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Shergina E, Richter KP, Daley CM, Faseru B, Choi WS, Gajewski BJ. Using Bayesian hierarchical models for controlled post hoc subgroup analysis of clinical trials: application to smoking cessation treatment in American Indians and Alaska Natives. J Biopharm Stat 2024; 34:513-525. [PMID: 37417836 PMCID: PMC10771533 DOI: 10.1080/10543406.2023.2233598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/01/2023] [Indexed: 07/08/2023]
Abstract
Clinical trials powered to detect subgroup effects provide the most reliable data on heterogeneity of treatment effect among different subpopulations. However, pre-specified subgroup analysis is not always practical and post hoc analysis results should be examined cautiously. Bayesian hierarchical modelling provides grounds for defining a controlled post hoc analysis plan that is developed after seeing outcome data for the population but before unblinding the outcome by subgroup. Using simulation based on the results from a tobacco cessation clinical trial conducted among the general population, we defined an analysis plan to assess treatment effect among American Indians and Alaska Natives (AI/AN) enrolled in the study. Patients were randomized into two arms using Bayesian adaptive design. For the opt-in arm, clinicians offered a cessation treatment plan after verifying that a patient was ready to quit. For the opt-out arm, clinicians provided all participants with free cessation medications and referred them to a Quitline. The study was powered to test a hypothesis of significantly higher quit rates for the opt-out arm at one-month post randomization. Overall, one-month abstinence rates were 15.9% and 21.5% (opt-in and opt-out arm, respectively). For AI/AN, one-month abstinence rates were 10.2% and 22.0% (opt-in and opt-out arm, respectively). The posterior probability that the abstinence rate in the treatment arm is higher is 0.96, indicating that AI/AN demonstrate response to treatment at almost the same probability as the whole population.
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Affiliation(s)
- Elena Shergina
- Department of Biostatistics & Data Science, University of Kansas Cancer Center, 3901 Rainbow Boulevard, Kansas City, KS, USA
| | - Kimber P. Richter
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, USA
| | - Christine Makosky Daley
- Department of Community and Health Population, Lehigh University, 27 Memorial Dr W, Bethlehem, PA, USA
| | - Babalola Faseru
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, USA
| | - Won S. Choi
- Department of Community and Health Population, Lehigh University, 27 Memorial Dr W, Bethlehem, PA, USA
| | - Byron J. Gajewski
- Department of Biostatistics & Data Science, University of Kansas Cancer Center, 3901 Rainbow Boulevard, Kansas City, KS, USA
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Hale JW, Pacheco JA, Lewis CS, Swimmer L, Daley SM, Nazir N, Daley CM, Choi WS. Everyday discrimination for American Indian tribal college students enrolled in the Internet All Nations Breath of Life program. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2679-2685. [PMID: 34871137 PMCID: PMC9167892 DOI: 10.1080/07448481.2021.1987246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/06/2021] [Accepted: 09/26/2021] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Identify factors associated with perceived discrimination, including depression, body image satisfaction, body mass index (BMI), social support, stress, and self-reported social status. PARTICIPANTS A total of 249 American Indian tribal college students. METHODS Students were recruited for an Internet-based smoking cessation program. A total of 249 students answered the Everyday Discrimination Scale questions to assess perceived discrimination. We conducted bivariate analyses to determine potential significant associations between perceived discrimination and health outcomes at baseline. RESULTS We found 63% of the sample reported racial discrimination. Among those who reported moderate/severe depression, 87% reported discrimination. Among those who were not satisfied with their body image, 70% reported racial discrimination. CONCLUSION Reports of racial discrimination are highly prevalent among our participants. We found reports of discrimination are significantly associated with depression and dissatisfaction with body image. Our study highlights a high priority population that perceives racial discrimination, potentially increasing their risk for adverse health outcomes.
