title: Tobacco Cessation in Economically Disadvantaged Dominican Republic Communities: Who are the Ex-Users?
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Ossip
authors.affiliation: Pontificia Universidad Católica Madre y Maestra, Santiago, Dominican Republic.
authors.forename: Zahíra
authors.initials: Z
authors.lastname: Quiñones
authors.affiliation: Pontificia Universidad Católica Madre y Maestra, Santiago, Dominican Republic; Hospital Regional Universitario José Maria Cabral y Baez, Santiago, Dominican Republic.
authors.forename: Sergio
authors.initials: S
authors.lastname: Diaz
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Thevenet-Morrison
authors.affiliation: Department of Clinical Sciences, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Fisher
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Holderness
authors.affiliation: Department of Biostatistics, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Xeuya
authors.initials: X
authors.lastname: Cai
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: McIntosh
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Dozier
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Chin
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Weber
authors.affiliation: Pontificia Universidad Católica Madre y Maestra, Santiago, Dominican Republic.
authors.forename: Jose Javier
authors.initials: JJ
authors.lastname: Sanchez
authors.affiliation: Centro de Atención Primaria Juan XXIII, Santiago, Dominican Republic.
authors.forename: Arisleyda
authors.initials: A
authors.lastname: Bautista
authors.affiliation: Private Practice, Santiago, Dominican Republic.
authors.forename: Almonte
authors.initials: A
authors.lastname: Héctor