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Cigarette smoking is the leading cause of preventable morbidity and mortality in the United States among all ethnic groups. National and regional surveys have found that on average Latinos smoke at lower rates than do whites and that among current smokers, Latinos smoke fewer cigarettes per day than do these other groups. Data from the 1997 National Health Interview Survey (NHIS) showed that the overall prevalence of current cigarette smoking was lower for Latinos (20.4%) than for whites (25.3%), although rates vary substantially by sex (Centers for Disease Control and Prevention 1999). For Latino men, the rates are approaching those of white men (26.2% vs. 27.4%), whereas for Latina women, the rates are low relative to white women (14.3% vs. 23.3%) (Centers for Disease Control and Prevention 1999). In the United States, from 1988 to 1995, the number of Latinos who reported being current smokers increased from 2.8 to 3.2 million. Concurrently, the number of Latinos who reported quitting decreased from 2.2 to 2.0 million, and the number of Latinos who have never smoked increased from 6.8 to 11.5 million (Centers for Disease Control and Prevention 2000c). For those who reported smoking every day, more than 20% of the whites reported smoking 21 or more cigarettes per day compared with 7% of the Latinos. For those who reported that they do not smoke every day, 83.4% of the Latinos reported smoking 5 or fewer cigarettes per day compared with 65.5% of the whites (Division of Adult and Community Health 1995-1999). During the 1990s, smoking rates increased among high school students in general (Centers for Disease Control and Prevention 2000). Data from a national survey conducted in 1999 indicated that 11.0% of middle-school Latino students (vs. 8.8% of white students) and 25.8% of high-school Latino students (vs. 32.8% of white students) smoked cigarettes (Centers for Disease Control and Prevention 2000c).

The level of acculturation as measured by a short language-based scale (Marin et al. 1987) appears to influence smoking behavior among Mexican

American and Central American Latinos (Marín et al. 1989; Pérez-Stable et al. 1998). Smoking rates were higher for the more acculturated Latino women but lower for the more acculturated men (Marín et al. 1989). These data suggest that smoking behavior among Latinos becomes more similar to that of whites with increasing levels of acculturation and, as a consequence, that smoking may become a more serious problem for Latino women. When one considers current smoking trends among Latino youth and the adverse effects of acculturation on smoking, increased tobacco-related disease morbidity among Latinos will be a concern in the future (U.S. Department of Health and Human Services 1998).

Latino smokers, especially Mexican Americans, reported smoking an average of 8 and 12 cigarettes per day for women and men, respectively (U.S. Department of Health and Human Services 1998). This number is substantially less than the average 19.1 and 23.4 cigarettes per day reported by white women and men, respectively (U.S. Department of Health and Human Services 1998). Although a lower proportion of highly acculturated Latino men smoke, they reported a greater number of cigarettes per day than less acculturated men (Marín et al. 1989). Among women, a higher proportion smoked, and they reported smoking more cigarettes per day as acculturation level increased (Marín et al. 1989). To some extent, Latinos underreport the consumption of cigarettes per day, but even after adjusting for a 20%-25% rate of underreporting among light smokers, Latinos are lighter smokers than whites; this finding is supported by biochemical studies (Pérez-Stable et al. 1990a, 1992a, 1995; Wells et al. 1998). These observations have important implications for cessation strategies because compared with heavy smokers, light smokers are more likely to successfully quit smoking with appropriate motivational messages and self-help methods (U.S. Department of Health and Human Services 1998).

A strong epidemiologic and clinical association is found between smoking and significant depressive symptoms and clinical depression. It is believed that some people may treat their depressed moods with nicotine. An association between cigarette smoking and significant depressive symptoms has been found in Latinos; an odds ratio (OR) of 1.7 (95% confidence interval [CI] = 1.3-2.2) for significant depressive symptoms was reported for current smokers compared with former smokers (OR = 1.1; 95% CI = 0.8-1.6) and never smokers (reference group) (Pérez-Stable et al. 1990b). The interaction of nicotine dependence with significant depressive symptoms, and how this interaction affects cessation, needs further study at both the individual and the community level (Marín and Pérez-Stable 1995).

Most cigarette smokers who successfully quit do so on their own, moti vated by a variety of psychological, social, and health-related reasons. Policies regulating smoking, media campaigns against smoking, well-designed self-help cessation materials, and advice from clinicians are potential elements of a public health strategy to promote nonsmoking. Given the substantial differences that exist in sociocultural backgrounds among ethnic groups in the United States, it is reasonable to postulate that ethnic differences in cigarette smoking behavior, attitudes, and beliefs should influence the content of smoking cessation intervention strategies. Studies have shown that, compared with whites, Latinos are less likely to smoke due to habitual cues; as likely to smoke due to emotional cues; and more likely to want to quit because of cigarette smoke's effects on others' health, interpersonal relationships, and their own health (Marín et al. 1990; Pérez-Stable et al. 1998). Latinos are also more likely than whites to report quitting smoking for at least 1 day in the previous year (63% vs. 51%) (Pérez-Stable et al. 1998). These data imply that culturally appropriate public health interventions may be an effective method of promoting smoking cessation among Latino smokers.

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