Racial and ethnic minorities
- Access to health care. Some racial and ethnic minority groups are less likely to have regular contact with a primary health care provider (Hargraves, 2003). Likewise, minorities are also less likely to receive tobacco cessation counseling from their providers. Language and cultural differences may affect the accessibility and quality of healthcare. In addition, racial and ethnic minority groups are less likely to have adequate health insurance, especially in terms of insurance coverage for nicotine replacement therapies and cessation counseling interventions (Kaiser, 2007).
- Exposure to advertising. Tobacco advertisements, such as billboards and newspaper ads, are found in higher densities in communities that are made up of primarily ethnic and racial minority groups (Primack, 2007).
- Cigarette preferences. Some racial and ethnic minorities, especially African Americans, have a higher tendency to smoke menthol cigarettes, which may result in increased nicotine dependence and a greater chance of tobacco-attributable disease (Garten, 2004). A greater dependency or addiction to nicotine makes it harder to quit smoking (Boonn, 2008).
- Stress. Ethnic and racial minorities are disproportionately affected by certain life stressors, such as poverty, discrimination and violence. These conditions may lead to a greater reliance on cigarettes as a coping mechanism (Wilkinson, 1997).
- Social Norms. Fewer ethnic and racial minorities view smoking as inappropriate. In some cultures, there is a higher degree of social acceptance of tobacco use (USDHHS, 1998).
Strategies to address these considerations:
- Tailor to Culture. Given the increasing proportions of racial and ethnic minorities in the United States, intervention strategies designed for these populations are of substantial public health importance. In some communities, group events are preferred to individual activities to promote social support and a family-like atmosphere. Education programs that reach the public with information about tobacco use can help individuals make informed decisions about quitting or not initiating tobacco use. Ideally, a tobacco use prevention education program is directed to a defined population and is sensitive to the social, economic and cultural issues affecting that population (McAdams, 2005).
- Provide cultural competency training. Strategies to reach racial and ethnic minority populations should be culturally relevant (NCCC). It may be useful to provide training in cultural competency to individuals who are working with a community so that they can learn more about the differences within and across communities and how these differences influence tobacco intervention design and implementation. See Cultural Competence for more information.
- Involve the priority populations. When possible, partnerships should be developed with professionals and community members from the racial and ethnic minority community to plan, implement and evaluate the intervention and ensure that intervention materials include language, visual content and ideals that are consistent with the culture of this community. Minorities, especially Native Americans and Hispanics, may be more sensitive to message strategies focusing on the negative social aspects and family influence for smoking cessation.
- Engage community stakeholders. Leadership and active participation by community members can strengthen the credibility of and respect for the intervention. For example, support from healthcare providers or community and religious leaders from the racial and ethnic minority community can influence the success of the intervention. Effective community programs involve and influence people in their homes, worksites, schools, places of worship, places of entertainment, health care settings, civic organizations and other public places. Changing policies that can influence societal organizations, systems and networks requires the involvement of community partners (CDC, 1999).
- Use established settings. Strategies should maximize participation in the intervention by having meetings or events at convenient locations and times. It may be useful to align interventions with church or community social events, build social support within the community and offer culturally-appropriate incentives to encourage participation.
- Increase price of tobacco. Racial and ethnic minorities may be particularly affected by the strategy of increasing the unit price of tobacco. Minority smokers would be more likely than other smokers to be encouraged to quit in response to a price increase (CDC, 1998).
- Use a comprehensive approach. Tobacco control interventions should include a many-sided approach to the community’s needs. Interventions that combine media, policy and program services address the critical issues of raising consciousness of the problem, motivating the community to take action, presenting the solutions in the strongest light to garner support from policymakers and meeting the needs of individuals and communities once policies are in place (McAdams, 2005).
- Enact Smoke-Free Laws. Smoke-free legislation has had a significant effect on adult smoking rates (Hahn, 2008). “No smoking” policies are the most common method to reduce environmental tobacco smoke in public places (Barbeau, 2004).
- Educate. Some interventions have used warnings and educational material to deter individuals from smoking in public places. More comprehensive efforts to reduce environmental tobacco smoke include educational campaigns for employees and managers, posting signs about the smoking policy and providing smoking cessation assistance for those who smoke (Barbeau, 2004).
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