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

 描述(由申请者提供)：美国印第安人(AI)的吸烟率是美国所有种族/民族中最高的(41%，白人和黑人为23%)。因此，他们死于与烟草有关的疾病是所有种族/民族中最高的；每五个人工智能中就有两个死于与烟草有关的疾病。尽管人工智能中吸烟和与烟草相关的疾病的比例非常低，但很少有研究人员解决这个重要问题，部分原因是烟草对许多人工智能来说是一种神圣的植物，因此不能像大多数戒烟计划那样被完全负面对待。堪萨斯大学医学中心美国印第安人社区健康中心的研究人员自2003年以来一直在使用基于社区的参与性研究(CBPR)来解决人工智能社区中娱乐烟草的使用问题，并成功地开发了一项根据文化定制的戒烟计划--所有国家的生命呼吸(ANBL)，该计划尊重烟草作为一种神圣的植物，并促进尊重它，而不是娱乐地滥用它。我们的面对面计划目前在基线后6个月的戒烟率为31%(P&lt；0.001，而此前针对多部落人口的最佳计划为P&lt；0.001)。尽管我们通过密集的面对面计划获得了成功，但我们无法通过这个计划接触到整个人工智能社区。因此，我们建议开发和试点测试一个基于电话的程序，并附带一个互动网站，以接触到更多的人工智能人口。我们将解决以下具体目标：(1)开发基于电话的ANBL个人版本和相应的互动网站；(2)对该计划进行形成性测试(N=10)，以确定试点所需的修改；以及(3)在80名人工智能吸烟者中进行tANBL试点测试，并估计干预的效果大小。我们的主要终点将是在基线后6个月通过唾液可替宁水平生化验证的休闲吸烟30天的时点戒烟情况。我们假设，tANBL中的戒烟率将明显好于目前文献中报道的非定制项目中的人工智能(30%对10%)。我们将解决以下次要目标：(1)最大化和评估干预计划及其所有组成部分的文化相关性；(2)检查实施基于电话的个人ANBL的可接受性和可行性；(3)检查那些在12周戒烟并在6个月内复发的吸烟者的复发原因；(4)检查tANBL的持续戒烟率；以及(5)检查非戒烟者每天减少吸烟的情况。

 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.