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，三分之一的人 所有癌症都直接归因于烟草的使用。少数群体和服务不足的人群经历 与烟草有关的严重差距，因为获得治疗的不平等，对健康的影响 烟草的影响、烟草公司的营销以及许多其他因素。例如，拉美裔美国人不太可能 比非西班牙裔白人在戒烟期间接受医疗保健提供者的帮助或 获得药物治疗的机会。此外，烟草是拉美裔美国人的一个主要公共卫生问题，因为 拉美裔美国人的四大死因与吸烟(即癌症、心脏病、中风)有关。 因此，在美国拉美裔美国人中预防疾病的一个基石是减少烟草的使用。尽管 在西班牙裔人群中减少吸烟至关重要，寻找有效的方法来做到这一点 受制于对这一人群中戒烟机制的研究不足。AS 在一份重要的报告中指出，“消除健康差距的根本挑战是 对烟草使用的近端和远端决定因素、尼古丁成瘾和 研究不足和历史上未得到充分服务的人群的相关后果“(消除烟草-- 相关的健康差距：摘要报告)。拟议的研究解决了这一差距。 这项纵向队列研究将考察邻里、个人和急性 讲西班牙语的西班牙裔成年人戒烟的个人内和情境决定因素 从墨西哥裔美国人(MA)队列研究招募的吸烟者(N=200)。所有的研究程序，治疗 材料和评估将用西班牙语进行。参与者将从2周前开始进行跟踪 他们的戒烟日期到戒烟后26周。他们将接受连续4周的评估(每周评估一次 通过停药后3周)使用最新的生态瞬时评估 (EMA)程序。所有参与者将接受由尼古丁贴片组成的戒烟治疗 治疗，自助材料，以及基于我们的经验验证的简短的面对面和电话咨询 对说西班牙语的西班牙裔吸烟者的干预(Wetter等人，在新闻中)。 研究戒烟的机制的研究非常少。 在西班牙语或西班牙裔吸烟者中，据我们所知，没有人有：(A) 调查社区的影响，或(B)包括使用EMA来调查急性 个人内部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，以及处理关于吸烟的主要报告中的主要建议 在少数群体中(USDHHS，1998年)和缩小健康差距(USDHHS.2002)。

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).