Tobacco Cessation among American Indian Cancer Survivors in Cherokee Nation

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Abstract Tobacco use is the leading cause of morbidity and mortality in the US, accounting for 30% of cancer deaths and resulting in more than $300 billion in annual health care expenditures and productivity loss. American Indian (AI) adults continue to have a higher prevalence of tobacco use (32%) compared to any other race/ethnic group (13%-25%) in the US and experience disproportionate rates of tobacco-related morbidity and mortality. In addition, AI individuals in Oklahoma have the highest age-adjusted cancer incidence (637 per 100,000) and mortality (255 per 100,000) rates compared to other racial groups. Continued use of tobacco after a cancer diagnosis increases the risk of secondary cancers and mortality compared to non-tobacco users. Cherokee Nation is the largest tribe in the United States with more than 378,000 enrolled members, and reducing tobacco use is one of the tribe's top priorities. Cherokee Nation works with Indian Health Service (IHS) to provide healthcare services for the AI population within their reservation area. Because of this system, any referral for specialty care not provided by Cherokee Nation must obtain approval through the IHS Purchased and Referred Care system, which may complicate oncology care. Furthermore, it is unclear whether AI cancer survivors routinely receive tobacco cessation treatment during their oncology care or while receiving primary care within the Cherokee Nation Health System. Our long-term goal is to reduce the prevalence of tobacco use among cancer survivors in Cherokee Nation. Our study aims to 1) evaluate tobacco cessation experiences among AI cancer survivors in Cherokee Nation; 2) identify current tobacco cessation practices in primary care and oncology settings, along with facilitators and barriers to delivering cessation treatment to Cherokee Nation cancer patients; and 3) develop tailored strategies to increase implementation and reach of tobacco cessation treatment for cancer survivors in Cherokee Nation. This study will provide insight into current practices and needs related to tobacco cessation for AI cancer survivors in Cherokee Nation. This project will provide preliminary data for an R01 proposal to compare the effectiveness of implementation strategies aimed at improving tobacco cessation treatment provided to cancer survivors. It will also provide opportunities for future implementation research focused on other evidence-based interventions for cancer survivors in Cherokee Nation.