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Tobacco use in the Dominican Republic: understanding the culture first
  1. A M Dozier1,
  2. D J Ossip-Klein2,
  3. S Diaz3,
  4. N P Chin2,
  5. E Sierra2,
  6. Z Quiñones3,
  7. T D Dye2,
  8. S McIntosh2,
  9. L Armstrong2
  1. 1Department of Community and Preventive Medicine, University of Rochester Medical Center, Rochester, New York, USA
  2. 2University of Rochester Medical Center, Rochester, New York, USA
  3. 3Pontificia Universidad Catolica Madre y Maestra, Dominican Republic
  1. Correspondence to:
 Ann M Dozier
 RN, PhD, Department of Community and Preventive Medicine, 601 Elmwood Avenue – Box 324, University of Rochester Medical Center, Rochester, New York 14642, USA; ann_dozier{at}


Objective: To conduct formative research on the landscape of tobacco use to guide survey and subsequent intervention development in the Dominican Republic (DR).

Design: Rapid Assessment Procedures, systematic qualitative methods (participant-observations, in-depth interviewing, focus groups) using bilingual mixed age and gendered teams from the United States and DR.

Subjects: Over 160 adults (men and women), ages 18 to 90 years, current, former and never smokers, community members and leaders from six underserved, economically disadvantaged DR communities.

Main outcome measures: Key domains: tobacco use patterns and attitudes; factors affecting smoking initiation, continuation, quitting; perceived risks/benefits/effects of smoking; and awareness/effects of advertising/regulations.

Results: Perceptions of prevalence varied widely. While “everybody” smokes, smokers or ex-smokers were sometimes difficult to find. Knowledge of health risks was limited to the newly mandated statement “Fumar es prejudicial para la salud” [Smoking is harmful to your health]. Smokers started due to parents, peers, learned lifestyle, fashion or as something to do. Smoking served as an escape, relaxation or diversion. Quit attempts relied on personal will, primarily for religious or medical reasons. Social smoking (custom or habit) (< 10 cigarettes per day) was viewed as a lifestyle choice rather than a vice or addiction. Out of respect, smokers selected where they smoked and around whom. Health care providers typically were reactive relative to tobacco cessation, focusing on individuals with smoking related conditions. Tobacco advertising was virtually ubiquitous. Anti-tobacco messages were effectively absent. Cultures of smoking and not smoking coexisted absent a culture of quitting.

Conclusions: Systematic qualitative methods provided pertinent information about tobacco attitudes and use to guide subsequent project steps. Integrating qualitative then quantitative research can be replicated in similar countries that lack empirical data on the cultural dimensions of tobacco use.

  • CTC, Community Technology Centers
  • DM, Dominican Republic
  • FCTC, Framework Convention for Tobacco Control
  • LAC, Latin American and Caribbean
  • LINCOS, Little Intelligent Communities
  • RAP, rapid assessment procedure
  • UR, University of Rochester
  • Dominic Republic
  • tobacco
  • global
  • qualitative methods

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  • Funding: This study was supported by NIH Fogarty International Center Grant #TW05945 (Ossip-Klein, PI)

  • Dr Ann Dozier and Dr Ossip-Klein on behalf of themselves and the other authors have no competing interest relative to the study reported in this manuscript

  • Approval from the University of Rochester IRB was obtained prior to beginning RAPs. Given the project’s preliminary stage, approval was not required from the DR’s nationally and internationally recognised ethics committee (IRB); however, the full protocol was submitted for their records