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)使用率是美国所有主要种族中最高的，为9%，而白人为4%。这一数字可能被低估了，因为该国各地区和部落在使用SLT方面存在很大差异。南部和北部平原的人工智能使用率最高，在一些部落中达到25%，导致与SLT相关的癌症，包括口腔癌、食道癌和胰腺癌，发病率更高，死亡率更高，死亡率不成比例。此外，在过去三十年中，SLT的使用率在一些部落社区一直在上升，而这些部落社区的使用率处于历史低位。我们这项提议的总体目标是利用基于社区的参与性研究(CBPR)为不同类型的人工智能人群开发和试点测试文化定制的SLT停止计划。我们假设(1)我们计划的参与者在基线后6个月将有更高的可替宁验证的7天点SLT戒烟率，与目前报道的未使用计划的任何种族的个人禁烟率(5%-10%)相比；(2)与基线相比，我们计划的参与者在基线后6个月将有更高的戒烟兴趣，更多的戒烟尝试，以及所有娱乐性烟草使用的减少。我们将致力于以下具体目标：(1)利用CBPR为人工智能制定一个文化定制的、基于群体的SLT戒断计划；(2)开发和评估与教育材料配套的科学准确性、可读性和文化适宜性；以及(3)试行测试，确定可行性和可接受性，并估计人工智能文化定制的SLT戒断计划的停止率。我们将解决以下次要目标：(1)确定促进文化定制的SLT戒断计划的传播并有助于计划成功或失败的因素；以及(2)检查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，我们将使用我们过去为人工智能开发成功的戒烟计划所使用的相同CBPR技术来开发该计划。我们还将对人工智能SLT用户进行一系列9个焦点小组，按年龄(15-18岁将分开)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的比例较高(N=45)。在第二阶段，我们将使用一个由三名专家组成的小组评估所有材料和网站的科学准确性，使用材料适宜性评估(SAM)评估可读性，通过对人工智能SLT用户和尝试过SLT的年轻人(N=25)进行一系列访谈，评估文化适当性。最后，在第三阶段，我们将对128名19岁及以上的AI SLT用户和20名15-18岁的AI SLT用户进行试点测试，并在试点期间对计划进行最终修改。我们还将检查参与者的尼古丁新陈代谢，因为这还没有被表征。

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.