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Culture, Diversity, Ethnicity and Tobacco UseMaryland Center for Quitting Use and Initiation of TobaccoMDQUIT.ORG
What is Culture?The confluence of genetic, familial, social, political, and historical influences that can shape
how individuals view themselves and their world,process experiences, and communicate and interact with others.
There are multiple subcultures in which individuals live (diversity within and across individuals)Individual participation/identification in a culture vary in how integrated into life and perspectiveCultural influences are not always conscious or explicit
CultureOften we use ethnicity and race as a measure of culture and diversityHowever, this is problematic since we can overlook diversity within an ethnic or cultural subgroup and overlook the dynamic nature of culture so we really develop cultural stereotypesActually each of us lives embedded in our own unique and often shared cultureCulture represents our lives in context and how that context affects our experiences and our views, beliefs and values
Cultural Competence
Understanding that there is often a gap between what we believe and how we see an issue and how someone in another cultural context sees the issueThe challenge is to create a shared narrative or view that both sides can understandCreating shared realities is the only way to create cultural competence
Our Goal TodayTo learn about how smoking, nicotine and various approaches to prevention and treatment of tobacco use can be better understood among subgroups of our population in MarylandTo explore ways
To create a shared view of the problem and the solution To acknowledge and develop a respect for cultural considerations of the various groups of individuals we want to reach with tobacco prevention and cessation messages.
Comparing Maryland Smoking Prevalence with Quitline Callers by Race & Ethnicity
Prevalence 2006 data and Quitline UseJan 1, 2007 through Dec 31, 2007
Data Sources: Free & Clear® Quarterly Reports 2007; 2006 Maryland Adult Tobacco Survey; Free & Clear® Maryland Quitline Year 2 Evaluation Report, Prepared by SSI, Inc.
Tobacco Use Prevalence, Quitline Use, and Satisfaction
Examination of the # of calls to Maryland Quitline (1-800-QUITNOW) for a full year
January 1, 2007 through December 31, 2007Examination of the prevalence of tobacco use in Maryland
Data derived from the 2006 Maryland Adult Tobacco Survey (MATS)
SSI, Inc. evaluated a sub-sample of callers to the MD Quitline & assessed their satisfaction with QL services
SSI, Inc = Social Solutions International, Inc.
Maryland Statewide Race & Ethnicity
0.6
1.2
3.6
39.1
53.7
1.7
0.0 10.0 20.0 30.0 40.0 50.0 60.0
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent of Callers (N= 5,982)
5.4
23.6
18.7
18.7
17.0
13.8
0.0 5.0 10.0 15.0 20.0 25.0 30.0
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent using tobacco
2007 Quitline Tobacco Users by Race & Ethnicity
2006 Prevalence of Tobacco Use by Race & Ethnicity
Source: 2006 Maryland Adult Tobacco SurveySource: 2007 Free & Clear® Quarterly Reports
Baltimore Region
2007 Quitline Tobacco Users by Race & Ethnicity
2006 Prevalence of Tobacco Use by Race & Ethnicity
Anne Arundel, Baltimore, Carroll, Harford, Howard, and Baltimore City
Source: 2007 Free & Clear® Quarterly Reports Source: 2006 Maryland Adult Tobacco Survey
9.5
25.7
23.1
20.0
21.3
18.6
0 5 10 15 20 25 30
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent using tobacco
0.5
1.2
2.9
38.1
55.6
1.9
0.0 10.0 20.0 30.0 40.0 50.0 60.0
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
up
Percent of Callers (N=4,308)
Baltimore City2007 Quitline Tobacco Users
by Race & Ethnicity Baltimore City
2006 Prevalence of Tobacco Use by Race & Ethnicity
Baltimore City
0.2
1.1
2.6
23.3
71.3
1.6
0 10 20 30 40 50 60 70 80
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent of Callers (N=2,709)
Source: 2007 Free & Clear® Quarterly Reports Source: 2006 Maryland Adult Tobacco Survey
17.8
32.0
33.6
18.7
23.7
25.8
0 10 20 30 40
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent using tobacco
Baltimore County2007 Quitline Tobacco Users
by Race & Ethnicity Baltimore County
2006 Prevalence of Tobacco Use by Race & Ethnicity Baltimore County
Source: 2007 Free & Clear® Quarterly Reports Source: 2006 Maryland Adult Tobacco Survey
14.9
29.6
21.5
19.9
14.7
0 5 10 15 20 25 30
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent using tobacco
0.9
1.3
3.3
57.7
34.8
2.3
0 10 20 30 40 50 60 70
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent of Callers (N=1,025)
Counties Bordering Baltimore City & Co.
