Development of a Telephone-Based Individual Smoking Cessation Program for American Indians

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 DESCRIPTION (provided by applicant): American Indians (AI) have the highest rates of smoking of any racial/ethnic group in the United States (41% versus 23% for whites and blacks). Consequently, they suffer the highest mortality from tobacco-related illnesses of any racial/ethnic group; two of every five AI die from a tobacco-related illness. Despite the abysmal rates of smoking and tobacco-related illness among AI, few researchers have addressed this important issue, in part because tobacco is a sacred plant to many AI and, as such, cannot be treated completely negatively, as most smoking cessation programs do. Researchers at the University of Kansas Medical Center, Center for American Indian Community Health have been using community-based participatory research (CBPR) to address recreational tobacco use in the AI community since 2003 and have developed a successful culturally-tailored smoking cessation program, All Nations Breath of Life (ANBL), that respects tobacco as a sacred plant and promotes honoring it rather than abusing it recreationally. Our in- person program currently has quit rates of 31% at 6-months post-baseline (P<0.001 compared to the best previously reported program for a multi-tribal population). Though we have experienced success through an intensive, in-person program, we are unable to reach the entire AI community with this program. Therefore, we propose the development and pilot testing of a telephone-based program with an accompanying interactive website to reach a larger AI population. We will address the following specific aims: (1) To develop an individual telephone-based version of ANBL and accompanying interactive website; (2) To conduct a formative test of the program (N=10) to determine modifications needed for the pilot; and (3) To pilot test tANBL in 80 AI smokers and estimate effect size of the intervention. Our primary endpoint will be 30-day point prevalence abstinence from recreational smoking biochemically verified by salivary cotinine level at 6 months post- baseline. We hypothesize that quit rates in tANBL will be significantly better than those currently reported in the literature for AI in untailored programs (30% versus 10%). We will address the following secondary aims: (1) To maximize and assess the cultural relevance of the intervention program and all of its components; (2) To examine the acceptability and feasibility of implementing an individual telephone-based ANBL; (3) To examine reasons for relapse among those smokers who were quit at 12 weeks and relapsed at 6 months; (4) To examine continuous abstinence rates for tANBL; and (5) To examine reduction in cigarettes per day among non-quitters.