Using Integrated Care for Addressing Tobacco Use Among Latino Populations

Abstract

Tobacco use remains the principal health hazard among Latinos, even though their overall prevalence is lower compared to the general population of tobacco users in the United States. Patterns of tobacco use among Latinos differ by nativity, country of origin, gender, and acculturation levels, and these patterns impact their experience of tobacco dependence and cessation. Evidence-based practices for the treatment of tobacco use and dependence include pharmacotherapy and brief or intensive behavioral interventions. Approved medications are nicotine replacement therapy, bupropion, and varenicline. Regardless of the clinical setting, all health care providers must ask every patient about their tobacco use (as part of their vital signs assessment) and advise about the benefits of quitting. Incorporating questions about tobacco use in the patient's electronic (or paper) health record is the first step in identifying tobacco users and facilitating communication among providers in an integrated health care setting. Proactively connecting the patient with a cessation service, such as a telephone quitline, significantly increases treatment enrollment compared to traditional referral approaches. Motivational Interviewing and Cognitive Behavioral/Social Learning models are the therapeutic approaches that have received more empirical support for the treatment of tobacco dependence. Despite similar interest in abstaining from tobacco use as compared with other racial/ethnic groups, Latinos experience notable disparities related to healthcare support for tobacco cessation. For example, Latinos rarely receive advice to quit from their providers and have limited use of cessation medications. Further, there is a dearth of information regarding the efficacy of behavioral and pharmacological cessation interventions among Latinos. Fortunately, emerging evidence seems promising. In particular, integrating cultural considerations into treatment, such as family involvement, personalized service (e.g., preferred-language, direct contact versus distribution of reading materials) and influences of the social network, have the potential to increase positive health outcomes. Clinic-level factors are essential to support and sustain individual providers' efforts to treat tobacco dependence. These include implementing a tobacco-free workplace policy, training of personnel, use of an interdisciplinary team including a "tobacco coordinator", and following a patient-centered model of care. Additional research devoted to enhancing tobacco cessation interventions among Latinos is warranted. However, when treating Latinos, providers and the healthcare system are called on to adopt and implement evidence-based practices that have proven effective with the general population of tobacco users and also work to incorporate cultural factors in the delivery of services.