1.1
1.6
3.5
73.2
18.6
2.4
0 10 20 30 40 50 60 70 80
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent of Callers (N=547)
2006 Prevalence of Tobacco Use by Race & Ethnicity
Bordering Counties
2007 Quitline Tobacco Users by Race & Ethnicity
Anne Arundel, Carroll, Harford, and Howard Counties
Source: 2007 Free & Clear® Quarterly Reports Source: 2006 Maryland Adult Tobacco Survey
9.7
28.3
6.6
19.3
15.3
18.5
0 5 10 15 20 25 30
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent using tobacco
Suburban Washington Region
1.1
0.5
7.2
21
67.2
4.7
0 10 20 30 40 50 60 70 80
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent of Callers (N=989)
2007 Quitline Tobacco Users by Race & Ethnicity
2006 Prevalence of Tobacco Use by Race & Ethnicity
Frederick, Montgomery, and Prince George’s Counties
Source: 2007 Free & Clear® Quarterly Reports Source: 2006 Maryland Adult Tobacco Survey
2.2
6.9
15.3
14.3
13.1
9.7
0 5 10 15 20 25 30
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent using tobacco
Southern Maryland Region
2007 Quitline Tobacco Users by Race & Ethnicity
2006 Prevalence of Tobacco Use by Race & Ethnicity
Calvert, Charles, and St Mary’s Counties
0.8
3.1
2.3
50.4
41.1
1.6
0 10 20 30 40 50 60
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent of Callers (N=129)
20.4
10.3
21.9
0.0 5.0 10.0 15.0 20.0 25.0
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent using tobacco
Source: 2007 Free & Clear® Quarterly Reports Source: 2006 Maryland Adult Tobacco Survey
Lower Eastern Shore Region
2007 Quitline Tobacco Users by Race & Ethnicity
2006 Prevalence of Tobacco Use by Race & Ethnicity
Dorchester, Somerset, Wicomico, and Worcester Counties
2.3
2.8
2.3
65.5
24.9
3.4
0 10 20 30 40 50 60 70
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent of Callers (N=177)
22.6
20.7
19.9
18.5 19.0 19.5 20.0 20.5 21.0 21.5 22.0 22.5 23.0
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent using tobacco
Source: 2007 Free & Clear® Quarterly Reports Source: 2006 Maryland Adult Tobacco Survey
Upper Eastern Shore Region
2007 Quitline Tobacco Users by Race & Ethnicity
2006 Prevalence of Tobacco Use by Race & Ethnicity
Caroline, Cecil, Kent, Queen Anne’s, and Talbot Counties
0
1.5
2.7
83.5
11.9
1.9
0 10 20 30 40 50 60 70 80 90
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent of Callers (N=260)
21.7
24.5
28.3
0.0 5.0 10.0 15.0 20.0 25.0 30.0
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent using tobacco
Source: 2007 Free & Clear® Quarterly Reports Source: 2006 Maryland Adult Tobacco Survey
Western Maryland Region
2007 Quitline Tobacco Users by Race & Ethnicity
2006 Prevalence of Tobacco Use by Race & Ethnicity
Allegany, Garrett, and Washington Counties
0
1
3.1
81.4
14.4
4.2
0 10 20 30 40 50 60 70 80 90
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent of Callers (N=97)
20.1
23.4
21.9
18.0 19.0 20.0 21.0 22.0 23.0 24.0
Asian
Am. Indian
Other
White
Black
Hispanic
Rac
ial &
Eth
nic
Gro
ups
Percent using tobacco
Source: 2007 Free & Clear® Quarterly Reports Source: 2006 Maryland Adult Tobacco Survey
5.6
39.7
54.8
2.2
22.5
28.6
31.6
17.3
6.7
64.0
29.3
5.7
0 20 40 60 80
Other
White
Black
Hispanic% of MD Population% of Smokers% of QL Callers
Quitline Reach in MD by Race & Ethnicity
Reach Effect Hispanic 0.13 Black 1.73 White 1.39 Other 0.25
Source: Free & Clear® Maryland Quitline Year 2 Evaluation Report, Prepared by SSI, Inc.
