Smokeless Tobacco Cessation among American Indians Using in-Person Groups

描述（由申请人提供）：美国印第安人（AI）的无烟烟草（SLT）使用率是美国主要种族中最高的，为9%，而白人为4%。这可能被低估了，因为不同地区和部落的SLT使用差异很大。南部和北部平原的人工智能地区的SLT使用率最高，在一些部落中达到25%，导致SLT相关癌症（包括口腔癌、食道癌和胰腺癌）的发病率和死亡率更高且不断上升。此外，在过去三十年中，SLT使用率在一些历史上较低的部落社区一直在上升。我们本提案的总体目标是使用基于社区的参与性研究（CBPR），为异质人工智能人群开发和试点测试适合文化的SLT戒烟计划。我们假设(1)与目前报道的未使用该计划的任何种族的个体的戒断率（5%-10%）相比，我们项目的参与者在基线后6个月的SLT中有更高的可替宁验证的7天点患病率戒断率；(2)与基线相比，我们项目的参与者在基线后6个月的戒烟兴趣增加，戒烟尝试增加，所有娱乐性烟草使用减少。我们将实现以下具体目标：(1)为使用CBPR的人工智能开发一个适合文化的、基于群体的SLT戒烟计划；(2)开发和评估教育材料的科学准确性、可读性和文化适宜性；(3)进行试点测试，确定针对人工智能的文化定制的SLT戒烟计划的可行性和可接受性，并估计戒烟率。我们将解决以下次要目标：(1)确定促进文化定制的SLT戒烟计划传播的因素，并有助于计划的成功或失败；(2)检测AI SLT使用者的尼古丁代谢。这项研究将分三个阶段进行。在第一阶段，我们将使用与过去开发成功的人工智能戒烟计划相同的CBPR技术来开发该计划。我们还将对AI SLT用户进行一系列的9个焦点小组，按年龄（15-18岁将被分开）和18岁以上的大学生身份进行分层，因为他们在项目开发中使用SLT的比例更高（N=45）。在第二阶段，我们将使用一个由三名专家组成的小组来评估所有材料和网站的科学准确性，使用材料适用性评估（SAM）来评估可读性，通过对AI SLT用户和尝试过SLT的年轻人（N=25）的一系列访谈来评估文化适宜性。最后，在第三阶段，我们将对128名年龄在19岁及以上的AI SLT用户和20名年龄在15-18岁的AI SLT用户进行试点测试，并在试点期间对该计划进行最终修改。我们还将检查参与者的尼古丁代谢，因为这还没有被描述。

DESCRIPTION (provided by applicant): American Indians (AI) have the highest rates of smokeless tobacco (SLT) use of any major ethnic group in the U.S. at 9% versus 4% among whites. This is likely an underestimate due to the wide variation in SLT use by region of the country and tribal affiliation. AI in the Southern and Northern Plains have the highest SLT use rates, reaching 25% among some tribes, contributing to higher and rising incidence and disproportionate mortality in SLT-related cancers, including oral, esophageal, and pancreatic cancers. In addition, over the last three decades rates of SLT use have been rising in some tribal communities with historically low rates. Our overall objective for this proposal is the development and pilot testing of a culturally tailored SLT cessation program for a heterogeneous AI population using community-based participatory research (CBPR). We hypothesize that (1) Participants in our program will have higher cotinine-verified 7-day point prevalence abstinence from SLT at 6-months post-baseline compared to currently reported rates of abstinence among individuals of any ethnic group not using a program (5%-10%); and (2) Participants in our program will have increased interest in quitting, more quit attempts, and reduction in all recreational tobacco use at 6-months post-baseline compared to baseline. We will address the following specific aims: (1) To develop a culturally tailored, group-based SLT cessation program for AI using CBPR; (2) To develop and assess for scientific accuracy, readability, and cultural-appropriateness accompanying educational materials; and (3) To pilot test, determine the feasibility and acceptability, and estimate the cessation rate of a culturally tailored SLT cessation program for AI. We will address the following secondary aims: (1) To identify factors that enhance dissemination of a culturally tailored SLT cessation program and contribute to program success or failure; and (2) To examine nicotine metabolism in AI SLT users. This study will take place in three phases. During Phase 1, we will develop the program using the same CBPR techniques that we have used in the past to develop our successful smoking cessation program for AI. We will also conduct a series of 9 focus groups of AI SLT users, stratified by age (15-18-year-olds will be separate) and status as a college student for those over age 18 because of their higher rates of SLT use for input on program development (N=45). During Phase 2, we will assess all materials and website for scientific accuracy using a panel of three experts, for readability using the Suitability Assessment of Materials (SAM), for cultural appropriateness using a series of interviews with AI SLT users and youth who have tried SLT (N=25). Finally, during Phase 3, we will pilot test the program with 128 AI SLT users age 19 and over and 20 AI SLT users age 15-18 and make final modifications to the program during the pilot. We will also examine nicotine metabolism in our participants because this has not yet been characterized.