title: A Qualitative Study Among Mexican Americans to Understand Factors Influencing the Adoption and Enforcement of Home Smoking Bans.
abstract: BACKGROUND
  One-third of Mexican-American children, in addition to nonsmoker adults, are exposed to secondhand smoke at home, yet few interventions target Mexican-American households. An effective, brief English language program, tested with United Way 2-1-1 callers in Atlanta, increased home smoking bans (confirmed by air monitors). Two randomized controlled trials in North Carolina and Texas replicated those results. We explored factors determining adoption and enforcement of smoking bans in Mexican-American households to inform program linguistic and cultural adaptation to broaden program reach and relevance.
  
  
  METHODS
  Bilingual interviewers recruited convenience samples of Mexican-American smokers and nonsmokers living with at least one smoker in Houston and San Diego households and asked open-ended questions regarding conditions for implementing home and vehicle smoking bans and conditions for varying acceptance of bans. Investigators independently reviewed English transcripts and completed a descriptive analysis using ATLAS.ti.
  
  
  RESULTS
  Participants (n = 43) were predominantly female (n = 31), current smokers (n = 26), interviewed in Spanish (n = 26), had annual household incomes less than $30000 (n = 24), and allowed smoking inside the home (n = 24). Themes related to difficulty creating and enforcing bans included courtesy, respect for guests and heads of household who smoke, and gender imbalances in decision making. Participants viewed protecting children's health as a reason for the ban but not protecting adult nonsmokers' health.
  
  
  CONCLUSIONS
  A dual-language, culturally adapted intervention targeting multigenerational Mexican-American households should address household differences regarding language and consider influences of cultural values on family dynamics and interactions with guests that may weaken bans.
  
  
  CONCLUSIONS
  Qualitative interviews suggested cultural and family considerations to address in adapting a brief evidence-based smoke-free homes intervention for Mexican Americans, including traditional gender roles, unique contexts of multigenerational households, and language preferences. Our work confirms previous research among Latinos regarding importance of common cultural constructs, such as respeto (deference), simpatia (courtesy and agreeability), and familismo (family attachment), which inform behaviors that may impede or facilitate adopting and enforcing home smoking bans. Decision-making gender imbalances, high regard for head-of-household and guest smokers, and less sensitivity to the health of nonsmoker adults compared with children may lead to permission to smoke indoors.
authors.affiliation: Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX.
authors.forename: Lara S
authors.initials: LS
authors.lastname: Savas
authors.affiliation: Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX.
authors.forename: Patricia Dolan
authors.initials: PD
authors.lastname: Mullen
authors.affiliation: Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA.
authors.forename: Melbourne F
authors.initials: MF
authors.lastname: Hovell
authors.affiliation: Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Cam
authors.initials: C
authors.lastname: Escoffrey
authors.affiliation: Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Fernandez
authors.affiliation: Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Jones
authors.affiliation: Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX.
authors.forename: Jazmine
authors.initials: J
authors.lastname: Cavazos
authors.affiliation: Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX.
authors.forename: Jo Ann A
authors.initials: JAA
authors.lastname: Gutierrez Monroy
authors.affiliation: Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Kegler
mesh_terms: D000328:Adult; D002140:California / Q000208:ethnology; D002648:Child; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D017058:Mexican Americans / Q000523:psychology*; D008800:Mexico / Q000208:ethnology; D036301:Qualitative Research; D061845:Smoke-Free Policy; D012907:Smoking / Q000208:ethnology* / Q000523:psychology*; D000074606:Smoking Prevention / Q000379:methods; D011795:Surveys and Questionnaires; D013781:Texas / Q000208:ethnology; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*
chemical_list: D014028:Tobacco Smoke Pollution