H1.7 Dincome (>$25,000) 12 70.59 50 58.82 0.425 1.626 0.518 5.103 0.405 H1.8 Place of residence Urban1 10 58.82 57 64.77 0.784 0.636 0.195 2.071 0.452 H1.9 Survey's language LangSurveySp 10 58.82 51 57.95 1.000 1.040 0.361 2.992 0.942 H1.10 Years living in the U.S. >5 YrUsa6 7 87.50 52 78.79 1.000 2.057 0.226 18.690 0.522 H1.11 Fluency 2 HC dfluency2hc 9 52.94 71 80.68 0.026 0.270 0.089 0.813 0.020 * H1.12 Orientation 4 Friends Dorient4f 8 47.06 56 63.64 0.278 0.495 0.172 1.430 0.194

Appendix K 7

Likelihood to Succeed if Decided to Quit Smoking Given Socioeconomic Status


gender Unlikely Likely 95% CI

Variable No % No % P FET OR Lower Upper P H1.1 Gender Male 6 60.00 76 80.00 0.220 3.445 0.816 14.538 0.092 H1.2 Dage 25 (Older than 24 yo) 7 70.00 81 85.26 0.204 1.257 0.150 10.508 0.833 H1.3 Marital Status dq12 M (married) 6 60.00 57 60.00 1.000 1.651 0.381 7.162 0.503 H1.4 Dminors 1=18yo 0r <; 0=>18yo 10 100.00 62 65.26 0.029 NA H1.5 dq28 Level of education (=>HS) 7 70.00 56 58.95 0.736 1.411 0.326 6.115 0.645 H1.6 rs67 Employed 10 100.00 82 86.32 0.357 NA H1.7 Dincome (>$25,000) 6 60.00 56 60.87 1.000 0.985 0.245 3.961 0.983 H1.8 Place of residence Urban1 5 50.00 62 65.26 0.490 0.447 0.100 2.273 0.353 H1.9 Survey's language LangSurveySp 8 80.00 53 55.79 0.187 3.310 0.627 17.489 0.159 H1.10 Years living in the U.S. >5 YrUsa6 4 80.00 55 79.71 1.000 1.268 0.107 15.090 0.851 H1.11 Fluency 2 HC dfluency2hc 5 50.00 75 78.95 0.055 0.199 0.044 0.903 0.036 * H1.12 Orientation 4 Friends Dorient4f 6 60.00 58 61.05 1.000 0.882 0.219 3.558 0.860

Appendix K 8

Level of Comfort Asking for Help to Quit Smoking Given Socioeconomic Status



Variable No % No % P FET OR Lower Upper P H1.1 Gender Male 33 80.49 46 76.67 0.807 0.806 0.302 2.148 0.666 H1.2 Dage 25 (Older than 24 yo) 33 80.49 52 86.67 0.420 0.603 0.159 2.279 0.455 H1.3 Marital Status dq12 M (married) 28 68.29 32 53.33 0.153 1.880 0.797 4.433 0.149 H1.4 Dminors 1=18yo 0r <; 0=>18yo 34 82.93 36 60.00 0.016 3.507 1.293 9.510 0.014 * H1.5 dq28 Level of education (=>HS) 25 60.98 36 61.02 1.000 0.990 0.434 2.258 0.981 H1.6 rs67 Employed 37 90.24 51 85.00 0.552 1.527 0.395 5.910 0.540 H1.7 Dincome (>$25,000) 26 63.41 33 56.90 0.540 1.263 0.549 2.905 0.583 H1.8 Place of residence Urban1 27 65.85 37 61.67 0.834 1.112 0.450 2.745 0.818 H1.9 Survey's language LangSurveySp 24 58.54 35 58.33 1.000 1.011 0.450 2.273 0.978 H1.10 Years living in the U.S. >5 YrUsa6 25 78.13 31 79.49 1.000 0.866 0.261 2.869 0.814 H1.11 Fluency 2 HC dfluency2hc 32 78.05 44 73.33 0.645 1.328 0.515 3.421 0.557 H1.12 Orientation 4 Friends Dorient4f 27 65.85 35 58.33 0.534 1.386 0.602 3.189 0.443

271

Appendix K 9 Agreement About the Only Way to Stop Smoking

is Through Will Power Given Socioeconomic Status Univariate


Disagree Agree 95% CI

Variable No % No % P FET OR Lower Upper P H1.1 Gender Male 5 55.56 77 80.21 0.103 2.936 0.687 12.546 0.146 H1.2 Dage 25 (Older than 24 yo) 9 100.00 79 82.29 0.349 6.060E+07 0.000 - 0.999 H1.3 Marital Status dq12 M (married) 3 33.33 60 62.50 0.151 0.340 0.074 1.568 0.167 H1.4 Dminors 1=18yo 0r <; 0=>18yo 6 66.67 66 68.75 1.000 1.404 0.257 7.657 0.695 H1.5 dq28 Level of education (=>HS) 6 75.00 57 59.38 0.475 2.786 0.450 17.239 0.271 H1.6 rs67 Employed 5 55.56 87 90.62 0.013 0.194 0.037 1.022 0.053 * H1.7 Dincome (>$25,000) 3 37.50 59 62.77 0.257 0.547 0.108 2.764 0.466 H1.8 Place of residence Urban1 4 44.44 63 65.63 0.279 0.762 0.170 3.415 0.723 H1.9 Survey's language LangSurveySp 6 66.67 55 57.29 0.731 1.832 0.387 8.662 0.445 H1.10 Years living in the U.S. >5 YrUsa6 5 100.00 54 78.26 0.576 1.345E+08 0.000 - 0.998 H1.11 Fluency 2 HC dfluency2hc 8 88.89 72 75.00 0.683 3.181 0.315 32.160 0.327 H1.12 Orientation 4 Friends Dorient4f 7 77.78 57 59.38 0.477 0.292 0.048 1.763 0.180

272

Appendix L

Group Comparisons Given Self-Reported Health Status

273

Appendix L 1

Never and Ever Smokers Given Self-Reported Health Status Univariate Multivariate Controlling by age and gender


H2.1 Self Reported Healthy Rq1 377 66.49 157 67.38 0.869 0.970 0.683 1.380 0.868 H2.2 Self Reported Interesting Things in Daily Life Rq2 451 80.54 176 75.54 0.125 1.466 0.983 2.186 0.061 H2.3 Self Reported Happiness Rq3 519 91.86 205 88.36 0.137 1.794 1.033 3.115 0.038 * H2.4 Self Reported Healthy Compare to Other People Rs1 430 75.57 174 74.04 0.655 1.202 0.819 1.763 0.347 H2.5 Self Reported Injury or Illness affecting daily routine during the past 12 months Rs2 208 36.49 104 44.26 0.047 0.778 0.557 1.086 0.139 H2.6 Physical Activity Past Week Rs23 421 73.99 186 79.15 0.126 0.937 0.630 1.396 0.751 H2.7 Adequate Exercise – cumex 191 33.51 91 38.72 0.168 1.050 0.774 1.481 0.783 H2.8 Self Reported Stressful Events During the past month Rs32. 456 80.00 196 83.40 0.279 0.677 0.439 1.044 0.078 H2.9 Self reported Major Injury or illness in the Past Year Rs33a 73 12.85 57 24.26 0.000 0.512 0.336 0.779 0.002 * H2.10 Change Residence in the Past Year Rs33b 97 17.02 37 15.74 0.755 1.070 0.685 1.671 0.768 H2.11 Major Change in Health of Relative in the past Year Rs33c 126 22.11 71 30.21 0.019 0.609 0.420 0.884 0.009 * H2.12 Major Change Family Get-togethers in the Past Year Rs33d 111 19.51 52 22.13 0.440 0.839 0.562 1.253 0.391 H2.13 5 + fav dfav 28 21.21 12 23.08 0.843 1.541 0.654 3.631 0.323 H2.14 DBMI 158 30.33 49 21.86 0.020 1.130 0.758 1.683 0.549

