Recruitment and Baseline Characteristics of American Indian Tribal College Students Participating in a Tribal College Tobacco and Behavioral Survey

Smoking Patterns Among Urban Alaska Native and American Indian Adults: The Alaska EARTH 10-Year Follow-up Study

INTRODUCTION

Data on cigarette smoking prevalence among Alaska Native and American Indian (ANAI) people are limited to cross-sectional studies or specific subpopulations. Using data from the Alaska Education and Research toward Health (EARTH) Study 10-year follow-up, this study assessed patterns of smoking from baseline and factors associated with current use.

AIMS AND METHODS

EARTH Study urban south central ANAI participants (N = 376; 73% women) provided questionnaire data on smoking at baseline and 10-year follow-up. Multivariable-adjusted logistic regression assessed whether gender, cultural factors (Tribal identity, language spoken in the home), depressive symptoms (PHQ-9), baseline smoking status, and baseline cigarettes per day (CPD) were associated with current smoking at follow-up.

RESULTS

Current smoking was 27% and 23% at baseline and follow-up, respectively. Of baseline smokers, 60% reported smoking at follow-up (77% men, 52% women). From multivariable-adjusted analyses, the odds of current smoking at follow-up were lower among women than men, those who never or formerly smoked versus currently smoked at baseline, and smoking <10 CPD compared with ≥10 CPD at baseline. PHQ-9 score or cultural variables were not associated with smoking at follow-up. Smoking fewer baseline CPD was associated with former smoking status (ie, quitting) at follow-up among women, but not men.

CONCLUSIONS

Our project is among the first to longitudinally explore smoking within an ANAI cohort. While we observed persistent smoking during a 10-year period, there were important differences by gender and CPD in quitting. These differences may be important to enhance the reach and efficacy of cessation interventions for ANAI people.

IMPLICATIONS

This study contributes novel longitudinal information on cigarette smoking prevalence during a 10-year period among Alaska Native and American Indian (ANAI) people. Prior data on smoking prevalence among ANAI people are limited to cross-sectional studies or specific subpopulations. Our project is among the first to longitudinally explore smoking prevalence within an ANAI cohort. We observed persistent smoking during a 10-year period. The study also contributes information on differences by gender and cigarettes smoked per day in quitting. These findings have implications for enhancing the reach and efficacy of cessation interventions for ANAI people.

Campus tobacco control policies and cessation interventions in college students: a commentary calling for research and action to address tobacco-related health disparities

Tobacco-related health disparities (TRHDs) have a significant impact on population health in the USA. Effectively preventing and controlling TRHDs among young adult populations require multiple prevention and cessation points, including within college/university contexts. This commentary addresses current campus tobacco control policies and cessation interventions for U.S. college students, with an emphasis on TRHDs and opportunities for research and research translation to reduce these disparities. This commentary is informed by literature published between 2010 and 2020 regarding (a) prevalence and impact of campus tobacco control policies; and/or (b) behavioral outcomes from cessation interventions for young adults attending colleges. Despite a doubling of college campuses adopting tobacco-free policies from 2012 to 2017, roughly two-thirds continue to operate without such policies. Few policies address alternative tobacco products (e.g., e-cigarettes, cigars/cigarillos, and hookah), and communication about and enforcement of existing policies is extremely limited. A broad range of cessation intervention strategies have targeted individuals in this age group, but with little focus on TRHDs and limited intervention dissemination. Importantly, college students representing populations at risk for TRHDs (e.g., racial/ethnic/sexual/gender minorities, low socioeconomic status) are less likely to be exposed to strong tobacco control policies or supports for cessation. There are untapped opportunities for behavioral medicine approaches to reduce TRHDs in college settings. Research findings regarding multilevel (policy, community-level, and individual-level) interventions must be translated to policy/practice in order to address tobacco use, particularly among vulnerable college student populations.

Recruitment best practices of a cardiovascular risk reduction randomised control trial in rural Alaska Native communities

Though not native to Alaska, tobacco use is common among Alaska Native people in the Norton Sound region, an area consisting of 16 communities with population size 107 to 3,695. We summarise best practices in recruiting Alaska Native adults who smoke for a randomised controlled tobacco treatment trial. Participants were Alaska Native, 19 years and older, smoking daily, with hypertension and/or high cholesterol, residing in the Norton Sound region of Alaska. Study staff travelled to the remote communities to recruit, typically staying 5 days. Screening and enrolment success was examined by day, season, and staffing level. From June 2015 - December 2018, the study team made 122 trips, screening 1089 individuals and enrolling 314 participants. In the field, days 2-3 (51%) were best for screening, while days 3-4 (53%) had the greatest enrolment. Community size correlated with enrolment (r = 0.83, p <.001). Recruitment was optimised in spring and with multiple staff in the field. Despite challenges (e.g., harsh weather, poor internet connectivity), with active outreach (e.g. tabling in busy areas, attending community events, utilising mixed media, collaborating with clinic staff), the project reached its recruitment goal. Study findings can inform community-based tobacco treatment research trials in remote areas.

