The American Lung Association's (ALA), "Freedom from Smoking" program has been considered the gold standard in smoking cessation programs. The population of low-acculturated Hispanics in Arizona has enjoyed fairly low smoking rates in the past, especially among women, but these rates are rising at an alarming rate. To help curb this trend, we will develop two new versions of the ALA program especially for this population and compare effectiveness. The first version will be a straight Spanish translation of the ALA program (i.e., the training manual for facilitators and the participant booklet). The cognitive/behavioral approach of the ALA program has been tested and is known to achieve quit rates of 27 percent in one year. However, since the program has been designed for the mainstream U.S. population, with a focus on individual choice, decision-making, and planning, the program may not work as well for Hispanics, particularly those with low levels of acculturation. Translation may improve results, but a cultural adaptation is also required. Hispanic culture is typically seen as more collectivistic, family-oriented, and socially integrated than mainstream U.S. culture. The second version of the program will include much of the translated materials from the original ALA program, but will include, based on local Hispanic focus group input and pilot testing, more environmental and social strategies for change. These two versions of the ALA program will be implemented in Local Projects the of Arizona Department of Health Services' Tobacco Education Prevention Program (TEPP) through ACTEV participants (ACTEV is the Arizona Cessation Training and evaluation program funded by TEPP), randomly assigned to two intervention groups of 200 low- acculturated Hispanic participants each. The two versions will be tested for effectiveness (abstinence rates at 6 and 26 weeks), and formatively evaluated for components of the program that have been culturally adapted. The proposals specific aims are: 1) Develop a Spanish language version of the ALA "Freedom From Smoking" cessation curriculum; 2) Adapt the Spanish language version of the ALA cessation program to better address cultural considerations of Hispanic culture; and 3) Compare the outcomes of straight translation vs. culturally adapted after implementation with 200 low-acculturated Hispanic participants in each program. The study hypothesis is: The enhanced Spanish language program adapted to local Hispanic culture (version two) will result in significantly higher abstinence rates at six months as compared with the basic Spanish translation (version one).
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