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.

A Dominican Republic (DR) based multi-community trial of smoking cessation viewed health care workers (HCWs) as potential interventionists. Effectively engaging them, requires a clear understanding of their attitudes and practices regarding smoking. A Rapid Assessment Procedure, conducted among HCWs in six economically disadvantaged communities, included physicians, nurses, other health professionals, paraprofessionals and lay workers. Attitudes and practices about smoking were consistent across the 82 HCWs and mostly reflected community views. HCWs lacked proactiveness related to smoking cessation and had a limited view of their role, attributing clients’ quitting successes to personal will. Prior cessation training was limited although interest was generally high. Material resources about smoking cessation were virtually absent. DR HCWs’ views represented features both distinct from and common to HCWs elsewhere. Any intervention with HCWs must first raise awareness before addressing their role in smoking cessation, discussing implementation barriers and include training and materials about risks and effective interventions.

Tobacco use is increasing globally, particularly in low and middle-income countries like the Dominican Republic (DR) where data have been lacking. Health care worker (HCW) interventions improve quit rates; asking patients about tobacco use at each visit is an evidence-based first step. This study provides the first quantitative examination of knowledge, attitudes and practices of DR HCWs regarding tobacco use. All HCWs (N = 153) in 7 economically disadvantaged DR communities were targeted with anonymous surveys. Approximately 70% (N = 107) completed the primary outcome item, asking about tobacco use at each encounter. Despite >85% strongly agreeing that they should ask about tobacco use at each encounter, only 48.6% reported doing so. While most (94.39%) strongly agreed that smoking is harmful, knowledge of specific health consequences varied from 98.13% for lung cancer to 41.12% for otitis media. Few received training in tobacco intervention (38.32%). Exploratory analyses revealed that always asking even if patients are healthy, strongly agreeing that tobacco causes cardiac disease, and always advising smoke-free homes were associated with always asking. Overall, results demonstrate a disconnect between HCW belief and practice. Though most agreed that always asking about tobacco was important, fewer than half did so. Gaps in HCW knowledge and practices suggest a need for education and policy/infrastructure support. To our knowledge, this is the first reported survey of DR HCWs regarding tobacco, and provides a foundation for future tobacco control in the DR.

Engaging partners for tobacco control within low and middle income countries (LMICs) at early stages of tobacco control presents both challenges and opportunities in the global effort to avert the one billion premature tobacco caused deaths projected for this century. The Dominican Republic (DR) is one such early stage country. The current paper reports on lessons learned from 12 years of partnered United States (US)-DR tobacco cessation research conducted through two NIH trials (Proyecto Doble T, PDT1 and 2). The projects began with a grassroots approach of working with interested communities to develop and test interventions for cessation and secondhand smoke reduction that could benefit the communities, while concurrently building local capacity and providing resources, data, and models of implementation that could be used to ripple upward to expand partnerships and tobacco intervention efforts nationally. Lessons learned are discussed in four key areas: partnering for research, logistical issues in setting up the research project, disseminating and national networking, and mentoring. Effectively addressing the global tobacco epidemic will require sustained focus on supporting LMIC infrastructures for tobacco control, drawing on lessons learned across partnered trials such as those reported here, to provide feasible and innovative approaches for addressing this modifiable public health crisis.

Introduction Tobacco use and harm continue to increase in low- and middle income countries (LMICs) globally. Smoking cessation is the most effective means of reducing morbidity and mortality from tobacco use. Increasing the prevalence of ex-users is an indicator of population cessation. Aims This study provides the first examination of factors associated with ex-tobacco use status in the Dominican Republic (DR), a LMIC in the Latin America and Caribbean region. Methods Baseline surveillance was conducted for 1177 randomly selected households in 7 economically disadvantaged DR communities (total N=2680 adult household members). Results Ex-user prevalence was 10.6% (1.0%–18.5% across communities), 14.8% were current users (9.1–20.4), and quit ratios were 41.7% (9.7%–52.7%). Among ever-users, females (OR 2.02, 95% CI 1.41, 2.90), older adults (45–64: OR 1.75, 95% CI 1.12, 2.74; 65+: OR 2.09, 95% CI 1.29, 3.39), and those who could read/write (OR 1.64, 95% CI 1.08, 2.50), had health conditions (OR 1.63, 95% CI 1.11, 2.41), and lived with ex-users (OR 1.70, 95% CI 1.12, 2.58) were over 60% to two times as likely to be ex-users. Those from remote communities (OR 0.52, 95% CI 0.36, 0.74), using chewed tobacco (OR 0.14, 95% CI 0.04, 0.48) and living with tobacco users (OR 0.55, 95% CI 0.37, 0.81) were less likely to be ex-users. Conclusions Ex-user prevalence and quit ratios were lower than for high income countries. Implementing broad tobacco control measures, combined with clinically targeting vulnerable groups, may increase tobacco cessation to most effectively reduce this public health crisis.

Background Tobacco use and exposure are serious public health problems that threaten to undermine improvements in maternal and child health, and add to already existing poor pregnancy outcomes in many low- and middle-income countries. The purpose of this study is to explore factors that characterize tobacco use and cessation during pregnancy among women in the Dominican Republic. Methods This study was part of a larger trial and includes a sample of women who participated in baseline surveillance and community assessments (N=613). Descriptive, bivariate, and multivariable analyses were conducted. Results Overall, 93.31% (n=572) of women experienced a past/current pregnancy and 22.44% (n=127) smoked during a past or current pregnancy. Among women who had smoked, 34.13% (n=43) stopped smoking due to a pregnancy, and 46.03% (n=58) were advised by a health care provider to quit smoking because of pregnancy. Women who were older, Catholic, and had a mother who used tobacco were three times more likely to smoke during a past or current pregnancy. Inability to read or write was also significantly associated with smoking during pregnancy. Women who were able to read and write and were from a tobacco growing community were three times more likely to quit smoking during pregnancy. Conclusion This study provides a preliminary understanding of factors influencing tobacco use and cessation among pregnant women in the Dominican Republic. It also informs a critical area for public health research and intervention, indicating opportunities to engage the health care provider community in intervening with pregnant women and their families.

Understanding social conditions prior to intervention design can enhance tobacco control interventions. This paper describes formative research conducted in 2010 about tobacco use in eight economically disadvantaged Dominican Republic (DR) communities, four of which participated in a previous intervention study (2003-2008). A combined US-DR team used a Rapid Assessment Process to collect qualitative social and cultural data on tobacco use, knowledge, and attitudes plus observations about social and policy factors such as exposure to secondhand smoke (SHS), tobacco regulations, pregnancy, health care provider (HCP) practices, and sustainability of the 2003-2008 intervention. This assessment found that tobacco use varied by age. While all ages typically used cigarettes, older adults used relatively more unprocessed tobacco, seen as less harmful and less addictive. Middle-aged smokers typically used commercial cigarettes, viewed as dangerous, addictive, expensive, and offensive. Young adults reported avoiding smoking but using relatively more smokeless tobacco. Smoking during pregnancy has reportedly decreased. SHS was viewed as harmful, although smokefree homes were uncommon. HCPs discussed tobacco issues mostly for patients with tobacco-related conditions. Sustainability of the 2003-2008 intervention appeared to be linked to active Community Technology Centers with strong leadership, and community social capital. This information could be used to design better targeted interventions in these communities.