Appendix L 2 Former and Current Smokers Given Self-Reported Health Status


age and gender FS CS 95% CI

Variable No % No % P FET OR Lower Upper P H2.1 Self Reported Healthy Rq1 83 65.35 73 70.19 0.481 0.932 0.518 1.679 0.815 H2.2 Self Reported Interesting Things in Daily Life Rq2 95 74.80 80 76.92 0.759 0.944 0.498 1.791 0.861 H2.3 Self Reported Happiness Rq3 113 88.98 90 87.38 0.837 1.149 0.490 2.694 0.749 H2.4 Self Reported Healthy Compare to Other People Rs1 92 71.88 80 76.19 0.549 0.981 0.521 1.849 0.954 H2.5 Self Reported Injury or Illness affecting daily routine during the past 12 months Rs2 54 42.19 50 47.62 0.429 0.776 0.448 1.344 0.366 H2.6 Physical Activity Past Week Rs23 103 80.47 82 78.10 0.745 1.218 0.625 2.375 0.562 H2.7 Adequate Exercise – cumex 49 38.28 41 39.05 1.000 0.928 0.525 1.637 0.795 H2.8 Self Reported Stressful Events During the past month Rs32. 107 83.59 88 83.81 1.000 1.059 0.508 2.204 0.879 H2.9 Self reported Major Injury or illness in the Past Year Rs33a 30 23.44 26 24.76 0.878 0.844 0.444 1.602 0.603 H2.10 Change Residence in the Past Year Rs33b 19 14.84 18 17.14 0.719 0.964 0.460 2.021 0.923 H2.11 Major Change in Health of Relative in the past Year Rs33c 40 31.25 31 29.52 0.886 1.026 0.565 1.864 0.933 H2.12 Major Change Family Get-togethers in the Past Year Rs33d 31 24.22 21 20.00 0.528 1.195 0.618 2.311 0.597 H2.13 5 + fav dfav 7 24.14 5 23.81 1.000 0.945 0.232 3.849 0.937 H2.14 DBMI 20 16.67 29 28.43 0.051 0.545 0.272 1.089 0.086

274

Appendix L 3 Smokers in the Maintenance, Preparation, and

Pre-Contemplation SOC Given Self-Reported Health Status Maintenance SOC

Preparation SOC


Variable No % No % No % P FET H2.1 Self Reported Healthy Rq1 83 65.35 53 72.60 20 64.52 0.542 H2.2 Self Reported Interesting Things in Daily Life Rq2 95 74.80 60 82.19 20 64.52 0.151 H2.3 Self Reported Happiness Rq3 113 88.98 63 87.50 27 87.10 0.879 H2.4 Self Reported Healthy Compare to Other People Rs1 92 71.88 56 75.68 24 77.42 0.794 H2.5 Self Reported Injury or Illness affecting daily routine during the past 12 months Rs2 54 42.19 33 44.59 17 54.84 0.437 H2.6 Physical Activity Past Week Rs23 103 80.47 55 74.32 27 87.10 0.337 H2.7 Adequate Exercise – cumex 49 38.28 28 37.84 13 41.94 0.946 H2.8 Self Reported Stressful Events During the past month Rs32. 107 83.59 64 86.49 24 77.42 0.491 H2.9 Self reported Major Injury or illness in the Past Year Rs33a 30 23.44 17 22.97 9 29.03 0.748 H2.10 Change Residence in the Past Year Rs33b 19 14.84 12 16.22 6 19.35 0.768 H2.11 Major Change in Health of Relative in the past Year Rs33c 40 31.25 17 22.97 14 45.16 0.084 H2.12 Major Change Family Get-togethers in the Past Year Rs33d 31 24.22 11 14.86 10 32.26 0.105 H2.13 5 + fav dfav 7 24.14 5 29.41 - - 0.600 H2.14 DBMI 20 16.67 18 25.35 11 35.48 0.061

Appendix L 4 Smokers in the Preparation and Pre-Contemplation SOC

Given Self-Reported Health Status Univariate

Multivariate Controlling by age and gender 95% CI

Preparation SOC

Pre-contemplation

SOC

Variable No % No % P FET OR Lower Upper P

H2.1 Self Reported Healthy Rq1 53 72.60 20 64.52 0.484 1.650 0.652 4.176 0.290 H2.2 Self Reported Interesting Things in Daily Life Rq2 60 82.19 20 64.52 0.074 2.645 1.000 6.996 0.050 * H2.3 Self Reported Happiness Rq3 63 87.50 27 87.10 1.000 1.053 0.288 3.848 0.938 H2.4 Self Reported Healthy Compare to Other People Rs1 56 75.68 24 77.42 1.000 1.042 0.374 2.908 0.937 H2.5 Self Reported Injury or Illness affecting daily routine during the past 12 months Rs2 33 44.59 17 54.84 0.395 0.687 0.290 1.630 0.395 H2.6 Physical Activity Past Week Rs23 55 74.32 27 87.10 0.199 0.428 0.130 1.403 0.161 H2.7 Adequate Exercise – cumex 28 37.84 13 41.94 0.827 0.870 0.350 2.164 0.765 H2.8 Self Reported Stressful Events During the past month Rs32. 64 86.49 24 77.42 0.259 2.163 0.709 6.593 0.175 H2.9 Self reported Major Injury or illness in the Past Year Rs33a 17 22.97 9 29.03 0.621 0.642 0.239 1.722 0.378 H2.10 Change Residence in the Past Year Rs33b 12 16.22 6 19.35 0.778 0.765 0.249 2.346 0.639 H2.11 Major Change in Health of Relative in the past Year Rs33c 17 22.97 14 45.16 0.034 0.314 0.123 0.802 0.015 * H2.12 Major Change Family Get-togethers in the Past Year Rs33d 11 14.86 10 32.26 0.060 0.349 0.126 0.967 0.043 * H2.13 5 + fav dfav 5 29.41 0 0 0.532 NA H2.14 DBMI 18 25.35 11 35.48 0.343 0.625 0.244 1.600 0.327

275

Appendix L 5 Smokers in the Preparation, Contemplation, and Pre-Contemplation SOC

Given Self-Reported Health Status Pre-contemplation SOC

Contemplation SOC

Preparation SOC

Variable No % No % No % P FET H2.1 Self Reported Healthy Rq1 15 83.33 18 60.00 42 71.93 0.242 H2.2 Self Reported Interesting Things in Daily Life Rq2 13 72.22 20 66.67 48 84.21 0.152 H2.3 Self Reported Happiness Rq3 16 88.89 27 90.00 48 85.71 0.921 H2.4 Self Reported Healthy Compare to Other People Rs1 16 88.89 23 76.67 42 72.41 0.405 H2.5 Self Reported Injury or Illness affecting daily routine during the past 12 months Rs2 8 44.44 14 46.67 28 48.28 0.965 H2.6 Physical Activity Past Week Rs23 16 88.89 20 66.67 46 79.31 0.197 H2.7 Adequate Exercise – cumex 7 38.89 10 33.33 24 41.38 0.737 H2.8 Self Reported Stressful Events During the past month Rs32. 14 77.78 24 80.00 51 87.93 0.395 H2.9 Self reported Major Injury or illness in the Past Year Rs33a 4 22.22 7 23.33 16 27.59 0.867 H2.10 Change Residence in the Past Year Rs33b 4 22.22 8 26.67 6 10.34 0.114 H2.11 Major Change in Health of Relative in the past Year Rs33c 6 33.33 10 33.33 15 25.86 0.676 H2.12 Major Change Family Get-togethers in the Past Year Rs33d 5 27.78 7 23.33 9 15.52 0.375 H2.13 5 + fav dfav - - 1 16.67 4 33.33 0.524 H2.14 DBMI 7 38.89 6 20.69 16 28.57 0.420

Appendix L 6 Likelihood to Succeed if Wanted to Quit Given Self-Reported Health Status


gender Unlikely Likely 95% CI

Variable No % No % P FET OR Lower Upper P H2.1 Self Reported Healthy Rq1 12 70.59 61 70.11 1.000 1.009 0.320 3.176 0.998 H2.2 Self Reported Interesting Things in Daily Life Rq2 14 82.35 66 75.86 0.756 1.492 0.390 5.709 0.559 H2.3 Self Reported Happiness Rq3 13 76.47 77 89.53 0.221 0.346 0.090 1.335 0.123 H2.4 Self Reported Healthy Compare to Other People Rs1 12 70.59 68 77.27 0.545 0.670 0.207 2.165 0.503 H2.5 Self Reported Injury or Illness affecting daily routine during the past 12 months Rs2 9

