The Dominican Republic (DR) is a tobacco-growing country and tobacco control efforts have been virtually nonexistent. This study provides a first systematic surveillance of tobacco use in 6 economically disadvantaged DR communities (2 small urban, 2 peri-urban, 2 rural; half were tobacco-growing). Approximately 175 households were randomly selected in each (total N=1048) and an adult household member reported on household demographics and resources (e.g., electricity), tobacco use and health conditions of household members, and household policies on tobacco use. Poverty and unemployment were high in all communities, and significant gaps in access to basic resources such as electricity, running water, telephones/cell phones, and secondary education were present. Exposure to tobacco smoke was high, with 38.4% of households reporting ≥1 tobacco user, and 75.5% allowing smoking in the home. Overall, 22.5% reported using tobacco, with commercial cigarettes (58.0%) or self-rolled cigarettes (20.1%) the most commonly used types. Considerable variability in prevalence and type of use was found across communities. Overall, tobacco use was higher in males, illiterate groups, ages 45+, rural dwellers, and tobacco-growing communities. Based on reported health conditions, tobacco attributable risks, and WHO mortality data, it is estimated that at least 2254 lives could potentially be saved each year in the DR with tobacco cessation. While it is expected that the reported prevalence of tobacco use and health conditions represent underestimates, these figures provide a starting point for understanding tobacco use and its prevalence in the Dominican Republic.

The current ethical structure for collaborative international health research stems largely from developed countries' standards of proper ethical practices. The result is that ethical committees in developing countries are required to adhere to standards that might impose practices that conflict with local culture and unintended interpretations of ethics, treatments, and research. This paper presents a case example of a joint international research project that successfully established inclusive ethical review processes as well as other groundwork and components necessary for the conduct of human behavior research and research capacity building in the host country.