Tailoring Evidence-Based Tobacco Control Interventions to Low-Middle Income Countries: A case example from the Dominican Republic

Using community partnership models to tailor evidence based smoking cessation interventions to local culture positively affected awareness and health care provider behavior. Both quantitative and qualitative formative baseline data informed the tailoring. This clinical trial compared three intervention and three control communities in the Dominican Republic. All were economically disadvantaged and matched on rural/urban and tobacco growing status. Interventions, based on evidence from other countries, included 1) community awareness raising (tobacco use risks, cessation benefits/resources (radio spots, community talks, health fairs, posters/printed materials, community partnerships) and 2) community cessation initiatives (training local Tobacco Cessation Specialists (TCS) and clinics/hospitals, and training health care providers (HCP) in brief interventions (3As model) with referral to TCS. The post intervention measure occurred approximately one year after intervention roll out. Preliminary data suggest changes in intervention vs. control communities, based on household surveillance data (N= 1105 yr1, 1092 yr2), community surveys (N=526 yr1, 525 yr2), and smoker cohort surveys (N=257 yr1, 255 yr2). Data were collected by trained local data collectors. In intervention communities, awareness about tobacco use and cessation resources increased (83% to 91%). Tobacco use prevalence decreased (21% to 17%), and former tobacco users increased (5.8% to 9.5%). Smokers reported HCPs asking about smoking increased (49% to 68%); HCP advising to quit increased from 53-65%. Tailoring evidence-based tobacco control interventions demonstrated encouraging results. In-depth understanding of the target population and overall community landscape, working from a community-participatory perspective, and implementation flexibility may increase the likelihood of such interventions becoming sustainable community resources.