52.94 41

46.59 0.792 1.257 0.442 3.581 0.668

H2.6 Physical Activity Past Week Rs23 14 82.35 68 77.27 0.759 1.337 0.347 5.161 0.673 H2.7 Adequate Exercise – cumex 3 17.65 38 43.18 0.049 0.242 0.603 0.929 0.039 * H2.8 Self Reported Stressful Events During the past month Rs32. 13

76.47 75

85.23 0.470 0.559 0.156 2.004 0.372

H2.9 Self reported Major Injury or illness in the Past Year Rs33a 7

41.18 19

21.59 0.123 2.826 0.920 8.679 0.070

H2.10 Change Residence in the Past Year Rs33b 3 17.65 15 17.05 1.000 1.092 0.275 4.330 0.901 H2.11 Major Change in Health of Relative in the past Year Rs33c 5

29.41 26 29.55 1.000 1.033 0.327 3.263 0.955

H2.12 Major Change Family Get-togethers in the Past Year Rs33d 2

11.76 19

21.59 0.514 0.492 0.103 2.351 0.374

H2.13 5 + fav dfav 0 0 5 27.78 0.549 NA H2.14 DBMI 6 35.29 23 27.06 0.559 1.497 0.491 4.561 0.478

276

Appendix L 7 Likelihood to Succeed if Decided to Quit Given Self-Reported Health Status


Unlikely Likely 95% CI

Variable No %

No %

P FET OR Lower Upper P

H2.1 Self Reported Healthy Rq1 8 80.00 65 69.15 0.719 1.367 0.258 7.243 0.713 H2.2 Self Reported Interesting Things in Daily Life Rq2 8 80.00 72 76.60 1.000 1.256 0.235 6.722 0.790 H2.3 Self Reported Happiness Rq3 7 70.00 83 89.25 0.112 0.313 0.064 1.541 0.153 H2.4 Self Reported Healthy Compare to Other People Rs1 7 70.00 73 76.84 0.699 0.571 0.127 2.575 0.466 H2.5 Self Reported Injury or Illness affecting daily routine during the past 12 months Rs2 5 50.00 45 47.37 1.000 1.243 0.313 4.946 0.757 H2.6 Physical Activity Past Week Rs23 8 80.00 74 77.89 1.000 1.174 0.214 6.422 0.854 H2.7 Adequate Exercise – cumex 3 30.00 38 40.00 0.737 0.905 0.186 4.394 0.902 H2.8 Self Reported Stressful Events During the past month Rs32. 8 80.00 80 84.21 0.663 0.498 0.086 2.896 0.435 H2.9 Self reported Major Injury or illness in the Past Year Rs33a 3 30.00 23 24.21 0.706 1.302 0.289 5.874 0.731 H2.10 Change Residence in the Past Year Rs33b 1 10.00 17 17.89 1.000 0.398 0.044 3.631 0.414 H2.11 Major Change in Health of Relative in the past Year Rs33c 3 30.00 28 29.47 1.000 0.882 0.195 3.984 0.871 H2.12 Major Change Family Get-togethers in the Past Year Rs33d 1 10.00 20 21.05 0.683 0.411 0.048 3.542 0.418 H2.13 5 + fav dfav ND H2.14 DBMI 3 33.33 26 27.96 0.711 1.072 0.235 4.892 0.928

Appendix L 8 Level of Comfort Asking for Help to Quit



Uncomfortable Comfortable 95% CI


H2.1 Self Reported Healthy Rq1 29 70.73 40 67.80 0.828 1.131 0.472 2.710 0.783 H2.2 Self Reported Interesting Things in Daily Life Rq2 35 85.37 41 69.49 0.095 2.576 0.920 7.214 0.072 H2.3 Self Reported Happiness Rq3 34 82.93 52 89.66 0.375 0.524 0.158 1.732 0.289 H2.4 Self Reported Healthy Compare to Other People Rs1 32 78.05 44 73.33 0.645 1.250 0.483 3.231 0.645 H2.5 Self Reported Injury or Illness affecting daily routine during the past 12 months Rs2 19 46.34 31 51.67 0.687 0.789 0.354 1.758 0.562 H2.6 Physical Activity Past Week Rs23 35 85.37 44 73.33 0.220 2.113 0.746 5.988 0.159 H2.7 Adequate Exercise – cumex 21 51.22 19 31.67 0.063 2.299 0.976 5.414 0.057 * H2.8 Self Reported Stressful Events During the past month Rs32. 38 92.68 48 80.00 0.094 3.258 0.852 12.457 0.084 H2.9 Self reported Major Injury or illness in the Past Year Rs33a 7 17.07 19 31.67 0.111

0.454

0.167

1.231

0.121

H2.10 Change Residence in the Past Year Rs33b 6 14.63 12 20.00 0.600 0.706 0.239 2.083 0.528 H2.11 Major Change in Health of Relative in the past Year Rs33c 11 26.83 20 33.33 0.518

0.755 0.312 1.826 0.532

H2.12 Major Change Family Get-togethers in the Past Year Rs33d 9 21.95 11 18.33 0.800 1.259 0.468 3.391 0.648 H2.13 5 + fav dfav 1 16.67 4 28.57 1.000 0.341 0.028 4.102 0.396 H2.14 DBMI 11 28.21 15 25.42 0.817 1.179 0.471 2.953 0.725

277

Appendix L 9 Agreement About the Only Way to Stop Smoking is Through Will Power




Variable No %

No %

P FET OR

Lower Upper P

H2.1 Self Reported Healthy Rq1 3 37.50 70 72.92 0.049 0.264 0.054 1.286 0.099 H2.2 Self Reported Interesting Things in Daily Life Rq2 5 62.50 75 78.13 0.382 0.362 0.071 1.837 0.220 H2.3 Self Reported Happiness Rq3 5 62.50 85 89.47 0.061 0.182 0.032 1.037 0.055 * H2.4 Self Reported Healthy Compare to Other People Rs1 6 66.67 74 77.08 0.442

0.928

0.185

4.659

0.928

H2.5 Self Reported Injury or Illness affecting daily routine during the past 12 months Rs2 5 55.56 45 46.88 0.733

1.572

0.374

6.607

0.537

H2.6 Physical Activity Past Week Rs23 8 88.89 74 77.08 0.680 2.671 0.292 24.403 0.384 Moderate Exercise modex 8 88.89 72 75.00 0.683 3.408 0.383 30.314 0.271 Vigorous Exercise – vigex 5 55.56 56 58.33 1.000 1.364 0.308 6.043 0.683 H2.7 Adequate Exercise – cumex 3 33.33 38 39.58 1.000 1.068 0.223 5.120 0.934 H2.8 Self Reported Stressful Events During the past month Rs32. 8 88.89 80 83.33 1.000 1.674

0.186

15.024

0.646

H2.9 Self reported Major Injury or illness in the Past Year Rs33a 6 66.67 20 20.83 0.007

5.736

1.216

27.051

0.027 *

H2.10 Change Residence in the Past Year Rs33b 3 33.33 15 15.63 0.182 2.332 0.486 11.202 0.290 H2.11 Major Change in Health of Relative in the past Year Rs33c 5 55.56 26 27.08 0.120 2.707 0.631 11.612 0.180 H2.12 Major Change Family Get-togethers in the Past Year Rs33d 2 22.22 19 19.79 1.000

0.907

0.151

5.453

0.915

H2.13 5 + fav dfav 0

0.00 5 26.32 1.000 0.000 0.000 - 0.999 H2.14 DBMI 8 88.89 21 22.58 0.000 39.402 3.799 408.623 0.002 *

278

Appendix M Group Comparisons Given Beliefs About Smoking

279

Appendix M 1

Never and Ever Smokers Given Beliefs About Smoking Univariate


Never Ever 95% CI


H3.1 Smoking Facilitates Friendship Rs34a 34 6.00 26 11.16 0.017 0.641 0.359 1.146 0.134 H3.2 Smoking Provides Pleasure Rs34b 102 18.25 94 40.00 0.000 0.364 0.252 0.526 0.000 * H3.3 Smoking Relieves Stress Rs34c 114 21.07 112 48.70 0.000 0.278 0.194 0.400 0.000 * H3.4 Smoking Can Help focus on activities Rs34d 48 8.63 34 14.66 0.015 0.800 0.477 1.341 0.397 H3.5 Smoking helps to Lose Weight Rs34e 119 21.64 67 29.26 0.027 0.830 0.567 1.214 0.336 H3.6 No Positive Aspects of Smoking Rsmokeben 336 58.95 76 32.34 0.000 2.600 1.848 3.660 0.000 * H3.7 Smoking Causes Lung Ca Rs76a 563 99.30 231 98.72 0.423 1.329 0.250 7.056 0.739 H3.8 Smoking Causes Heart Disease Rs76c 509 94.09 207 91.19 0.157 2.252 1.175 4.314 0.014 * H3.9 People Smoke because they want to rs35 445 78.35 172 73.19 0.119 0.974 0.661 1.433 0.892 H3.10 People smoke because it is a habit rs36 446 78.52 194 82.55 0.211 0.797 0.522 1.219 0.295 H3.11 People who smoke cannot control they smoke or not rs37 320 56.74 131 55.98 0.875 1.079 0.774 1.505 0.653 H3.12 As long as you are healthy, it is OK to smoke rs38 39 6.87 13 5.53 0.532 1.282 0.645 2.548 0.478 H3.13 About smoking, there are more harms than benefits ds39 522 91.58 213 90.64 0.681 1.236 0.688 2.217 0.478