ABBREVIATIONS

CVD: Cardiovascular disease; VTC: Video teleconferencing; ANMC: Alaska Native Medical Centre; HEALTHH: Healing and Empowering Alaskan Lives Towards Healthy Hearts; NSHC: Norton Sound Health Corporation; RERB: Research Ethics Review Board.

Genetics of Smoking Behaviors in American Indians

BACKGROUND

The smoking behavior of American Indians (AI) differs from that of non-Hispanic whites (NHW). Typically light smokers, cessation interventions in AIs are generally less effective. To develop more effective cessation programs for AIs, clinicians, researchers, and public health workers need a better understanding of the genetic factors involved in their smoking behavior. Our aim was to assess whether SNPs associated with smoking behavior in NHWs are also associated with smoking in AIs.

METHODS

We collected questionnaire data on smoking behaviors and analyzed blood and saliva samples from two Tribal populations with dramatically different cultures and smoking prevalence, one in the Northern Plains (n = 323) and the other in the Southwest (n = 176). A total of 384 SNPs were genotyped using an Illumina custom GoldenGate platform. Samples were also assessed for cotinine and 3-hydroxycotinine as markers of nicotine intake and nicotine metabolite ratio.

RESULTS

Among 499 participants, we identified, in the Northern Plains sample only, a variant of the gamma-aminobutyric acid receptor subunit alpha-2 (GABRA2) (rs2119767) on chromosome 4p that was associated with many of the intake biomarkers of smoking we examined, suggesting a role for this gene in modifying smoking behavior in this population. We also identified three SNPs, in the Southwest sample only, as significant correlates of only cigarettes per day: rs4274224, rs4245147 (both dopamine receptor D2 gene), and rs1386493 (tryptophan hydroxylase 2 gene).

CONCLUSIONS

The contribution of many genes known to underlie smoking behaviors in NHWs may differ in AIs.

IMPACT

Once validated, these variants could be useful in developing more effective cessation strategies.

Tobacco Cessation Behavior Among Smoking and Smokeless Form Tobacco Users in the Indigenous Population of Ernakulam, India

Purpose:

Tobacco usage is the leading preventable cause of death in the world today. The tribes in Kuttampuzha region are the aboriginal tribal community found predominantly in the south Indian state of Kerala, India, and this study was conducted to identify tobacco cessation behavior in smoking and smokeless form of tobacco users among them.

Materials and Methods:

A cross-sectional design survey was conducted among 516 indigenous community people of Kuttampuzha area of Kerala, India, for the outcome of quit attempts made by the current tobacco users. The sociodemographic variables and tobacco user data collected were subjected to statistical analysis using Open Source R Software.

Results:

When considered the quit attempts among current smoking and smokeless form of tobacco users, a statistically significant difference was found in subjects who had quit attempts of 1 day or longer in the previous year (P = 0.01) than who were in groups of quit attempts more than 30 days or more than 6 months. Smokers had higher probability predicted of attempting quitting in comparison to smokeless form of tobacco users (odds ratio [OR] = 1.24, confidence interval [CI] = 1.09–1.39). The probability of doing a quit attempt was higher among users of tobacco who were having a comparatively higher socioeconomic status (OR = 1.30, CI = 1.12–1.48).

Conclusion:

This study provides useful insights into different determinants for quit attempts of tobacco users in South India, exploring the sociodemographic features of attempts to quit. International prevention and cessation initiatives will need to be customized to the social-cultural context of these primitive tribal areas of Kuttampuzha, Kerala, to help in prevention and cessation of tobacco usage.

One-Time Education Sessions to Help American Indian Smokeless Tobacco Users Quit

American Indian (AI) smokeless tobacco use rates are the highest of all racial/ethnic groups within the United States. Despite this, no effective cessation program currently exists that acknowledges the cultural significance of tobacco among many American Indian tribal nations. Participants were smokeless tobacco users, over 18 years of age, and were recruited through community partners. We modified the All Nations Snuff Out Smokeless Tobacco group-based program to be delivered as a one-time education session intervention. This was delivered to 80 participants and follow-up data was collected by self-report at 6-months. The mean age of participants was 35 and most were male (70%). A majority (69%) grew up on a AI reservation; the mean age of first smokeless tobacco use was 16 years of age. Of program completers reached for 6-month post baseline, 46% reported 0 days of SLT use; 13.5% of participants reduced; while 36% reported continued daily use. In intention to treat analysis those lost to follow-up are considered current users, the quit rate was 12.5% and among those who were still using, 4.0% reduced their use. In this study, a one-time education session intervention was effective for those who prefer an individual based approach to quitting SLT use. Follow up strategies to increase participant retention at 6-months should be explored.