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Affiliation(s)
- Jason W Hale
- American Indian Health Research & Education Alliance, Inc., Institute for Indigenous Studies, College of Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Joseph A Pacheco
- American Indian Health Research & Education Alliance, Inc., Institute for Indigenous Studies, College of Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Charley S Lewis
- American Indian Health Research & Education Alliance, Inc., Institute for Indigenous Studies, College of Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Luke Swimmer
- American Indian Health Research & Education Alliance, Inc., Institute for Indigenous Studies, College of Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Sean M Daley
- American Indian Health Research & Education Alliance, Inc., Institute for Indigenous Studies, College of Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Niaman Nazir
- American Indian Health Research & Education Alliance, Inc., Center for American Indian Community Health, Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Christine M Daley
- American Indian Health Research & Education Alliance, Inc., Institute for Indigenous Studies, College of Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Won S Choi
- American Indian Health Research & Education Alliance, Inc., Center for American Indian Community Health, Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
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Hirchak KA, Oluwoye O, Nadeau M, Richardson M, Bajet K, Brigman M, Herron JL, Hernandez-Vallant A, Vasquez A, Pham C, Oliver KA, Baukol P, Webb K, Belone L, McDonell MG, Venner KL, Campbell ANC. Coming together for something good: recommendations from a scoping review for dissemination and implementation science to improve indigenous substance use disorder treatment. Front Public Health 2023; 11:1265122. [PMID: 37915816 PMCID: PMC10616787 DOI: 10.3389/fpubh.2023.1265122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Dissemination and Implementation (D&I) science is growing among Indigenous communities. Indigenous communities are adapting and implementing evidence-based treatments for substance use disorders (SUD) to fit the needs of their communities. D&I science offers frameworks, models, and theories to increase implementation success, but research is needed to center Indigenous knowledge, enhancing D&I so that it is more applicable within Indigenous contexts. In this scoping review, we examined the current state of D&I science for SUD interventions among Indigenous communities and identified best-practice SUD implementation approaches. Methods PubMed and PsycINFO databases were queried for articles written in English, published in the United States, Canada, Australia, and New Zealand. We included key search terms for Indigenous populations and 35 content keywords. We categorized the data using the adapted and extended Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework that emphasizes equity and sustainability. RE-AIM has also been used as a primary model to consistently identify implementation outcomes. Results Twenty articles were identified from the original unduplicated count of over 24,000. Over half the articles discussed processes related to Reach, Adoption, and Implementation. Effectiveness was discussed by 50% of the studies (n = 10), with 25% of the articles discussing Maintenance/sustainability (n = 4). Findings also highlighted the importance of the application of each RE-AIM domain for meaningful, well-defined community-engaged approaches. Conclusion Finding indicated a need to prioritize Indigenous methods to culturally center, re-align and adapt Western treatments and frameworks to increase health equity and improve SUD treatment outcomes. Utility in the use of the modified RE-AIM and the continued modification for Indigenous communities was also noted.
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Affiliation(s)
- Katherine A. Hirchak
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Oladunni Oluwoye
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Melanie Nadeau
- Department of Indigenous Health, University of North Dakota, Grand Forks, ND, United States
| | - Meenakshi Richardson
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Department of Human Development, Washington State University, Vancouver, WA, United States
| | - Kelsey Bajet
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Mariah Brigman
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Jalene L. Herron
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Alexandra Hernandez-Vallant
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Angel Vasquez
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, United States
| | - Cuong Pham
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | | | - Paulette Baukol
- NorthStar Node, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Kellie Webb
- Eastern Shoshone Recovery Center, Fort Washakie, WY, United States
| | - Lorenda Belone
- Population Health, University of New Mexico, Albuquerque, NM, United States
| | - Michael G. McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Kamilla L. Venner
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Aimee N. C. Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, United States
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Kuśnierczyk P, Taucher E, Domagała-Kulawik J. Editorial: Comparison of lung cancer and chronic obstructive pulmonary disease in smokers and never-smokers. Front Immunol 2023; 14:1143288. [PMID: 36825024 PMCID: PMC9942942 DOI: 10.3389/fimmu.2023.1143288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Affiliation(s)
- Piotr Kuśnierczyk
- Laboratory of Immunogenetics and Tissue Immunology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland,*Correspondence: Piotr Kuśnierczyk,
| | - Elisabeth Taucher
- Department of Internal Medicine, Division of Pulmonology, Medical University Graz, Graz, Austria