Appendix M 2 Former and Current Smokers Given Beliefs About Smoking




Upper P

H3.1 Smoking Facilitates Friendship Rs34a 16 12.50 10 9.52 0.533 1.230 0.505 2.996 0.649 H3.2 Smoking Provides Pleasure Rs34b 49 38.28 44 41.90 0.593 0.708 0.403 1.244 0.229 H3.3 Smoking Relieves Stress Rs34c 53 43.09 57 54.29 0.111 0.696 0.400 1.211 0.200 H3.4 Smoking Can Help focus on activities Rs34d 15 11.90 17 16.35 0.346 0.581 0.259 1.304 0.188 H3.5 Smoking helps to Lose Weight Rs34e 42 34.15 24 22.86 0.078 1.605 0.864 2.982 0.134 H3.6 No Positive Aspects of Smoking Rsmokeben 48 37.50 28 26.67 0.092 1.839 1.018 3.323 0.044 * H3.7 Smoking Causes Lung Ca Rs76a 127 99.22 102 98.08 0.589 5.086 0.441 58.593 0.191 H3.8 Smoking Causes Heart Disease Rs76c 116 93.55 90 89.11 0.335 1.668 0.609 4.567 0.320 H3.9 People Smoke because they want to rs35 92 71.88 80 76.19 0.549 0.969 0.515 1.822 0.921 H3.10 People smoke because it is a habit rs36 108 84.38 105 100.00 0.492 1.434 0.693 2.967 0.332 H3.11 People who smoke cannot control they smoke or not rs37 68 53.54 62 59.05 0.427 0.828 0.477 1.438 0.502 H3.12 As long as you are healthy, it is OK to smoke rs38 5 3.91 7 6.67 0.384 0.642 0.183 2.247 0.488 H3.13 About smoking, there are more harms than benefits ds39 123 96.09 89 84.76 0.005 6.472 2.044 20.494 0.001 *

280

Appendix M 3 Smokers in the Maintenance, Preparation,

and Pre-Contemplation SOC Given Beliefs About Smoking Maintenance SOC

Preparation SOC


Variable No %

No % No % P FET H3.1 Smoking Facilitates Friendship Rs34a 16 12.7 4 5.41 6 19.35 0.084 H3.2 Smoking Provides Pleasure Rs34b 41 32.28 27 36.49 17 54.84 0.199 H3.3 Smoking Relieves Stress Rs34c 53 43.09 43 58.11 14 45.16 0.113 H3.4 Smoking Can Help focus on activities Rs34d 15 11.9 11 15.07 6 19.35 0.495 H3.5 Smoking helps to Lose Weight Rs34e 42 34.15 16 21.62 8 25.81 0.162 H3.6 No Positive Aspects of Smoking Rsmokeben 48 37.5 21 28.38 7 22.58 0.185 H3.7 Smoking Causes Lung Ca Rs76a 127 99.22 71 97.26 31 100 0.545 H3.8 Smoking Causes Heart Disease Rs76c 116 93.55 64 91.43 26 83.87 0.213 H3.9 People Smoke because they want to rs35 92 71.87 58 78.38 22 70.97 0.551 H3.10 People smoke because it is a habit rs36 108 84.37 58 78.38 27 87.1 0.474 H3.11 People who smoke cannot control they smoke or not rs37 68 53.54 46 62.16 16 51.61 0.444 H3.12 As long as you are healthy, it is OK to smoke rs38 5 3.91 5 6.76 2 6.45 0.633 H3.13 About smoking, there are more harms than benefits ds39 123 96.09 62 83.78 27 87.1 0.007 *

Appendix M 4 Smokers in the Preparation, and Pre-Contemplation SOC

Given Beliefs About Smoking Univariate


Preparation SOC

Pre-contemplation

SOC 95% CI

Variable

No % No % P

FET OR

Lower

Upper P H3.1 Smoking Facilitates Friendship Rs34a 4 5.41 6 19.35 0.061 0.216 0.052 0.891 0.034 * H3.2 Smoking Provides Pleasure Rs34b 27 36.49 17 54.84 0.089 0.373 0.150 0.930 0.034 * H3.3 Smoking Relieves Stress Rs34c 43 58.11 14 45.16 0.284 1.771 0.730 4.296 0.206 H3.4 Smoking Can Help focus on activities Rs34d 11 15.07 6 19.35 0.575 0.716 0.233 2.200 0.560 H3.5 Smoking helps to Lose Weight Rs34e 16 21.62 8 25.81 0.621 0.806 0.298 2.181 0.671 H3.6 No Positive Aspects of Smoking Rsmokeben 21 28.38 7 22.58 0.633 1.514 0.551 4.161 0.421 H3.7 Smoking Causes Lung Ca Rs76a 71 97.26 31 100.00 1.000 NA H3.8 Smoking Causes Heart Disease Rs76c 64 91.43 26 83.87 0.305 1.972 0.530 7.329 0.311 H3.9 People Smoke because they want to rs35 58 78.38 22 70.97 0.456 2.220 0.768 6.419 0.141 H3.10 People smoke because it is a habit rs36 58 78.38 27 87.10 0.416 0.508 0.151 1.709 0.274 H3.11 People who smoke cannot control they smoke or not rs37 46 62.16 16 51.61 0.386 1.492 0.629 3.536 0.364 H3.12 As long as you are healthy, it is OK to smoke rs38 5 6.76 2 6.45 1.000 1.189 0.209 6.754 0.845 H3.13 About smoking, there are more harms than benefits ds39 62 83.78 27 87.10 0.773 0.927 0.261 3.287 0.907

281

Appendix M 5 Smokers in the Preparation, Contemplation,

and Pre-Contemplation SOC Given Beliefs About Smoking Pre-contemplation SOC

Contemplation SOC

Preparation SOC

Variable No % No % No % P FET H3.1 Smoking Facilitates Friendship Rs34a 3 16.67 1 3.33 6 10.34 0.254 H3.2 Smoking Provides Pleasure Rs34b 8 44.44 15 50.00 22 37.93 0.551 H3.3 Smoking Relieves Stress Rs34c 8 44.44 21 70.00 29 50.00 0.126 H3.4 Smoking Can Help focus on activities Rs34d 2 11.11 7 23.33 9 15.79 0.564 H3.5 Smoking helps to Lose Weight Rs34e 3 17.65 6 20.00 15 25.86 0.772 H3.6 No Positive Aspects of Smoking Rsmokeben 4 22.22 6 20.00 18 31.03 0.522 H3.7 Smoking Causes Lung Ca Rs76a 17 94.44 30 100.00 56 98.25 0.395 H3.8 Smoking Causes Heart Disease Rs76c 15 83.33 25 83.33 51 94.44 0.158 H3.9 People Smoke because they want to rs35 14 77.78 25 83.33 41 70.69 0.456 H3.10 People smoke because it is a habit rs36 16 88.89 24 80.00 45 77.59 0.711 H3.11 People who smoke cannot control they smoke or not rs37 11 61.11 14 46.67 38 65.52 0.254 H3.12 As long as you are healthy, it is OK to smoke rs38 2 11.11 3 10.00 3 5.17 0.542 H3.13 About smoking, there are more harms than benefits ds39 12 66.67 27 90.00 50 86.21 0.108

