LOPEZ-QUINTERO ET AL. RESPOND

Abstract

A reduction in smoking rates in the United States represents one of the main public health achievements of the past 3 decades. Multiple strategies for smoking cessation at the macro level (e.g., restricted access to tobacco and restricted exposure to tobacco-promoting messages) and to a somewhat lesser extent at the individual level (e.g., behavioral and pharmacological cessation strategies) have contributed to this success.1,2 These interventions, however, have not been disseminated uniformly throughout the population, as reflected by smoking trends1 and physician-provided smoking cessation advice to patients across racial groups.3 Levinson et al. have shown that Hispanic smokers are less likely than non-Hispanic Whites in Colorado to use smoking cessation pharmacotherapy.4 We have not found any nationally representative report on racial differences in pharmacotherapy use and did not address this in our report of physician-provided quitting advice.3 David et al.5 suggested that strategies such as the Community Based Research Partnership (a collaborative approach to research that recognizes the unique contributions of multiple partners)6 enhance nicotine replacement therapy uptake among Hispanics, although the authors provide little information about recruitment success and the specific contributions of the community-based research partnership model to their trial outcomes. Programs that recognize the cultural values, beliefs, and fears of Hispanics and that foster scientific and professional partnerships in and with the community are successful in increasing community participation and awareness.7,8 Community-based research partnerships may be appropriate for smoking prevention and cessation goals in Hispanic populations and warrant further investigation. At the same time, such strategies do not mitigate the responsibility of primary care physicians and other health care providers to promote quitting among their smoking patients of all races. Physician intervention in this area is particularly relevant because advice by a health care provider to quit is associated with an increased use of effective therapies for tobacco dependence, especially among Medicaid patients,9 and because of the proven efficacy of nicotine replacement therapy and other pharmacotherapy.2,4,10 Further headway in reaching national targets for smoking and smoking cessation in all racial groups will likely require a greater involvement of health care providers in the clinic and in the community. An exploration of the multiple approaches to achieving physician–community partnerships is warranted.