摘要：Objectives. We sought to modify an instrument and to use it to collect information on smoking knowledge, attitudes, beliefs, and behaviors among Hispanics/Latinos, and to adapt survey methods to obtain high participation levels. Methods. Promotoras (outreach workers) conducted face-to-face interviews with 1485 Hispanic adults (July 2007–April 2008). The project team used GeoFrame field enumeration methods to develop a sampling frame from households in randomly selected colonias (residential areas along the Texas–Mexico border that may lack some basic necessities (e.g. portable water), in El Paso, Texas. Results. The revised questionnaire included 36 unchanged items from the State Adult Tobacco Survey, 7 modified items, and 17 new items focusing on possible culturally specific quitting methods, secondhand smoke issues, and attitudes and knowledge about tobacco use that might be unique for Hispanic/Latino groups. The eligibility rate was 90.2%, and the conservative combined completed screener and interview response rate was 80.0%. Conclusions. Strategic, targeted, carefully designed methods and surveys can achieve high reach and response rates in hard-to-reach populations. Similar procedures could be used to obtain cooperation of groups who may not be accessible with traditional methods. The size of the Hispanic population in the United States has changed dramatically over the past 35 years. In 1970, 9.6 million Hispanic adults and children resided in the United States (4.7% of the total population); by July 2006, the number had more than quadrupled, reaching 44.3 million Hispanic adults and children, 14.8% of the total adult population. 1 The growth rate of the Hispanic population was more than 3 times the growth rate of the entire US population between 2000 and 2006. In 2004, the Census Bureau projected that the number of Hispanics living in the United States will reach 102.6 million by the year 2050 and will likely compose about 24% of the population. 2 There is reason to believe that this population may not be readily accessible for data collection. Documentation of some of the potential barriers to participation can be found in ethnographic research carried out during the 2000 Census. 3 Ethnographic studies in colonias (residential areas along the Texas–Mexico border that may lack some basic necessities ) , one of which was in Texas, documented barriers to census enumeration: irregular housing, little or no knowledge of English, limited formal education, concerns regarding confidentiality, and complex and fluid households. Translations, enumeration strategies, advertisements, and reassurance about confidentiality were employed, and resulting evidence reveals success in addressing the concerns. The importance of community collaboration for improving participation rates has been documented. 4 , 5 One health-related behavior of interest for all populations is tobacco use. Hispanic and Latino populations in the United States face unique challenges that may put them at higher risk for tobacco use and for exposure to secondhand smoke for several reasons: (1) racial/ethnic communities continue to be targeted by tobacco industry sponsorship efforts, including Mexican rodeos, Cinco de Mayo (May 5th) festivities, and activities associated with Hispanic heritage month 6 ; (2) more Hispanic and Latino workers may be exposed to secondhand smoke in the workplace than are other groups, despite the fact that there is a high percentage of smoke-free homes and strong support for smoke-free policies in workplaces among Hispanics and Latinos 7 ; (3) preliminary findings suggest that as Hispanic and Latino women become more acculturated into mainstream US society their smoking rates may increase, a pattern that does not seem to be occurring among men, where the rate is already elevated 8 ; and (4) overall prevalence rates of current smoking (smoking every day or some days) among Hispanic adults remains low at 13.3% 9 and among Hispanic high-school students (smoking at least once in the past 30 days) is 16.7%. 10 However, there may be marked differences in prevalence rates among subgroups of Hispanics and Latinos. For example, a recent analysis of 2002–2005 data from the National Survey on Drug Use and Health revealed that for Mexican respondents, the prevalence of past-30-day cigarette smoking was 23.8%, whereas for those self-identified as Puerto Rican the prevalence was 31.5%. 11 Some research has revealed that the attitudes, behaviors, knowledge, and experience of Hispanic and Latino persons residing in the United States regarding tobacco use may differ from those of persons in non-Hispanic groups, which may warrant customized approaches to smoking prevention and cessation programs. 12 , 13 Although Hispanic young adults acknowledge the adverse health effects associated with tobacco use, smoking among Hispanic youths continues to be a social activity. In Hispanic cultures, smoking among females is actively discouraged. Young adults also appear to be unwilling to access resources for cessation partly because family and family relationships are considered to be an integral part of smoking prevention and cessation. Targeted, sustained interventions in the Spanish language may also be limited, in part because of the perception that tobacco use is not a problem among Hispanic and Latino populations. 14 A strategy that may help identify and address tobacco-related issues among Hispanic populations in the United States is the collection of specific data measuring knowledge, attitudes, beliefs, and behaviors that is obtained in culturally sensitive and relevant ways. To this end, M. O., L. L. P., S. L. T., and R. S. C., who were affiliated with the Centers for Disease Control and Prevention's (CDC's) Office on Smoking and Health, examined available survey methods, tobacco-related instruments, and their utility for obtaining information from Hispanic populations. An additional objective was to achieve acceptable levels of participation and response rates from a population that does not always respond to standard telephone or mail survey methods. 3 There were 2 phases to the project; the first focused on designing a Hispanic/Latino Adult Tobacco Survey (Hispanic/Latino ATS) to collect information from this population. The second phase of the project involved developing data collection methods and sampling techniques that would reach the target population (Hispanic and Latino adults living in the United States).