Appendix M 6 Likelihood to Succeed if Wanted to Quit Given Beliefs About Smoking

Univariate Multivariate Controlling

by age and gender



H3.1 Smoking Facilitates Friendship Rs34a 3 17.65 7 7.95 0.204 2.391 0.534 10.700 0.254 H3.2 Smoking Provides Pleasure Rs34b 9 2.94 35 39.77 0.422 1.859 0.635 5.410 0.258 H3.3 Smoking Relieves Stress Rs34c 10 58.82 47 53.41 0.793 1.320 0.450 3.871 0.613 H3.4 Smoking Can Help focus on activities Rs34d 4 23.53 13 14.77 0.472 1.747 0.491 6.110 0.389 H3.5 Smoking helps to Lose Weight Rs34e 6 35.29 18 20.45 0.211 2.112 0.687 6.493 0.192 H3.6 No Positive Aspects of Smoking Rsmokeben 4 23.53 24 27.27 1.000 0.784 0.230 .672 0.697 H3.7 Smoking Causes Lung Ca Rs76a 17 100.00 85 97.70 1.000 NA H3.8 Smoking Causes Heart Disease Rs76c 15 88.24 75 89.29 1.000 0.881 0.169 4.599 0.881 H3.9 People Smoke because they want to rs35 11 64.71 69 78.41 0.228 0.455 0.136 1.520 0.201 H3.10 People smoke because it is a habit rs36 14 82.35 71 80.68 1.000 1.133 0.291 4.406 0.857 H3.11 People who smoke cannot control they smoke or not rs37 7 41.18 55 62.50 0.114 0.423 0.146 1.221 0.112 H3.12 As long as you are healthy, it is OK to smoke rs38 1 5.88 6 6.82 1.000 0.786 0.087 7.107 0.830 H3.13 About smoking, there are more harms than benefits ds39 15 88.24 74 84.09 1.000 1.405 0.280 7.053 0.679

282

Appendix M 7 Likelihood to Succeed if Decided to Quit Given Beliefs About Smoking


age and gender Unlikely Likely 95% CI


H3.1 Smoking Facilitates Friendship Rs34a 2 20.00 8 8.42 0.242 4.864 0.706 33.498 0.108 H3.2 Smoking Provides Pleasure Rs34b 6 60.00 38 40.00 0.314 2.247 0.539 9.375 0.267 H3.3 Smoking Relieves Stress Rs34c 6 60.00 51 53.68 0.751 0.900 0.210 3.859 0.888 H3.4 Smoking Can Help focus on activities Rs34d 3 30.00 14 14.89 0.208 2.337 0.465 11.731 0.303 H3.5 Smoking helps to Lose Weight Rs34e 4 40.00 20 21.05 0.231 2.421 0.572 10.246 0.230 H3.6 No Positive Aspects of Smoking Rsmokeben 2 20.00 26 27.37 1.000 0.738 0.138 3.928 0.720 H3.7 Smoking Causes Lung Ca Rs76a 10 100.00 92 97.87 1.000 NA H3.8 Smoking Causes Heart Disease Rs76c 8 88.89 82 89.13 1.000 1.426 0.143 14.248 0.763 H3.9 People Smoke because they want to rs35 6 60.00 74 77.89 0.244 0.114 0.018 0.671 0.016 * H3.10 People smoke because it is a habit rs36 8 80.00 77 81.05 1.000 0.725 0.130 4.045 0.714 H3.11 People who smoke cannot control they smoke or not rs37 7 70.00 55 57.89 0.521 1.815 0.418 7.876 0.426 H3.12 As long as you are healthy, it is OK to smoke rs38 1 10.00 6 6.32 0.515 2.202 0.207 23.478 0.513 H3.13 About smoking, there are more harms than benefits ds39 9 90.00 80 84.21 1.000 1.370 0.150 12.522 0.760

Appendix M 8 Level of Comfort Asking for Help to Quit Given Beliefs About Smoking


age and gender Variable Uncomfortable Comfortable 95% CI

No % No %

P FET OR

Lower

Upper P

H3.1 Smoking Facilitates Friendship Rs34a 4 9.76 6 10.00 1.000 0.924 0.239 3.578 0.909 H3.2 Smoking Provides Pleasure Rs34b 20 48.78 23 38.33 0.314 1.654 0.722 3.789 0.234 H3.3 Smoking Relieves Stress Rs34c 24 58.54 30 50.00 0.313 1.644 0.720 3.756 0.238 H3.4 Smoking Can Help focus on activities Rs34d 6 14.63 10 16.95 1.000 0.846 0.280 2.551 0.766 H3.5 Smoking helps to Lose Weight Rs34e 8 19.51 14 23.33 0.807 0.799 0.300 2.125 0.653 H3.6 No Positive Aspects of Smoking Rsmokeben 11 26.83 17 28.33 1.000 0.895 0.364 2.202 0.810 H3.7 Smoking Causes Lung Ca Rs76a 40 97.56 58 98.31 1.000 0.620 0.035 11.143 0.746 H3.8 Smoking Causes Heart Disease Rs76c 33 84.62 54 93.10 0.194 0.376 0.096 1.481 0.162 H3.9 People Smoke because they want to rs35 32 78.05 45 75.00 0.814 1.185 0.435 3.229 0.740 H3.10 People smoke because it is a habit rs36 34 82.93 48 80.00 0.799 1.223 0.435 3.436 0.703 H3.11 People who smoke cannot control they smoke or not rs37 26 63.41 33 55.00 0.420 1.436 0.634 3.253 0.386 H3.12 As long as you are healthy, it is OK to smoke rs38 1 2.44 5 8.33 0.397 0.256 0.028 2.306 0.225 H3.13 About smoking, there are more harms than benefits ds39 35 85.37 51 85.00 1.000 0.987 0.309 3.148 0.982

283

Appendix M 9 Agreement About the Only Way to Stop Smoking is Through Will Power

Given Beliefs About Smoking Univariate


Variable Disagree Agree 95% CI

No % No % P FET OR

Lower

Upper P

H3.1 Smoking Facilitates Friendship Rs34a 0 - 10 10.42 0.596 0.000 0.000 - 0.999 H3.2 Smoking Provides Pleasure Rs34b 3 33.33 41 42.71 0.731 0.438 0.092 2.082 0.299 H3.3 Smoking Relieves Stress Rs34c 4 44.44 53 55.21 0.729 0.507 0.113 2.270 0.375 H3.4 Smoking Can Help focus on activities Rs34d 1 11.11 16 16.84 1.000 0.758 0.084 6.876 0.806 H3.5 Smoking helps to Lose Weight Rs34e 2 22.22 22 22.92 1.000 1.078 0.196 5.926 0.931 H3.6 No Positive Aspects of Smoking Rsmokeben 4 44.44 24 25.00 0.243 3.519 0.773 16.010 0.104 H3.7 Smoking Causes Lung Ca Rs76a 9 100.00 93 97.89 1.000 2.65E+08 0.000 - 0.999 H3.8 Smoking Causes Heart Disease Rs76c 9 100.00 81 88.04 0.592 1.735 0.000 - 0.999 H3.9 People Smoke because they want to rs35 5 55.56 75 78.13 0.212 0.361 0.074 1.772 0.209 H3.10 People smoke because it is a habit rs36 6 66.67 79 82.29 0.368 0.429 0.088 2.103 0.297 H3.11 People who smoke cannot control they smoke or not rs37 6 66.67 56 58.33 0.734 1.489 0.325 6.820 0.608 H3.12 As long as you are healthy, it is OK to smoke rs38 1 11.11 6 6.25 0.476 3.776 0.338 42.222 0.281 H3.13 About smoking, there are more harms than benefits ds39 5 55.56 84 87.50 0.029 0.200 0.040 0.991 0.049 *

284

Appendix N Group Comparisons Given Behaviors About Second-Hand Smoke

285

Appendix N 1

Never and Ever Smokers Given Behaviors About Second-Hand Smoke Univariate


Never Ever 95% CI

Variable No % No % P FET OR

Lower

Upper P

H4.1 Comfortable with others smoking around you Rs62 57 10.02 82 35.34 0.000 0.234 0.155 0.353 0.000 * H4.2 House someone smokes Rs64 37 6.49 37 15.75 0.000 0.352 0.207 0.598 0.000 * H4.3 Car someone smokes Rs66 82 14.39 71 30.21 0.000 0.382 0.256 0.572 0.000 * H4.4 smoking not Allowed at home Rs65 538 94.55 194 82.55 0.000 3.424 1.992 5.885 0.000 * H4.5 Someone smokes in work area Rs70 55 14.95 31 19.75 0.198 0.810 0.481 1.364 0.428 H4.6 Smoking not permitted at work's common areas Rs71 312 84.78 129 83.77 0.792 1.154 0.662 2.010 0.614 H4.7 Prefer works where smoking is not allowed Rs73 352 82.05 122 60.40 0.000 3.035 2.014 4.572 0.000 * H4.8 SHS (1=exposure to shs; 0=no shs) 259 45.44 161 68.51 0.000 0.392 0.277 0.557 0.000 * H4.9 MinorsSHS 188 32.98 105 44.68 0.002 0.443 0.311 0.631 0.000 *