Low rates of alcohol and tobacco use, strong cultural ties for Native American college students in the Southwest

INTRODUCTION

College attendance is associated with an increased risk for substance use yet we know little about substance use among Native American college students and its regional variation. This study examined alcohol, tobacco, and drug use and their relation to gender, institution, age, and cultural involvement among Native American college students in the Southwest.

METHODS

Native American community college and university students in a large Southwest city (N = 347) completed an online survey about past-month and lifetime substance use and involvement in cultural activities.

RESULTS

Cultural involvement was related to less past-month substance use. In the past month, 43% drank alcohol, 27% binge drank, 20% used drugs, and 13% were current smokers. Males, community college students, and older individuals were more likely to have a positive CAGE-AID and have used drugs more than 100 times. Younger individuals were more likely to use marijuana in the past month.

CONCLUSIONS

These findings highlight cultural strengths and comparatively low rates of tobacco and alcohol use among Native American college students in the Southwest.

Clearing the air: American Indian tribal college students' exposure to second hand smoke & attitudes towards smoke free campus policies

OBJECTIVE

The purpose of this study was to examine knowledge, awareness, and support for campus smoke-free policies.

PARTICIPANTS

1,256 American Indian tribal college students from three tribal colleges in the Midwest and Northern Plains.

METHODS

Data are from an observational cross-sectional study of American Indian tribal college students, collected through a web-based survey.

RESULTS

Only 40% of tribal college students reported not being exposed to second hand smoke in the past 7 days. A majority of nonsmokers (66%) agreed or strongly agreed with having a smoke-free campus, while 34.2% of smokers also agreed or strongly agreed. Overall, more than a third (36.6%) of tribal college students were not aware of their campus smoking policies.

CONCLUSIONS

Tribal campuses serving American Indian students have been much slower in adopting smoke-free campus policies. Our findings show that tribal college students would support a smoke-free campus policy.

Development of a Culturally Appropriate Smokeless Tobacco Cessation Program for American Indians

This study describes a multiphasic approach to the development of a smokeless tobacco cessation program targeted for American Indians (AI) of different tribal nations. The authors gathered formative data from a series of focus groups and interviews to investigate the knowledge, attitudes, and beliefs of AI and smokeless tobacco (SLT) use. Predominant themes emerged from four major topic areas (SLT use, initiation and barriers, policy, and program development) across both studies. This study further assessed educational materials developed for the cessation program for scientific accuracy, readability, and cultural appropriateness. Program materials were scientifically accurate and culturally appropriate. The average corrected reading grade level was 6.3 using the Fry formula and 7.1 using the SMOG formula. Based on this research, a detailed approach to formative research can be used in combination with input from community members to develop health interventions that address health disparities for a specific population.

American Indian Tribal College Student's Knowledge, Attitudes and Beliefs about Recreational and Traditional Tobacco Use

INTRODUCTION

American Indians (AI) have the highest smoking rates of any racial/ethnic group in the U.S., in addition to low success rates of tobacco cessation. The substitution of commercial tobacco for traditional tobacco may have played a role in the prevalence rates of recreational tobacco use among AI. The present study explored the impact of tribal college students' knowledge, attitudes and beliefs about traditional tobacco use on their recreational cigarette smoking behaviors.

METHODS

Multiple methods were used to recruit participants attending a tribal college. A total of 101 AI tribal college students completed a demographic survey and participated in focus groups or individual interviews assessing traditional and recreational tobacco use.

RESULTS

AI tribal college student's recreational smoking has an influence on various health behaviors, including poor eating habits, decreased physical activity, and elevated tobacco use in association with alcohol consumption. Differences between the use of and motivation behind smokeless tobacco and cigarette use were seen. In addition, participants reported differences between using tobacco for traditional purposes such as in ceremony or during prayer in comparison to recreational tobacco use. Conclusion: These findings highlight AI students' beliefs about recreational tobacco, smokeless tobacco, and traditional tobacco use. Differences related to behaviors associated with traditional tobacco use have important implications for future cessation efforts for AI smokers.