Libre Del Cigarrillo

In the United States, more than 16 million people have a disease caused by smoking, such as cancer, heart disease, stroke, and lung diseases. Tobacco cessation can improve health outcomes. In 2015, 22.7 million adult smokers said they wanted to quit, and 7.5% of smokers successfully quit in 2018. Self-help materials can be a cost-effective way to provide smokers resources and tools to help them quit. However, disparities exist for Hispanic smokers, who are less likely than non-Hispanic smokers to receive advice to quit from a health care professional or to be offered tobacco cessation services.

Libre del Cigarrillo is a self-help program for Spanish-speaking Hispanic/Latino smokers that consists of 11 booklets and 9 pamphlets mailed over an 18-month period as well as one support call. The program is a transcreation of Stop Smoking for Good; the development of Libre del Cigarrillo involved translating and culturally adapting Stop Smoking for Good materials for Spanish speakers, including adding a booklet and the support call to enhance the program's alignment with Hispanic/Latino cultural values. Stop Smoking for Good was based on the 12-month Forever Free program, which consists of eight booklets designed to prevent relapse among former smokers by conveying the content of cognitive-behavioral counseling typically provided in a clinic setting.

Two booklets are mailed at enrollment. The first is written for friends and family members of the smoker. It educates friends and family members about how to provide support to help the participant quit smoking. The second, for smokers, is an introduction summarizing the process of quitting, preparing to quit, pharmacotherapies, and potential challenges. The program's remaining nine booklets focus on smoking urges, weight control and smoking, smoking relapse, health and smoking, stress management, lifestyle changes, and remaining smoke free, and they include information on the use of pharmacotherapy. These booklets are sent to smokers at 1, 2, 3, 5, 7, 9, 12, 15, and 18 months after enrollment. The nine trifold pamphlets, sent in the months when no booklet is sent, reinforce key messages about quitting smoking. Written in the first-person narrative of a former smoker, the pamphlets aim to provide a sense of social support.

The 10-minute support phone call, which occurs before the booklets and pamphlets are mailed, provides participants with personal contact and aims to build trust in the program. During the call, which is conducted in Spanish, the staff member describes the purpose of the program, explains how to use the booklets and pamphlets, asks the participant about his or her reasons for wanting to quit smoking, and helps the participant set a quit date.

The support call takes 10 minutes. Time is also required to develop a mailing list and package the program materials to be mailed over an 18-month period.

The intervention is intended for adults who smoke at least five cigarettes per week, want to quit, and prefer to speak in Spanish.

The program is suitable for implementation in the home.

Required resources to implement the program include the following: 

Booklets
-- Booklet 0: Para Mis Familiares y Amigos
-- Booklet 1: Introducción
-- Booklet 2: Los Deseos de Fumar
-- Booklet 3: Dejar de Fumar y el Peso
-- Booklet 4: ¿Qué Ocurre Si Se Fuma un Cigarrillo?
-- Booklet 5: Su Salud
-- Booklet 6: El Estrés y los Estados de Ánimo
-- Booklet 7: El Equilibrio en el Estilo de Vida
-- Booklet 8: Vivir Sin Cigarrillos
-- Booklet 9: Los Beneficios de Dejar de Fumar
-- Booklet 10: El Camino que le Espera

Pamphlets
-- Pamphlet 1: La Historia de Angélica
-- Pamphlet 2: La Historia de Mario
-- Pamphlet 3: La Historia de Rafael
-- Pamphlet 4: La Historia de Jorge Luís
-- Pamphlet 5: La Historia de Carmen
-- Pamphlet 6: La Historia de María Estela
-- Pamphlet 7: La Historia de José Luís
-- Pamphlet 8: La Historia de Carolina
-- Pamphlet 9: La Historia de Ramiro 

For costs associated with this program, please contact the developers, Thomas Brandon and Vani Simmons. (See products page on the EBCCP website for developer contact information.)

A randomized controlled trial compared smokers participating in two mailed self-help interventions that varied in duration and intensity. Researchers recruited Spanish-speaking smokers by advertising on websites, TV, and public transportation as well as through a Cultural Advisory Board (CAB). Smokers called a toll-free telephone number, and eligible smokers (n=1,417)—those who smoked at least five cigarettes per week over the past year, were not already enrolled in a face-to-face smoking cessation program, spoke Spanish only or Spanish and English, preferred receiving materials in Spanish, and were at least 18 years old—were enrolled into one of two groups: Libre del Cigarrillo (LDC, n=714) or usual care (UC, n=703). Participants in the LDC group received the 18-month LDC program, and those in the UC group received a self-help booklet in Spanish that was being disseminated at the time of the study. 

At baseline, participants answered questions on demographics, acculturation, pharmacotherapy use, and nicotine dependence (using the Spanish Fagerström Test for Nicotine Dependence). Across the two groups, the average age of participants was 49.8 years, and 48.3% were women. Most participants identified their race as White (46.6%) or did not report their race (41.0%). Participants reported that they were Mexican/Mexican American (33.8%), Cuban (22.4%), Puerto Rican (16.7%), South American (8.9%), Central American (6.2%), Dominican (2.6%), of more than one subgroup (8.0%), or “other” (1.4%). 

The primary outcome was self-reported 7-day point-prevalence abstinence (i.e., no tobacco cigarettes smoked in the previous 7 days), which was analyzed using logistic regression. Secondary outcomes also assessed abstinence at 30-day point-prevalence and 90-day point-prevalence. Participants were assessed at baseline and at 6-month intervals up to 24 months after baseline.

• The 7-day abstinence rate was higher among LDC participants than UC participants at 6 (p<.001), 12 (p=<.001), 18 (p=.001), and 24 months (p=.002).

Additional Findings

• The 30-day abstinence rate was higher among LDC participants than UC participants at 6 (p<.001), 12 (p<.001), 18 (p=.009), and 24 months (p=.009).

• The 90-day abstinence rate was higher among LDC participants than UC participants at 6 (p<.001), 12 (p<.001), 18 (p=.001), and 24 months (p=.007).

• For male participants, the 7-day abstinence rate was higher in the LDC than UC group at all follow-up points (all p values<.001).

• For female participants, the 7-day abstinence rate was higher in the LDC than UC group at 6 (p=.015) and 12 months (p=.017).

• The cost per quitter in the LDC group at 24 months was $683.93.