Appendix N 2 Former and Current Smokers Given Behaviors About Second-Hand Smoke



Variable No % No %

P FET OR

Lower

Upper P

H4.1 Comfortable with others smoking around you Rs62 20 15.87 61 58.65 0.000 0.113 0.058 0.222 0.000 * H4.2 House someone smokes Rs64 9 7.03 27 25.71 0.000 0.154 0.063 0.377 0.000 * H4.3 Car someone smokes Rs66 19 14.84 51 48.57 0.000 0.238 0.125 0.452 0.000 * H4.4 smoking not Allowed at home Rs65 116 90.63 77 73.33 0.001 5.837 2.524 13.497 0.000 * H4.5 Someone smokes in work area Rs70 13 14.77 18 26.87 0.071 0.484 0.211 1.113 0.088 H4.6 Smoking not permitted at work's common areas Rs71 72 82.76 55 84.62 0.827 0.776 0.315 1.909 0.580 H4.7 Prefer works where smoking is not allowed Rs73 84 77.78 38 41.3 0.000 4.465 2.35 8.484 0.000 * H4.8 SHS (1=exposure to shs; 0=no shs) 72 56.25 87 82.86 0.000 0.293 0.155 0.556 0.000 * H4.9 MinorsSHS 46 35.94 58 55.24 0.004 0.568 0.324 0.995 0.048 *

Appendix N 3 Smokers in the Maintenance, Preparation, and Pre-Contemplation

SOC Given Behaviors About Second-Hand Smoke Maintenance SOC

Preparation SOC


Variable No % No % No % P FET H4.1 Comfortable with others smoking around you Rs62 20 15.87 41 55.41 20 66.67 0.000 * H4.2 House someone smokes Rs64 9 7.03 18 24.32 9 29.03 0.000 * H4.3 Car someone smokes Rs66 19 14.84 32 43.24 19 61.29 0.000 * H4.4 smoking not Allowed at home Rs65 116 90.62 53 71.62 24 77.42 0.001 * H4.5 Someone smokes in work area Rs70 13 14.77 13 27.66 5 25.00 0.166 H4.6 Smoking not permitted at work's common areas Rs71 72 82.76 38 82.61 17 89.47 0.903 H4.7 Prefer works where smoking is not allowed Rs73 84 77.78 28 43.75 10 35.71 0.000 * H4.8 SHS (1=exposure to shs; 0=no shs) 72 56.25 60 81.08 27 87.10 0.000 * H4.9 MinorsSHS 46 35.94 38 51.35 20 64.52 0.006 *

286

Appendix N 4 Smokers in the Preparation and Pre-Contemplation SOC Given Behaviors

About Second-Hand Smoke


gender Variable WTQ NWTQ 95% CI

No % No % P FET OR Lower Upper P H4.1 Comfortable with others smoking around you Rs62 41 55.41 20 66.67 0.380 0.519 0.205 1.313 0.166 H4.2 House someone smokes Rs64 18 24.32 9 29.03 0.631 0.595 0.218 1.620 0.309 H4.3 Car someone smokes Rs66 32 43.24 19 61.29 0.134 0.588 0.240 1.442 0.246 H4.4 smoking not Allowed at home Rs65 53 71.62 24 77.42 0.633 1.021 0.355 2.939 0.969 H4.5 Someone smokes in work area Rs70 13 27.66 5 25.00 1.000 1.190 0.356 3.981 0.778 H4.6 Smoking not permitted at work's common areas Rs71 38 82.61 17 89.47 0.710 0.549 0.103 2.917 0.482 H4.7 Prefer works where smoking is not allowed Rs73 28 43.75 10 35.71 0.500 1.296 0.510 3.298 0.586 H4.8 SHS (1=exposure to shs; 0=no shs) 60 81.08 27 87.10 0.576 0.624 0.185 2.099 0.446 H4.9 MinorsSHS 38 51.35 20 64.52 0.283 0.638 0.261 1.560 0.325

Appendix N 5 Smokers in the Preparation, Contemplation, and Pre-Contemplation SOC

Given Behaviors About Second-Hand Smoke Pre-contemplation SOC

Contemplation SOC Preparation SOC

Variable No % No % No % P FET H4.1 Comfortable with others smoking around you Rs62 13 72.22 17 58.62 32 55.17 0.485 H4.2 House someone smokes Rs64 6 33.33 7 23.33 15 25.86 0.723 H4.3 Car someone smokes Rs66 8 44.44 22 73.33 22 37.93 0.007 * H4.4 smoking not Allowed at home Rs65 12 66.67 22 73.33 43 74.14 0.797 H4.5 Someone smokes in work area Rs70 3 20.00 3 18.75 12 32.43 0.573 H4.6 Smoking not permitted at work's common areas Rs71 14 100.00 13 81.25 29 80.56 0.214 H4.7 Prefer works where smoking is not allowed Rs73 5 33.33 11 40.74 22 43.14 0.808 H4.8 SHS (1=exposure to shs; 0=no shs) 14 77.78 29 96.67 45 77.59 0.048 * H4.9 MinorsSHS 9 50.00 18 60.00 31 53.45 0.776

Appendix N 6 Likelihood to Succeed if Wanted to Quit Given Behaviors

About Second-Hand Smoke


and gender Unlikely Likely 95% CI

Variable No % No % P FET OR Lower Upper P H4.1 Comfortable with others smoking around you Rs62 12 75.00 49 55.68 0.177 2.544 0.745 8.688 0.136 H4.2 House someone smokes Rs64 8 47.06 19 21.59 0.037 3.699 1.187 11.529 0.024 * H4.3 Car someone smokes Rs66 9 52.94 42 47.73 0.793 1.193 0.402 3.540 0.751 H4.4 smoking not Allowed at home Rs65 11 64.71 66 75.00 0.382 0.532 0.158 1.730 0.288 H4.5 Someone smokes in work area Rs70 5 45.45 13 23.21 0.149 2.766 0.716 10.693 0.140 H4.6 Smoking not permitted at work's common areas Rs71 9 81.82 46 85.19 0.673 0.754 0.135 4.213 0.748 H4.7 Prefer works where smoking is not allowed Rs73 6 40.00 32 41.56 1.000 0.997 0.318 3.128 0.996 H4.8 SHS (1=exposure to shs; 0=no shs) 16 94.12 71 80.68 0.294 3.934 0.486 31.854 0.199 H4.9 MinorsSHS 12 70.59 46 52.27 0.192 0.282 0.723 7.196 0.159

287

Appendix N 7 Likelihood to Succeed if Decided to Quit Given

Behaviors About Second-Hand Smoke Univariate Multivariate Controlling by age and gender


H4.1 Comfortable with others smoking around you Rs62 8 80.00 53 56.38 0.190 3.433 0.651 18.121 0.146 H4.2 House someone smokes Rs64 2 20.00 25 26.32 1.000 0.962 0.178 5.212 0.964 H4.3 Car someone smokes Rs66 5 50.00 46 48.42 1.000 0.641 0.152 2.701 0.545 H4.4 smoking not Allowed at home Rs65 9 90.00 68 71.58 0.283 2.791 0.303 25.667 0.365 H4.5 Someone smokes in work area Rs70 3 42.86 15 25.00 0.375 2.279 0.412 12.598 0.345 H4.6 Smoking not permitted at work's common areas Rs71 6 85.71 49 84.48 1.000 1.192 0.118 11.988 0.882 H4.7 Prefer works where smoking is not allowed Rs73 4 40.00 34 41.46 1.000 1.045 0.243 4.494 0.953 H4.8 SHS (1=exposure to shs; 0=no shs) 9 90.00 78 82.11 1.000 1.663 0.187 14.759 0.648 H4.9 MinorsSHS 9 90.00 49 51.58 0.022 6.841 0.803 58.29 0.079