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Rusk AM, Kanj AN, Murad MH, Hassett LC, Kennedy CC. Smoking Cessation Interventions in Indigenous North Americans: A Meta-Narrative Systematic Review. Nicotine Tob Res 2023; 25:3-11. [PMID: 35869642 PMCID: PMC9717368 DOI: 10.1093/ntr/ntac181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Indigenous North Americans have the highest cigarette smoking prevalence among all racial and ethnic groups in the United States. We seek to identify effective components of smoking cessation interventions in Indigenous people in the United States associated with favorable cessation outcomes. METHODS A review of literature studying smoking cessation interventions in Indigenous North Americans (American Indians and Alaska Natives) from January 2010 through August 2021 was completed. The primary objective of this study was to identify components of interventions associated with positive smoking cessation outcomes in Indigenous people. The studies identified were synthesized in a meta-narrative approach. RESULTS Ten studies out of 608 titles were included (6 randomized trials, 2 single-arm studies, 1 cohort study, and 1 prospective observational study). Five categories of smoking cessation interventions were identified; phone or web-based tools, culturally-tailored interventions, the inclusion of Indigenous study personnel, pharmaceutical cessation aids, and behavioral health interventions. Phone and web tools, cultural tailoring, and inclusion of Indigenous personnel conditions inconsistently influenced smoking cessation. Pharmaceutical aids were viewed favorably among participants. Individualized behavioral counseling sessions were effective at promoting smoking cessation, as was input from local communities in the planning and implementation phases of study. CONCLUSION A successful smoking cessation intervention in Indigenous North Americans includes Tribal or community input in intervention design and implementation; should provide individualized counseling sessions for participants, and offer access to validated smoking cessation tools including pharmacotherapy. IMPLICATIONS This study identifies a paucity of smoking interventions utilizing standard of care interventions in Indigenous North Americans. Standard of care interventions including individualized cessation counseling and pharmacotherapy were effective at promoting cessation. The use of novel culturally tailored cessation interventions was not more effective than existing evidence-based care with the exception of including Tribal and local community input in intervention implementation. Future smoking cessation interventions in Indigenous North Americans should prioritize the use of standard of care cessation interventions.
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Affiliation(s)
- Ann M Rusk
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
- Respiratory Health Equity Clinical Research Laboratory at Mayo Clinic, Rochester, MN, USA
| | - Amjad N Kanj
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- Respiratory Health Equity Clinical Research Laboratory at Mayo Clinic, Rochester, MN, USA
| | - Mohammad H Murad
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Cassie C Kennedy
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
- Respiratory Health Equity Clinical Research Laboratory at Mayo Clinic, Rochester, MN, USA
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Julian McFarlane S, Occa A, Peng W, Awonuga O, Morgan SE. Community-Based Participatory Research (CBPR) to Enhance Participation of Racial/Ethnic Minorities in Clinical Trials: A 10-Year Systematic Review. HEALTH COMMUNICATION 2022; 37:1075-1092. [PMID: 34420460 DOI: 10.1080/10410236.2021.1943978] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There has not been a significant improvement in the rate of clinical trial accrual in more than 20 years. Worse, the challenge of inadequate representation among racial and ethnic minorities also persists, deepening disparities in health. Community-Based Participatory Research (CBPR) is a participatory communication method that centers on effective dialogue between researchers and community stakeholders with the goal of creating an equitable partnership for health and social change. The objective of the current study was to provide an update since a systematic review in 2012, on the current status of the empirical research, with a particular focus on the elements of CBPR methods used to improve the rate of accrual of members of racial and ethnic minority communities for clinical trials. Our systematic review found a large increase in the number of CBPR related studies and studies related to racial and ethnic representation in research. More than 85% of studies employing CBPR methods saw statistically positive outcomes. Specifically, the elements of CBPR that are associated with these positive outcomes include community partner participation in (1) a study advisory committee, (2) data collection, (3) the development of interventions, and (4) participant recruitment. However, the results of our study indicate that researchers need to be more transparent about the extent of community participation as well as more thoroughly and accurately describe the nature of the partnership with members of minority communities in order to build upon the scientific literature on community-engaged methods.
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Affiliation(s)
| | - Aurora Occa
- Department of Communication, University of Kentucky
| | - Wei Peng
- Murrow College of Communication, Washington State University
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Mills DE, Schaefer KR, Beans JA, Todd MR, Robinson RF, Thummel KE, Dillard DA, Avey JP. Retention in a 6-Month Smoking Cessation Study Among Alaska Native and American Indian People. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2022; 29:71-89. [PMID: 36178748 PMCID: PMC9552566 DOI: 10.5820/aian.2903.2022.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Participant retention in longitudinal health research is necessary for generalizable results. Understanding factors that correlate with increased retention could improve retention in future studies. Here, we describe how participant and study process measures are associated with retention in a longitudinal tobacco cessation research study performed in Anchorage, Alaska. Specifically, we conducted a secondary analysis exploring retention among 151 Alaska Native and American Indian (ANAI) people and described our study processes using study retention categories from a recent meta-analysis. We found that our study processes influence retention among ANAI urban residents more than measures collected about the participant. For study process measures, calls where a participant answered and calls participants placed to the study team were associated with higher retention. Calls where the participant did not answer were associated with lower retention. For participant measures, only lower annual income was associated with lower retention at 6 weeks. Promoting communication from participants to the study team could improve retention, and alternative communication methods could be used after unsuccessful calls. Finally, categorizing our study retention strategies demonstrated that additional barrier-reduction strategies might be warranted.
