title: Cultural buffering as a protective factor against electronic cigarette use among Hispanic emergency department patients.
abstract: Hispanics in the U.S. historically use tobacco at lower rates than other racial and ethnic groups. Cultural buffering, the process by which aspects of traditional Hispanic culture delay the adoption of unhealthy behaviors, is believed to be a protective factor against tobacco use. Electronic cigarettes (e-cigarettes) are a new tobacco product that have not been extensively studied, and it is unknown if cultural factors that protect against tobacco use will buffer against e-cigarette use among the Hispanic population.
  
  
  
  This cross-sectional study was conducted at the emergency department (ED) in a safety-net hospital in 2014. Patients visiting the ED participated in a survey assessing demographics and substance use. Cultural buffering was operationalized as participants' primary language spoken at home. Multivariate logistic regression and generalized estimating equations examined the association between Hispanic cultural buffering and e-cigarette ever-use.
  
  
  
  Of the 1476 Hispanic ED patients (age: 46.6M±14.5SD, 49.3% male), 7.6% reported e-cigarette ever-use and 11.1% reported current combustible cigarette use. In adjusted models, Spanish speakers were half as likely to report e-cigarette ever-use (O.R.: 0.54, 95% C.I.: 0.34-0.84, p=0.007), compared with English speakers. Combustible cigarette use remained the most significant factor associated with e-cigarette ever-use (O.R.: 9.28, 95% C.I.:7.44-11.56, p<0.001). In higher-income neighborhoods, English speakers reported e-cigarette ever-use at higher rates than Spanish speakers (28.2% vs. 5.9%, p<0.001).
  
  
  
  Cultural buffering was protective against e-cigarette ever-use, especially in higher-income neighborhoods. These results support research on culturally-sensitive prevention programs for new and emerging tobacco products in Hispanic communities.
authors: Department of Emergency Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA. Electronic address: chunnoklam@gmail.com.
authors: Chun Nok
authors: CN
authors: Lam
authors: Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
authors: Nicholas I
authors: NI
authors: Goldenson
authors: Department of Emergency Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
authors: Elizabeth
authors: E
authors: Burner
authors: Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
authors: Jennifer B
authors: JB
authors: Unger
mesh_terms: D000328:Adult; D002140:California; D003430:Cross-Sectional Studies; D003469:Culture; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D065840:Protective Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Cultural buffering; Electronic cigarettes; General estimating equations; Hispanic/Latino; Neighborhood poverty; Primary language