Appendix N 8 Level of Comfort Asking for Help to Quit

Given Behaviors About Second-Hand Smoke Univariate


Uncomfortable Comfortable 95% CI Variable No % No % P FET OR Lower Upper P H4.1 Comfortable with others smoking around you Rs62 23 56.10 36 61.02 0.682 0.846 0.371 1.932 0.692 H4.2 House someone smokes Rs64 7 17.07 18 30.00 0.164 0.478 0.173 1.322 0.155 H4.3 Car someone smokes Rs66 19 46.34 31 51.67 0.687 0.747 0.321 1.735 0.497 H4.4 smoking not Allowed at home Rs65 30 73.17 44 73.33 1.000 0.917 0.353 2.380 0.858 H4.5 Someone smokes in work area Rs70 8 30.77 9 24.32 0.579 1.387 0.447 4.311 0.571 H4.6 Smoking not permitted at work's common areas Rs71 21 84.00 31 83.78 1.000 0.985 0.245 3.959 0.983 H4.7 Prefer works where smoking is not allowed Rs73 12 32.43 24 47.06 0.193 0.534 0.220 1.299 0.167 H4.8 SHS (1=exposure to shs; 0=no shs) 34 82.93 49 81.67 1.000 1.109 0.389 3.158 0.847 H4.9 MinorsSHS 27 65.85 29 48.33 0.104 2.149 0.926 4.988 0.075

Appendix N 9 Agreement about the Only Way to Stop Smoking is Through Will Power

Given Behaviors About Second-Hand Smoke


gender Disagree Agree 95% CI

Variable No % No % P FET OR Lower Upper P H4.1 Comfortable with others smoking around you Rs62 6 66.67 55 57.89 0.733 1.237 0.273 5.618 0.783 H4.2 House someone smokes Rs64 4 44.44 23 23.96 0.231 2.043 0.466 8.956 0.343 H4.3 Car someone smokes Rs66 2 22.22 49 51.04 0.162 0.401 0.073 2.197 0.292 H4.4 smoking not Allowed at home Rs65 4 44.44 73 76.04 0.055 0.368 0.084 1.600 0.182 H4.5 Someone smokes in work area Rs70 1 25.00 17 26.98 1.000 0.950 0.087 10.330 0.966 H4.6 Smoking not permitted at work's common areas Rs71. 3 75.00 52 85.25 0.496 0.413 0.034 5.070 0.489 H4.7 Prefer works where smoking is not allowed Rs73 1 20.00 37 42.53 0.400 0.261 0.024 2.903 0.275 H4.8 SHS (1=exposure to shs; 0=no shs) 7 77.78 80 83.33 0.650 0.528 0.090 3.087 0.479 H4.9 MinorsSHS 4 44.44 54 56.25 0.510 0.755 0.169 3.385 0.714

288

Appendix O Group Comparisons Given Behaviors About Smoking

and Beliefs About Stopping Smoking

289

Appendix O 1 Never and Ever Smokers Given Behaviors

About Smoking and Beliefs About Stopping Smoking Univariate Multivariate Controlling by age and gender


H5.1 rCHOADIC 93 16.55 50 21.37 0.128 0.884 0.581 1.344 0.563

Appendix O 2 Former and Current Smokers Given Behaviors

About Smoking and Beliefs About Stopping Smoking Univariate



H5.1 rCHOADIC 27 21.26 22 20.95 1.000 0.912 0.465 1.787 0.787 H5.11 Smoked first cigarette after 18 yo Ds50T18yo 19 14.84 28 26.92 0.032 0.349 0.170 0.718 0.004 * 5.12 Smoking cigarettes regularly after 18 yo Ds51R18yo 63 49.22 66 62.86 0.047 0.419 0.235 0.745 0.003 *

Appendix O 3 Smokers in the Maintenance, Preparation, and Pre-Contemplation SOC Given Behaviors About Smoking and Beliefs About Stopping Smoking

Maintenance SOC

Preparation SOC


Variable No % No % No % P FET H5.1 rCHOADIC 27 21.26 16 21.62 6 19.35 1.000 H5.11 Smoked first cigarette after 18 yo Ds50T18yo 19 14.84 22 30.14 6 19.35 0.037 * H5.12 Smoking cigarettes regularly after 18 yo Ds51R18yo 63 49.22 49 66.22 17 54.84 0.064

290

Appendix O 4

Smokers in the Preparation and Pre-Contemplation SOC Given Behaviors About Smoking and Beliefs About Stopping Smoking


age and gender

Preparation SOC

Pre-contemplation SOC 95% CI

Variable No % No % P FET OR Lower Upper P H5.1 rCHOADIC 16 21.62 6 19.35 1.000 0.805 0.254 2.549 0.713 H5.2 Smoke cigarettes every day rs44 38 51.35 16 51.61 1.000 0.958 0.407 2.254 0.922 H5.3 First cigarette smoked within 30 minutes after waking up rs52

12 16.44 6 19.35 0.779

0.829

0.274

2.510

0.740

H5.4 Smoking more when facing stressful events rs53

35 47.30 17 54.84 0.526

0.684

0.274 1.708

0.416

H5.5 Comfortable smoking around others rs54 30 41.67 18 60.00 0.127 0.490 0.197 1.217 0.125 H5.6 Does not enjoy smoking rS56 43 58.11 11 36.67 0.054 2.409 0.975 5.954 0.057 H5.7 Very likely to succeed if want to stop smoking rs58

46 62.16 8 25.81 0.001

5.441

2.058 14.384

0.001 *

H5.8 Very likely to succeed if decide to stop smoking rs59

52 70.27 12 38.71 0.004

3.574

1.424 8.969

0.007 *

H5.9 Very comfortable asking for help to stop smoking rs60

28 38.36 14 50.00 0.368

0.632

0.256 1.558

0.319

H5.10 Ability to stop smoking through own will power rs61

67 90.54 29 93.55 0.620

0.959

0.173 5.307

0.962

H5.11 Smoked first cigarette after 18 yo Ds50T18yo 22 30.14 6 19.35 0.336 1.690 0.598 4.777 0.322 H5.12 Smoking cigarettes regularly after 18 yo Ds51R18yo

49 66.22 17 54.84 0.279

1.406

0.579 3.412 0.452

H5.13 smokes= >5 cigarettes/day rs45 23 60.53 11 68.75 0.759 0.582 0.155 2.184 0.422 H5.14 Quitting smoking for a day or more in the past year Ds55

53 75.71 20 68.97 0.616

2.051

0.716 5.873

0.181

Appendix O 5 Smokers in the Preparation, Contemplation, and Pre-contemplation SOC

Given Behaviors About Smoking and Beliefs About Stopping Smoking Pre-contemplation SOC

Contemplation SOC

Preparation SOC

Variable No % No % No % P FET H5.1 rCHOADIC 4 22.22 4 13.33 15 25.86 0.408 H5.2 Smoke cigarettes every day rs44 8 44.44 19 63.33 28 48.28 0.335 H5.3 First cigarette smoked within 30 minutes after waking up rs52 3 16.67 7 23.33 8 14.04 0.529 H5.4 Smoking more when facing stressful events rs53 11 61.11 17 56.67 25 43.10 0.324 H5.5 Comfortable smoking around others rs54 11 64.71 16 55.17 22 38.60 0.109 H5.6 Does not enjoy smoking rS56 5 29.41 11 36.67 38 65.52 0.005 * H5.7 Very likely to succeed if want to stop smoking rs58 12 70.59 13 43.33 29 50.00 0.198 H5.8 Very likely to succeed if decide to stop smoking rs59 14 82.35 15 50.00 35 60.34 0.085 H5.9 Very comfortable asking for help to stop smoking rs60 10 71.43 11 36.67 21 36.84 0.061 H5.10 Ability to stop smoking through own will power rs61 16 94.12 29 96.67 51 87.93 0.452 H5.11 Smoked first cigarette after 18 yo Ds50T18yo 6 33.33 4 13.33 18 31.58 0.131 H5.12 Smoking cigarettes regularly after 18 yo Ds51R18yo 11 61.11 13 43.33 42 72.41 0.030 * H5.13 smokes= >5 cigarettes/day rs45 6 75.00 9 47.37 20 71.43 0.175 H5.14 Quitting smoking for a day or more in the past year Ds55 9 56.25 24 80.00 40 74.07 0.205