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Hale JW, Lewis C, Nazir N, Daley SM, Goeckner R, Gunville J, Faseru B, Greiner KA, Choi WS, Daley CM. One-Time Education Sessions to Help American Indian Smokeless Tobacco Users Quit. J Community Health 2019; 45:526-533. [PMID: 31773565 DOI: 10.1007/s10900-019-00771-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Jason W Hale
- Center for American Indian Community Health, University of Kansas Medical Center, MS 1030, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA. .,Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, USA. .,American Indian Health Research and Education Alliance, Inc., Kansas City, KS, USA.
| | - Charley Lewis
- Center for American Indian Community Health, University of Kansas Medical Center, MS 1030, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.,Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.,American Indian Health Research and Education Alliance, Inc., Kansas City, KS, USA
| | - Niaman Nazir
- Center for American Indian Community Health, University of Kansas Medical Center, MS 1030, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sean M Daley
- Center for American Indian Studies, Johnson County Community College, Overland Park, KS, USA.,American Indian Health Research and Education Alliance, Inc., Kansas City, KS, USA.,Department of Anthropology, Johnson County Community College, Overland Park, KS, USA
| | - Ryan Goeckner
- American Indian Health Research and Education Alliance, Inc., Kansas City, KS, USA
| | - Jordyn Gunville
- Center for American Indian Community Health, University of Kansas Medical Center, MS 1030, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.,Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.,American Indian Health Research and Education Alliance, Inc., Kansas City, KS, USA
| | - Babalola Faseru
- Center for American Indian Community Health, University of Kansas Medical Center, MS 1030, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - K Allen Greiner
- Center for American Indian Community Health, University of Kansas Medical Center, MS 1030, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.,Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Won S Choi
- Center for American Indian Community Health, University of Kansas Medical Center, MS 1030, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Christine Makosky Daley
- Center for American Indian Community Health, University of Kansas Medical Center, MS 1030, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.,Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.,American Indian Health Research and Education Alliance, Inc., Kansas City, KS, USA.,Indigenous Studies Program, University of Kansas, Lawrence, KS, USA
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Anderson KM, Kegler MC, Bundy LT, Henderson P, Halfacre J, Escoffery C. Adaptation of a brief smoke-free homes intervention for American Indian and Alaska Native families. BMC Public Health 2019; 19:981. [PMID: 31337379 PMCID: PMC6651935 DOI: 10.1186/s12889-019-7301-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/10/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The goal of adaptation is to maintain the effectiveness of the original intervention by preserving the core elements that account for its success while delivering an intervention that is tailored to the new community and/or cultural context. The current study describes the process of adapting an evidence-based smoke-free homes (SFH) intervention for use in American Indian/Alaska Native (AI/AN) households. METHODS We followed a systematic adaptation process. We first assessed the community through focus groups coordinated in collaboration with tribal partners. Because our team included the original developers of the intervention, the steps of understanding the intervention, selecting the intervention and consulting with experts were simplified. Additional steps included consulting with stakeholders through a national work group and collaboratively deciding what needed adaptation. RESULTS A number of key themes pertinent to the adaptation of the SFH intervention were identified in the focus groups. These included the gravity of messaging about commercial tobacco use; respect, familialism, and intergenerationalism; imagery, including significant symbolism, colors, and representative role models; whether and how to address traditional tobacco; and, barriers to a SFH not adequately addressed in the original materials. CONCLUSIONS Adaptation of an intervention to create smoke-free homes in AI/AN families necessitated both surface structure changes such as appearance of role models and deep structure changes that addressed core values, and beliefs and traditions.
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Affiliation(s)
- Katherine M. Anderson
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Michelle C. Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Lucja T. Bundy
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | | | | | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA USA
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Rollins K, Lewis C, Edward Smith T, Goeckner RT, Hale JW, Nazir N, Faseru B, Allen Greiner K, Daley SM, Choi WS, Daley CM. Development of a Culturally Appropriate Smokeless Tobacco Cessation Program for American Indians. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2018; 11:45-55. [PMID: 30906672 PMCID: PMC6426307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
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.
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