Neighborhood and individual-level determinants of smoking cessation among Hispani

烟草是美国成年人可预防的死亡和疾病的主要原因， 所有癌症都直接归因于吸烟。少数民族和得不到充分服务的人口 由于在获得治疗方面的不平等， 烟草公司的营销，以及许多其他因素。例如，西班牙裔人不太可能 比非西班牙裔白人在戒烟尝试期间接受医疗保健提供者的帮助， 获得药物治疗。此外，烟草是西班牙裔美国人的一个主要公共卫生问题， 西班牙裔美国人的4个主要死因与吸烟有关（即，癌症、心脏病、中风）。 因此，在美国拉美裔人中预防疾病的基石是减少烟草使用。尽管 减少西班牙裔人群吸烟的重要性，寻找有效的方法来做到这一点是至关重要的。 由于缺乏对这一人群戒烟机制的研究，作为 在一份著名的报告中指出，“消除健康差距的挑战的根本原因是， 对烟草使用、尼古丁成瘾和 在研究不足和历史上得不到充分服务的人群中的相关后果”（消除烟草- 相关健康差异：总结报告）。拟议的研究解决了这一差距。 这项纵向队列研究将研究邻里，个人和急性的影响， 西班牙裔成年人戒烟的个人因素和背景因素 从墨西哥裔美国人（MA）队列研究招募的吸烟者（N=200）。所有研究程序、治疗 材料和评估将以西班牙语进行。将在研究开始前2周对参与者进行跟踪。 从戒烟日到戒烟后26周。他们将接受连续4周的评估（提前1周 停药后3周内）使用最新的科学生态学瞬时评估 (EMA)程序.所有参与者将接受戒烟治疗，包括尼古丁贴片 治疗，自助材料，以及简短的面对面和电话咨询，根据我们的实验室验证， 对西班牙语西班牙裔吸烟者的干预（Wetter等人，出版中）。 很少有研究探讨戒烟的潜在机制 在西班牙语或西班牙裔吸烟者中，据我们所知，没有人：（a） 调查了邻里的影响，或（B）包括使用EMA调查急性 自我和环境对戒烟过程的影响。因此，拟议的研究将使 对该领域的独特贡献，以及解决有关吸烟的主要报告中的关键建议 在少数民族中（USDHHS，1998年）和减少健康差距（USDHHS，2002年）。

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