QL EvaluationRespondents were 285 tobacco users 18-85 (M = 46.1 ± 11.9) years of age60.1% were female51.2% were Black or African American8.1% were Hispanic40.3% graduated from high school and 45.2% reported some post-high school educationAlmost all (98.6%) were cigarette smokersOver 2/3 (75.7%) reported smoking for 20 or more years3/4 (74.9%) reported smoking a pack a day or lessApproximately 3/4 enrolled in the multi-call program and 1/4 enrolled in the one-call program
Quitline SatisfactionEvaluation Sample: 285 tobacco users who received Quitline services between Jan 1
and Sep 28, 2007.Question: "Overall, how satisfied were you with the quitline?”
Results:Satisfaction was consistent across race, age, gender, education
level.Overall satisfied with services (“very”, “mostly”, or “somewhat”):
89.8% of Whites or Caucasians91.6% of Blacks or African Americans surveyed100% of Hispanics surveyed
Source: Free & Clear® Maryland Quitline Year 2 Evaluation Report, Prepared by SSI, Inc.
Underage Tobacco Use
Source: 2006 Maryland Youth Tobacco Survey (MYTS)
Statewide Rates of Current (past month) Tobacco Use among Underage Youth (2006 MYTS)
16.7
34.5
22.7
13.3
18.2
12.8
0 5 10 15 20 25 30 35 40
White
Native Hawaiian / PacificIslander
Alaskan Native /American Indian
Asian
Hispanic / Latino
Black / African-American
Percent Using Tobacco
Statewide Current (past month) Tobacco Use by School Status
24.6
38.0
35.4
18.5
24.5
15.6
5.5
22.3
11.7
4.6
8.2
8.6
0 5 10 15 20 25 30 35 40
White
Native Hawaiian / PacificIslander
Alaskan Native /American Indian
Asian
Hispanic / Latino
Black / African-American
Percent Using Tobacco
High School Middle School1.8
2.9
4.0
3.0
1.7
4.5
Transition rate
Underage Tobacco Use by Individual Grades
32.4
21.6
23.0
25.5
13.2
5.8
3.0
31.9
22.7
24.5
22.3
13.2
7.8
6.0
17.3
14.6
15.7
15.0
11.7
9.3
5.8
34.2
28.1
22.4
16.0
9.4
5.0
2.4
0.0 10.0 20.0 30.0 40.0
12th
11th
10th
9th
8th
7th
6th
Gra
de
Percent Using Tobacco
WhiteBlack / African-AmericanHispanic / LatinoOther
Conclusions
We need to evaluate our reach into communities that have different cultural experiences We are reaching some groups with targeted approachesHopefully in dialogue with our speakers and our local health professionals we can become more effective in engaging all our subgroups by listening to their needs and addressing their concerns
MDQUIT Resource Center for Tobacco Use Prevention and Cessation
Dr. Carlo DiClemente, DirectorDr. Janine Delahanty, Associate DirectorFrancoise Jean-Louis, Administrative AssistantCenter Specialists
Miranda GarayPreston GreeneMeredith HolmgrenDebra Malfi (On Internship)Onna VanOrden
Undergraduate Research AssistantsHabits Lab Graduate Research Assistants