Tobacco use in six economically disadvantaged communities in the Dominican Republic

Abstract

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.

Tobacco Use and Exposure to Secondhand Smoke Among Pregnant Women in the Dominican Republic: An Exploratory Look into Attitudes, Beliefs, Perceptions, and Practices

“…The implemented questionnaire also included items from the study of Ossip-Klein et al (2008) to assess demographic information, parental tobacco use history, health care provider questions, and exposure to tobacco use and marketing. The questionnaire was administered in interview format in order to include women who were of low literacy or illiterate.…”

“…The second stage consisted of pretesting the survey (in both English and Spanish), which involved receiving feedback from colleagues on content, formatting, structure, and cultural appropriateness to create a final draft for the pilot testing phase. Pilot testing involved a real-life administration of all study procedures (e.g., recruitment, verbal consent, screening questions, and survey administration) with a small convenience sample of pregnant women very similar to the target population (Ossip-Klein et al, 2008). The results from all three development phases resulted in a final survey instrument that was culturally specific to the Dominican Republic.…”

“…The following variables were adapted from Bloch et al (2008) for direct comparison to the Latin American countries, Argentina, Uruguay, Ecuador, Brazil, and Guatemala included in that study and from Ossip-Klein et al (2008).…”

“…The Dominican Republic is an important country to study because it is a tobacco-producing country in the LAC region, with high levels of poverty and no coordinated surveillance systems or infrastructures in place to monitor tobacco use and tobacco-related disease, disabilities, and deaths (Ossip-Klein et al, 2008). Early data from the Dominican Republic indicated that 17% of women smoke (1993 data) and approximately 65% of women who had ever been pregnant smoked during most of their pregnancies (1989 estimate;Ozawa, Bello, Ito, and Saito, 1997;Pan American Health Organization, 1992;Shafey et al, 2003).…”

The Global Tobacco Epidemic

“…For example, we have identified wide geographic variability as well as novel forms of tobacco use in our work in the Dominican Republic. 14,15 Evidence for harm is available for at least some noncigarette products, such as waterpipes 16 and chewed tobacco in the form of betel quid, 17 whereas limited but emerging data are available for new and often unregulated products such as electronic cigarettes. 18 Second, there is a need to track tobacco use in special populations such as other substance users, and vulnerable populations such as pregnant women, children, older adults, and the economically disadvantaged, whose trajectories for use and exposure may vary from that of other groups and for whom focused interventions may be needed.…”