Building a world where young people reject tobacco and anyone can quit 1 What Quitters Want Consumers’ Views on Disparities Helen Lettlow, Dr PH December 7-8, 2005

Building a world where young people reject tobacco and anyone can quit 2 Consumers Speak Out on Disparities in Health Care  In a study commissioned by the Commonwealth Fund, consumers were asked about their perceptions about disparities in health care.  The Harvard Forums on Health* conducted the national poll to explore the public’s knowledge about disparities and their opinions about various policies to remedy inequities in the health care system. *The Harvard Forums on Health commissioned Lake Snell Perry & Associates (LSPA) to conduct the study

Building a world where young people reject tobacco and anyone can quit 3 Americans Speak Out on Disparities in Health Care Americans of different races disagree about issues of disparities in health care Americans differ as to the reason minorities may be treated differently in the health care arena Hispanics point to cultural and language barriers African Americans are especially likely to feel health care professionals treat minority patients different than whites

Building a world where young people reject tobacco and anyone can quit 4 Poll Findings: perceived disparities by race

Building a world where young people reject tobacco and anyone can quit 5 Access To Care Issues For Hispanics Across all age groups, Hispanics are substantially more likely than non-Hispanic whites or African Americans to lack health insurances. For more than a decade the uninsured rates for Hispanics adults and children have been two to three more times those for non-Hispanics whites. Within the Hispanic population, adults who do not speak English fluently have greater difficulties communicating with and understanding their health care providers.

Building a world where young people reject tobacco and anyone can quit 6 Cultural approaches to counseling and education Use of community-based health advisors, or promotoras, peer-to-peer educators and advocates Engaging community leaders as program planners, advisors, and evaluators Hiring health care workers and other staff that reflect the ethnic/racial target population

Building a world where young people reject tobacco and anyone can quit 7 Cultural approaches to counseling and education Utilize community-based venues for conducting group counseling and informational sessions Activate referral agreements with local health departments, clinics, social service providers, and neighborhood health centers Cover transportation costs, and free access to NRT’s provide incentives, and other aids

Building a world where young people reject tobacco and anyone can quit 8 Community approaches in tobacco control Si Puedo (Yes, I Can) –8-week program uses bi-weekly group meetings Pathways to Freedom –Use church based venues for faith based cessation Chicago Lung Association Cessation Program –Designed for whites; uses minority venues to advertise; ALA self-help techniques and cessation support groups

Building a world where young people reject tobacco and anyone can quit 9 Provider approaches in tobacco control Health care providers, primarily physicians and dentists, are often successful in informing patients about the urgency of quitting smoking Providers are particularly effective with groups that exhibit high “power distance”: deference to authority figures (see Hofsted 1980) The limitation is that large proportions of minorities lack access to primary care providers (see Aday et al 1993)

Building a world where young people reject tobacco and anyone can quit 10 Cultural issues to consider Rate of quit attempts vary by race/ethnicity Level of public awareness about the effects of smoking vary by race/ethnicity Degree of tobacco company marketing and sponsorships effect attitudes and behaviors Availability of language-appropriate and low literacy written materials are limited Communication styles and customs influence likelihood of seeking professional services

Building a world where young people reject tobacco and anyone can quit 11 Cultural Awareness Tips to Consider Advertise the service through local radio stations, print media, newsletters Evaluate usefulness of printed self-help materials Use evidence based counseling models, but add: cultural icons, local media outreach Take time to become informed about the target population’s culture, values and attitudes Invest in the process of building relationships to minimize mistrust, embrace another viewpoint

Building a world where young people reject tobacco and anyone can quit 12 Cultural Awareness Tips to Consider Avoid platitudes and quick fixes (e.g., Hispanics are family oriented.) Take time to establish rapport with clients Utilize trained interpreters and professionals who speak the language and represent the target population Be prepared to address or refer for co-morbidities and social problems

Building a world where young people reject tobacco and anyone can quit 13 Cultural Awareness Tips to Consider Provide or refer to individual counseling vs. group counseling settings Be prepared to provide more intensive follow-up via telephone, peer outreach or home visits Observe the variety in communication styles across cultures (e.g. direct vs. indirect ) Study demographic shifts in your local area that impact service delivery Invite members of diverse groups to the table

Building a world where young people reject tobacco and anyone can quit 14 Cultural Awareness Tips to Consider Include diverse members to plan and develop new approaches that: –Reflect community values, attitudes and norms –Resonate with their cultural history –Have relevance to their social, economic and political realities –Use positive imagery –Use appropriate language and literacy levels –Empower participants to feel engaged

Building a world where young people reject tobacco and anyone can quit 15 Contact Us American Legacy Foundation 2030 M Street, NW, 6th floor Washington, DC (202)