Smoking Cessation Among Latinos in Substance Use Disorder Treatment: Tertiary Prevention of Tobacco-Related Disease

INTRODUCTION: This qualitative study examined tobacco use behaviors and barriers to/supports for smoking cessation among low-income Latinos in treatment for substance use disorders (SUD). Persons in SUD treatment have higher mortality rates from tobacco-related disease than from causes related to alcohol or other drug use disorder. While high smoking rates have been documented among persons with SUD, little is known about the smoking behaviors and cessation needs of ethnic minority smokers in SUD treatment. METHODS: Bilingual researchers interviewed Latino/a clients (n=30) and Latino/a treatment program directors (n=5) at five urban, community-based SUD treatment programs with majority Latino/a client populations in Northern California. Client eligibility criteria were being a current smoker or having quit smoking within the past month; self-identifying as Hispanic or Latino/a/x; and having been in the treatment program for at least two weeks. All director interviewees were former smokers. Confidential semi-structured interviews were conducted in Spanish or English at treatment program sites and were digitally recorded and transcribed. Interview transcripts were analyzed thematically using ATLAS.ti software. Study procedures were approved by the Institutional Review Board of the Pacific Institute for Research and Evaluation. RESULTS: All client interviewees reported smoking combustible cigarettes as opposed to other tobacco products, and most preferred mentholated cigarettes. Cigarettes per day (CPD) smoked by client interviewees ranged from 5 to 20, with 10 (half a pack) being the most common response. Both client and director interviewees described social bonding over cigarettes as a major barrier to smoking cessation among clients. Other commonly reported barriers to cessation were: (1) the belief that quitting would lead to a relapse of alcohol or other drug use; (2) being around family or friends who smoked; and (3) for many, stress from everyday struggles as an immigrant (specifically, fear of being deported, difficulty securing work, and worries about not being able to economically support family members locally and in the country of origin). The most commonly reported supports for cessation were: (1) belief in one’s “will power” (self-efficacy to quit); (2) not wanting to smoke in front of one’s parents or children; and (3) applying Twelve Step principles (especially an emphasis on abstinence from all drugs, including nicotine) to tobacco cessation. CONCLUSION: Tobacco use cessation is an important tertiary prevention measure for persons in SUD treatment who smoke. These findings represent a first step toward designing culturally and linguistically appropriate smoking cessation services that address the specific needs of low-income Latino smokers with SUD comorbidity.