Researchers from Moffitt Cancer Center and the University of South Florida have evaluated how Florida health care and social service agencies distribute “Libres para Siempre” (“Forever Free®”), a Spanish smoking relapse prevention booklet series.

Their analysis found that 10 agencies distributed the booklets actively and passively, but those methods may not have helped the material reach its intended audience, Spanish-speaking smokers who have quit but are at risk for relapse.

Their study appeared in a March issue of the Journal of Cancer Education.

“Previous research suggests that although the current smoking rates among Hispanics are lower than the overall prevalence in the United States, Hispanic smokers are less likely to quit successfully or to use smoking cessation aids,” said study co-author Vani Nath Simmons, Ph.D., assistant member of the Health Outcomes and Behavior Program at Moffitt. “Consequently, there is a great need to increase the availability of culturally relevant tobacco information in Spanish. The first aim of this study was to evaluate the distribution process of ‘Libres para Siempre’ to identify the strategies, methods and barriers to distribution. Secondly, we wanted feedback from the agencies on the booklets’ quality and usefulness.”

The researchers noted that the relapse rate for self-quitters is 95 to 98 percent and that Hispanic smokers are less likely than their non-Hispanic white counterparts to be advised to quit smoking.

“Forever Free®,” a series of self-help booklets developed at Moffitt to help smokers, who have quit from relapsing, was found to be cost effective and beneficial for reducing smoking relapse among English speakers. To increase its reach to more diverse populations, the “Forever Free®” booklets were adapted to create a culturally appropriate Spanish version, “Libres para Siempre.” This study examined how health care and social service agencies in Florida disseminated those Spanish booklets.

“To truly make an impact, we needed to make sure the booklets were getting into the hands of the intended audience,” Simmons said.

Active distribution included in-person presentation of the booklets at community events or use of the booklet as part of counseling or tobacco-related classes. Passive distribution included displaying the booklet at agency lobbies, events and health fairs.

There were barriers to optimal distribution. For example, the booklets are a set of eight. Some agencies distributed booklets individually. Some distributors gave booklets to those who may have been interested in quitting smoking, rather than those who had quit and were likely to relapse. The booklets target those in danger of relapse.

“Understanding how these booklets are used in the real world can lead to future research to test alternative distribution strategies,” noted Simmons. “We determined that some agencies were unable to understand the distinction between interventions for initial smoking cessation and intervention as relapse prevention.”

In evaluating the quality and usefulness of the booklets, agency representatives found them beneficial for their clients.

The authors concluded that the distribution process for “Libres para Siempre” could serve as a pilot study to evaluate strategies and methods of distribution, and find the best ways to reach those Hispanics needing relapse prevention materials.

Funding for the study came from the University of South Florida Area Health Education Center and the Florida Department of Health.

About Moffitt Cancer Center
Located in Tampa, Moffitt is one of only 41 National Cancer Institute-designated Comprehensive Cancer Centers, a distinction that recognizes Moffitt’s excellence in research, its contributions to clinical trials, prevention and cancer control. Since 1999, Moffitt has been listed in U.S. News & World Report as one of “America’s Best Hospitals” for cancer. With more than 4,200 employees, Moffitt has an economic impact on the state of nearly $2 billion.

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H. Lee Moffitt Cancer Center & Research Institute