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

多达三分之二的美国印第安人（AI）成年人居住在美国北方平原地区 抽商业香烟。结果，北方平原的人工智能患上与吸烟有关的癌症的几率很高 是其他种族的三倍与其他人相比，人工智能戒烟的可能性只有一半左右。 种族现有戒烟计划的可及性和参与性差被认为是一个主要原因 人工智能吸烟者的低戒烟率。我们的长期目标是为AI商业吸烟者开发戒烟干预措施 影响广泛、引人入胜、文化上合适的。NCI的QuitGuide是一款公开的智能手机 戒烟应用程序，允许立即访问交互式治疗内容，例如实时 指导如何导航吸烟触发器，因此具有很大的潜力，以达到和从事人工智能 吸烟者。然而，QuitGuide不包括对人工智能人员特有的触发因素的指导，例如商业 在战俘中使用香烟令人惊叹，也没有解决传统烟草问题，而传统烟草是战俘中常见的精神实践 人工智能在北方平原。缺乏关于传统烟草使用的内容尤其成问题，因为 我们团队先前的研究表明，商业戒烟中对传统烟草的文化参考 信息可以提高戒烟的自我效能。我们目前的目标是开发和试点测试一个适合文化的 人工智能商业吸烟者的戒烟指南版本。我们的假设是，一个文化定制的退出指南将 与标准QuitGuide相比，AI吸烟者的可行性和可接受性评级更高。项目 建立在共济会癌症中心和美国印第安人癌症基金会的研究合作基础上 AI社区。我们的多学科团队在人工智能烟草使用，戒烟，定制 癌症预防干预到人工智能的文化，以及智能手机应用程序的开发。我们的社区合作伙伴 代表一个位于农村的部落和一个为人工智能服务的城市诊所，两者都位于北方平原 美国的区域。一个社区咨询委员会将监督所有活动，我们有一个协议， 我们的第一个目标是进行深入的采访， 在人工智能吸烟者（n=40）和关键信息提供者（n=10）中，指导戒烟指南的文化定制， 这是一个定制的应用原型。我们的第二个目标是评估初步的可行性和可接受性， 使用AI吸烟者（两组n=6; N=12）中的迭代测试定制应用程序原型，并改进应用程序。 我们的第三个目标是进行一项试点随机对照试验，以测试可行性，可接受性和初步 在AI吸烟者中，定制的QuitGuide应用程序（n=40）与标准QuitGuide应用程序（n=40）的有效性。在 结论是，我们将有一个蓝图来指导临床试验的发展， 为人工智能吸烟者量身定制的QuitGuide智能手机应用程序。鉴于北方的人工智能 平原经历了一些最极端的吸烟差异，这种文化定制的治疗方法可以 对认可机构中烟草相关癌症的负担产生有意义的公共卫生影响。

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.