1. Gendered Cultural Norms and Smoking
Influences on Tobacco Use Among Urban Hispanic Young Adults: Findings from A Qualitative Study
Jennifer D. McCleary-Sills, MPH, PhD(c)1; Evelyn Rosario2, Lee Bone, MPH, RN1,3 , Frances Stillman, EdD4
1 Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society; 2 Esperanza Center, Community Outreach Team, Baltimore, MD;
3The Hopkins Center for Health Disparities Solutions, 4Johns Hopkins Bloomberg School of Public Health, Institute for Global Tobacco Control
Background
Methodology
Gendered Cultural Norms and Smoking
Conclusions
These results provide essential guidance for the development of culturally and contextually appropriate intervention strategies and policy recommendations to eliminate tobacco use among urban Hispanic young adults.
-Interventions aiming to prevent or reduce smoking among
Hispanic young adults must consider the strong influence of
cultural norms, particularly gender-related norms and perceptions.
-The health risks associated with smoking and secondhand smoke
are well understood by this population.
-Smoking behaviors and decisions are largely viewed as a matter
of personal responsibility and choice, though the strong influence
of peers, family members, and advertising is acknowledged.
Between June and July 2008, we conducted four focus groups with Hispanic young adults at Esperanza Center:
Participants were recruited by the Community Outreach Team at Esperanza Center:
- all participants were year old immigrants who had lived in
Baltimore between 6 months and 5 years
-focus groups were segregated by gender and smoking status.
-a total of 13 young men and 11 young women participated.
Focus groups were conducted in Spanish using a discussion guide covering 5 central thematic domains:
-Community and social norms around tobacco use
-Attitudes and awareness of tobacco policy/initiatives
-Outside influences: overt and covert tobacco advertising
-Personal attitudes and perceptions of tobacco use
-Individual level factors and experiences
Discussions were recorded, translated into English, and transcribed, then analyzed using Atlas Ti (v. 5.2)
-Major themes were identified under each domain
- 10 code families were created, with 182 non-unique quotations
-Among Hispanics, lung cancer is the leading cause of cancer-related death for men and the second leading cause of cancer death for women.
-By the age of 15, 20% of Hispanic youth are regular smokers, and 29% are regular smokers by the age of 23.
-Over a fifth of Hispanics in Baltimore City use tobacco regularly, a higher prevalence than among Hispanics at the national level.
-This Community-Based Participatory Research project explored the social and environmental influences and norms that encourage or discourage tobacco use among Hispanic young adults in Baltimore.
Photo Source: Intelligencer Online, June 2009
“Naturally I was curious and I asked my brothers if I could try it. And my brothers would tell me that it is not right, it is not good, it doesn’t look good for a woman to smoke.” (Female Smoker)
“Back home smoking is really looked down upon, something that women could not do in public, but men could.” (Female Non-smoker)
“It looks bad if a girl smokes. She gives a bad example, to her kids. If you see a woman smoking and drinking, you think she’s a certain kind of woman, you think she walks the streets.” (Male Smoker)
Acknowledgements
Research Partnership
This research was supported by grant #P60MD from the National Center on Minority Health and Health Disparities (NCMHD) of the National Institutes of Health (NIH).
The research team is grateful to several community partners for their support of and contributions to this project:
The focus group participants
The Hopkins Center for Health Disparities Solutions
The Esperanza Center staff and clients
The Latino Providers Network
Father Gustavo Arias-Gómez and the St. Michael’s Parish
Youth Group
Mr. Dominic Smith
The Johns Hopkins School of Public Health research team partnered with Esperanza Center, an community-based organization providing health, legal, literacy, and other social services to immigrants in East Baltimore.
Key staff from Esperanza Center participated in each stage of the research process, including:
-development and tailoring of
research instruments;
-identifying and recruiting
participants
-reviewing and contributing to
relevant presentations and
manuscripts
Immigration & Smoking
Key Findings
“There are a lot of young people who when they come here they go off the rails, start drinking and smoking.” (Female Smoker)
“Latin women smoke more here because often you can do it without other people seeing you.” (Female Non-smoker)
“Yes, it got much worse, I never smoked in El Salvador. I came here, and now I smoke a lot.” (Male Smoker)
“When I started going to school here (in the U.S.) I picked up the habit. Since then I was smoking 2 packs a day. But I don’t smoke anymore.” (Male Smoker)
The data identified multiple social and familial influences on Hispanic young adults' smoking and non-smoking behaviors:
Cultural identity and gender norms leverage substantial influence
-Due to gendered cultural norms, recruitment of female participants
for both the smoking and non-smoking focus groups was challenging.
-Participants identified changes in smoking behavior related to
immigration from their home countries to the United States.
Despite participants’ acknowledgement of the high price of cigarettes, cost was not mentioned a factor influential in their smoking decisions.
Contact information
Jennifer McCleary-Sills, MPH
PhD Candidate
Department of Health, Behavior, and Society
Johns Hopkins Bloomberg School of Public Health
Esperanza Center, East Baltimore
Photo Source: JHSPH SOURCE web site