291

Appendix O 6 Likelihood to Succeed if Wanted to Quit Given Behaviors

About Smoking and Beliefs About Stopping Smoking Univariate



Variable No %

No % P FET OR

Lower

Upper P

H5.1 rCHOADIC 5 29.41 17

19.32 0.344

1.936

0.535

7.004

0.314

H5.2 Smoke cigarettes every day rs44 12 70.59 42

47.73 0.113

0.266

0.862

8.211

0.089

H5.3 First cigarette smoked within 30 minutes after waking up rs52 4

23.53 14

15.91 0.488

1.602

0.454

5.652

0.464

H5.4 Smoking more when facing stressful events rs53 10 58.82 42

47.73 0.438

1.765

0.589

5.295

0.310

H5.5 Comfortable smoking around others rs54 10

58.82 38

44.71 0.303

1.710

0.580

5.040

0.331

H5.6 Does not enjoy smoking rS56 6

35.29 48

55.17 0.185

0.436

0.147

1.292

0.134

H5.7 Very likely to succeed if want to stop smoking rs58 Excluded from analysis H5.8 Very likely to succeed if decide to stop smoking rs59 Excluded from analysis

H5.9 Very comfortable asking for help to stop smoking rs60 8 50.00 34

40.00 0.582

1.488

0.508

4.355

0.469

H5.10 Ability to stop smoking through own will power rs61 14 82.35 82

93.18 0.159

0.261

0.051

1.332

0.106

H5.11 Smoked first cigarette after 18 yo Ds50T18yo 2 11.76 26

29.89 0.147

0.319

0.068

1.506

0.149

H5.12 Smoking cigarettes regularly after 18 yo Ds51R18yo 8

47.06 58

65.91 0.174

0.444

0.151

1.308

0.141

H5.13 smokes= >5 cigarettes/day rs45 9 75.00 25

59.52 0.500

2.226

0.496

9.992

0.296

H5.14 Quitting smoking for a day or more in the past year Ds55 12

70.59 61

74.39 0.766

0.755

0.227

2.513

0.647

292

Appendix O 7 Likelihood to Succeed if Decided to Quit Given Behaviors

About Smoking and Beliefs About Stopping Smoking


age and gender Unlikely Likely 95% CI

Variable No %

No % P FET OR

Lower

Upper P

H5.1 rCHOADIC 3 30.00 19 20.00 0.434

5.978

0.983

36.365

0.052

H5.2 Smoke cigarettes every day rs44 6 60.00 48 50.53 0.742

1.494

0.377

5.920

0.568

H5.3 First cigarette smoked within 30 minutes after waking up rs52 2 20.00 16

17.02 0.683

1.285

0.236

6.991

0.772

H5.4 Smoking more when facing stressful events rs53 6 60.00 46 48.42 0.526

0.917

0.185 4.545 0.915

H5.5 Comfortable smoking around others rs54 5 50.00 43 46.74 1.000

1.200

0.282 5.103 0.805

H5.6 Does not enjoy smoking rS56 4 40.00 50 53.19 0.515

0.826

0.199 3.433 0.793

H5.7 Very likely to succeed if want to stop smoking rs58 Excluded from analysis H5.8 Very likely to succeed if decide to stop smoking rs59 Excluded from analysis H5.9 Very comfortable asking for help to stop smoking rs60 3 30.00 39

42.86 0.516

0.471

0.106 2.094 0.322

H5.10 Ability to stop smoking through own will power rs61 10 100.00 86 90.53 0.596 NA

H5.11 Smoked first cigarette after 18 yo Ds50T18yo 3 30.00 25 26.60 1.000

1.421

0.314 6.419 0.648

H5.12 Smoking cigarettes regularly after 18 yo Ds51R18yo 7 70.00 59

62.11 0.741

2.278

0.499 10.397 0.288

H5.13 smokes= >5 cigarettes/day rs45 4 66.67 30 62.50 1.000

0.825

0.070 9.775 0.879

H5.14 Quitting smoking for a day or more in the past year Ds55 9 90.00 64

71.91 0.284

3.339

0.355 31.384 0.291

293

Appendix O 8

Level of Comfort Asking for Help to Quit Given Behaviors About Smoking and Beliefs About Stopping Smoking




Upper P

H5.1 rCHOADIC 11 26.83 10 16.67 0.225

2.108

0.727

6.113

0.170

H5.2 Smoke cigarettes every day rs44 16 39.02 35 58.33 0.070

0.457

0.203 1.030 0.059

H5.3 First cigarette smoked within 30 minutes after waking up rs52 5 12.20 12

20.00 0.419

0.559

0.180 1.732 0.313

H5.4 Smoking more when facing stressful events rs53 20 48.78 31 51.67 0.841

0.934 0.402 2.173 0.875

H5.5 Comfortable smoking around others rs54 18 45.00 29 50.00 0.684

0.790 0.346 1.805 0.576

H5.6 Does not enjoy smoking rS56 22 53.66 31 51.67 1.000

1.079 0.484 2.404 0.853

H5.7 Very likely to succeed if want to stop smoking rs58 22 53.66 30

50.00 0.840

1.137 0.511 2.29 0.754

H5.8 Very likely to succeed if decide to stop smoking rs59 22 53.66 39

65.00 0.302

0.598 0.258 1.39 0.233

H5.9 Very comfortable asking for help to stop smoking rs60 Excluded from analysis H5.10 Ability to stop smoking through own will power rs61 40 97.56 52

86.67 0.079

6.130 0.71 52.916 0.099

H5.11 Smoked first cigarette after 18 yo Ds50T18yo 9 21.95 18 30.51 0.370

0.650 0.257 1.643 0.362

H5.12 Smoking cigarettes regularly after 18 yo Ds51R18yo 25 60.98 40

66.67 0.673

0.775 0.331 1.815 0.557

H5.13 smokes= >5 cigarettes/day rs45 10 62.50 22 62.86 1.000

0.874 0.241 3.171 0.837

H5.14 Quitting smoking for a day or more in the past year Ds55 33 84.62 39

68.42 0.094

2.588 0.902 7.423 0.077

294

Appendix O 9 Agreement About the Only Way to Stop Smoking is Through Will Power

Given Behaviors About Smoking and Beliefs About Stop Smoking Univariate



Variable No %

No % P FET OR

Lower

Upper P

H5.1 rCHOADIC 3 33.33 19

19.79 0.392

1.801

0.326

9.952

0.500

H5.2 Smoke cigarettes every day rs44 7 77.78 47

48.96 0.162

4.144

0.745

23.061

0.105

H5.3 First cigarette smoked within 30 minutes after waking up rs52 3

33.33 15

15.79 0.186

2.898

0.599

14.028

0.186

H5.4 Smoking more when facing stressful events rs53 6 66.67 46

47.92 0.319

2.014 0.433 9.366 0.372

H5.5 Comfortable smoking around others rs54 2 22.22 46

49.46 0.167

0.314 0.056 1.763 0.188

H5.6 Does not enjoy smoking rS56 5 55.56 49

51.58 1.000

1.080 0.256 4.551 0.916

H5.7 Very likely to succeed if want to stop smoking rs58 4

44.44 50

52.08 0.737

0.755 0.18 3.175 0.702

H5.8 Very likely to succeed if decide to stop smoking rs59 7

77.78 57

59.38 0.477

2.033 0.364 11.355 0.419

H5.9 Very comfortable asking for help to stop smoking rs60 7

77.78 35

38.04 0.032

7.893 1.336 46.641 0.023 *

H5.10 Ability to stop smoking through own will power rs61 Excluded from analysis

H5.11 Smoked first cigarette after 18 yo Ds50T18yo 3 33.33 25

26.32 0.699

1.002 0.203 4.945 0.998

H5.12 Smoking cigarettes regularly after 18 yo Ds51R18yo 4

44.44 62

64.58 0.287

0.305 0.066 1.402 0.127

H5.13 smokes= >5 cigarettes/day rs45 6 85.71 28

59.57 0.239

4.009 0.374 42.982 0.251

H5.14 Quitting smoking for a day or more in the past year Ds55 5

62.50 68

74.73 0.429

0.779 0.161 3.771 0.756

disertation gs format printed

Documents

jos guillermo

jos william castellanos

emotional support

special gratitude

university of minnesota

fine friend

committee member

immense gratitude