Cigarette Smoking among American Indian Women Experiencing Intimate Partner Violence

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Smoking prevalence among intimate partner violence (IPV)-victimized women is as high as 70%, which is approximately three times greater than among women nationally. IPV-victimized women are more likely to suffer from substance use, depression, anxiety, and post-traumatic stress disorder --all of which are risk factors for smoking. Among women who have experienced IPV, post-traumatic stress disorder severity is related to nicotine dependence. American Indian women, including Lakota Tribal women, experience IPV 30% more than women from any other racial group. Furthermore, smoking prevalence among Lakota Tribal women is amongst the highest in the United States, commonly reaching and exceeding 50%. The high rates of smoking and early age of initiation among Lakota Tribal women are accompanied by rising rates of mortality from cardiovascular disease and lung cancer, which are leading causes of death among Lakota Tribal women. Despite the high levels of IPV and smoking experienced by Lakota Tribal women, there have been no studies that have explored IPV and smoking behavior in this special population. If significant efforts are to be made to help IPV- victimized Lakota Tribal women to quit smoking, it is vital to examine and document contextual issues related to smoking and IPV in this special population. Thus, our primary study objective is to document the viewpoints of IPV-victimized women and strategies that could be used to adapt an intervention. Our Specific Aims are to: AIM 1. Employ a secondary data analysis to assess the prevalence and correlates of smoking in IPV-victimized American Indian women. Using the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project data we will conduct a secondary data analysis to determine the prevalence of smoking and its correlates in IPV-victimized American Indian women. We expect higher smoking prevalence in IPV-victimized American Indian women smokers compared to a general sample of American Indian women. We expect higher PTSD and depression prevalence in IPV-victimized American Indian women smokers compared to a general sample of American Indian women; AIM 2. Assess knowledge, attitudes and beliefs about smoking cessation, co-occurring conditions, and perceived barriers to quitting among Lakota Tribal women who have experienced IPV. We will conduct 15 key informant interviews and six focus groups with Lakota Tribal women who have experienced IPV and are former or current smokers. Key informant and focus group participants will identify perceived barriers and promoters for quitting. Posttraumatic stress disorder, anxiety and other triggers for smoking and pharmacotherapy will be discussed. We expect that few participants know about the importance of quitting smoking and AIM 3. Use a participatory approach to translate the qualitative findings into an adapted, culturally informed smoking cessation intervention. Using data collected from our use of qualitative methods, we will further culturally- and/or situationally-adapt a well-known American Indian culturally-tailored smoking cessation curriculum for IPV-victimized Lakota Tribal women.