Development and pilot testing of a culturally-tailored smartphone-delivered intervention for commercial smoking cessation in American Indians

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As many as two out of every three American Indian (AI) adults located in the northern plains region of the US smoke commercial cigarettes. As a result, AIs in the northern plains experience rates of smoking-related cancers as high as three-fold other races. AIs are only about half as likely to quit commercial smoking compared to other races. Poor access and engagement with existing cessation programs has been put forward as a main reason for low quitting in AI smokers. Our long-term goal is to develop cessation interventions for AI commercial smokers that are wide-reaching, engaging, and culturally appropriate. NCI’s QuitGuide is a publicly available smartphone app for smoking cessation that allows for immediate access to interactive treatment content, such as real-time guidance on how to navigate smoking triggers, and therefore has great potential for reaching and engaging AI smokers. However, QuitGuide does not include guidance on triggers unique to AI persons such as commercial cigarette use at pow wows nor does it address traditional tobacco which is a spiritual practice common among AIs in the northern plains. The lack of content on traditional tobacco use is particularly problematic because of our team’s prior research showing that cultural references to traditional tobacco in commercial smoking cessation messages can improve self-efficacy to quit. Our present objective is to develop and pilot test a culturally-tailored version of the QuitGuide in AI commercial smokers. Our hypothesis is that a culturally-tailored QuitGuide will result in greater ratings of feasibility and acceptability in AI smokers versus the standard QuitGuide. The project builds on the Masonic Cancer Center’s and the American Indian Cancer Foundation’s research collaborations with AI communities. Our multidisciplinary team has expertise in AI tobacco use, smoking cessation, tailoring cancer prevention interventions to the cultural of AIs, and smartphone app development. Our community partners represent a rurally located Tribe and an urban clinic serving AIs, both of which are located in the northern plains region of the US. A community advisory board will oversee all activities and we have an agreement to work with the same technology experts who created NCI’s QuitGuide app. Our first aim is to conduct in-depth interviews among AI smokers (n=40) and key-informants (n=10) to guide the cultural tailoring of the QuitGuide that will result in a tailored app prototype. Our second aim is to assess the preliminary feasibility and acceptability of the tailored app prototype using iterative testing among AI smokers (two groups of n=6; N=12) and to refine the app. Our third aim is to conduct a pilot randomized controlled trial to test the feasibility, acceptability, and preliminary efficacy of the tailored QuitGuide app (n=40) versus the standard QuitGuide app (n=40) among AI smokers. At the conclusion, we will have a blueprint to guide the development of a clinical trial intended to test the efficacy of a culturally-tailored version of the QuitGuide smartphone app for AI smokers. Given that AIs in the northern plains experience some of the most extreme smoking disparities, this culturally-tailored treatment approach could have a meaningful public health impact on the burden of tobacco-related cancers among AIs.