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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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Goeckner R, Lewis CS, Simon AL, Pacheco J, Hale J, Choi WS, Daley CM. Understanding American Indian tribal college student knowledge, attitudes, beliefs, and behaviors surrounding alternative tobacco products. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-7. [PMID: 38683876 DOI: 10.1080/07448481.2024.2338416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/22/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES To examine knowledge, attitudes, beliefs, and behaviors about alternative tobacco products among American Indian tribal college students. PARTICIPANTS One hundred and five tribal college students. METHODS Focus groups, one interview, and demographic surveys. RESULTS Tobacco use varied across the sample with 35.2% of the participants being users of ENDS products and 29.5% were cigarette smokers. Overall, participants viewed electronic nicotine delivery systems and chewing tobacco as primary examples of alternative tobacco products and described a generational divide between alternative and conventional tobacco product use. Alternative tobacco products were not considered suitable for use in traditional contexts. CONCLUSIONS Previously successful cessation programs in this population have relied on cultural tailoring related to traditional tobacco use in American Indian communities. Our findings suggest that this strategy may be less effective for addressing alternative tobacco use. Reliance on the importance of family relationships may prove more impactful in future programming.
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Affiliation(s)
- Ryan Goeckner
- Institute for Indigenous Studies, Lehigh University, Bethlehem, Pennsylvania, USA
- Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania, USA
- Department of Anthropology, The Ohio State University, Columbus, Ohio, USA
| | - Charley S Lewis
- Institute for Indigenous Studies, Lehigh University, Bethlehem, Pennsylvania, USA
- Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania, USA
- Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ashlee L Simon
- Institute for Indigenous Studies, Lehigh University, Bethlehem, Pennsylvania, USA
- Department of English, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Joe Pacheco
- Institute for Indigenous Studies, Lehigh University, Bethlehem, Pennsylvania, USA
- Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Jason Hale
- Institute for Indigenous Studies, Lehigh University, Bethlehem, Pennsylvania, USA
- Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Won S Choi
- Institute for Indigenous Studies, Lehigh University, Bethlehem, Pennsylvania, USA
- Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Christine Makosky Daley
- Institute for Indigenous Studies, Lehigh University, Bethlehem, Pennsylvania, USA
- Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania, USA
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Leinberger-Jabari A, Golob MM, Lindson N, Hartmann-Boyce J. Effectiveness of culturally tailoring smoking cessation interventions for reducing or quitting combustible tobacco: A systematic review and meta-analyses. Addiction 2024; 119:629-648. [PMID: 38105395 DOI: 10.1111/add.16400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/24/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND AIMS Standard approaches to smoking cessation may not be as effective for certain populations, and tailoring on cultural factors could improve their effectiveness. This systematic review measured the effectiveness of culturally tailoring smoking cessation interventions on quitting or reducing smoking combustible tobacco. METHOD We searched MEDLINE, PsychInfo, Embase and Cochrane Central Register from inception to 21 June 2023 for randomized controlled trials (RCTs) of community-based, primary care or web-based interventions for smoking cessation in adults who smoked tobacco, with measurement of smoking abstinence or reduction at least 3 months following baseline. We examined comparisons between either an intensity-matched culturally tailored intervention and a non-tailored intervention or a standard non-tailored intervention and the same intervention plus a culturally tailored adjunct. We sub-grouped studies according to the level of tailoring and performed subgroup analyses where appropriate. We assessed risk of bias and certainty of evidence. RESULTS We identified 43 studies, 33 of which were meta-analyzed (n = 12 346 participants). We found moderate certainty evidence, limited by heterogeneity, that intensity-matched culturally tailored cessation interventions increased quit success when compared with non-tailored interventions at 3-month follow-up or longer (n = 5602, risk ratio [RR] = 1.29 95% confidence interval [CI] 1.10, 1.51, I2 = 47%, 14 studies). We found a positive effect of adding a culturally tailored component to a standard intervention compared with the standard intervention alone (n = 6674, RR = 1.47, 95% CI 1.10, 1.95, I2 = 74%, 18 studies), but our certainty in this effect was low due to imprecision and substantial statistical heterogeneity. CONCLUSION Culturally tailored smoking cessation interventions may help more people to quit smoking than a non-tailored intervention. Adapting or adding cultural components to smoking cessation interventions originally developed for majority populations could improve cessation rates in populations who do not fully identify with majority cultural norms.
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Affiliation(s)
- Andrea Leinberger-Jabari
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Department of Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Melanie M Golob
- Department of Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Nicola Lindson
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
- Department of Health Policy and Promotion, University of Massachusetts Amherst, Amherst, United States
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Cooley C, Pickner W, Widome R, Jennings D, Stately A, Cole AB, Cash J, Dorr C, Hernadez C, Hatsukami D, Businelle M, Carroll DM. American Indian Perspectives on Culturally Aligning a Digital Smoking Cessation Resource. Nicotine Tob Res 2024; 26:39-45. [PMID: 37535663 PMCID: PMC10734387 DOI: 10.1093/ntr/ntad142] [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: 04/12/2023] [Revised: 07/18/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Innovative smoking cessation approaches that overcome barriers such as traveling to program site or that require the staff and infrastructure for sustaining are likely needed to improve smoking quit rates among American Indian (AI) peoples in the United States. In this study, qualitative methods identified recommendations from AI peoples to guide alignment of an evidence-based smoking cessation smartphone app (i.e., QuitGuide) to the culture and needs of AI persons. METHODS Semi-structured interviews were conducted with AI adults who smoke (n = 40) and with public health professionals (n = 6). Questions included: "The app asks if something triggered you to slip and lists several options. What options were you expecting to see on this list?" as well as how to make the app more engaging such as "What would make the app more helpful for AI peoples, like you, who want to quit smoking?." Constant comparative techniques were used to develop codes and themes. RESULTS Loss, grief, and not accessing traditional tobacco were put forward as smoking triggers to be addressed in the app. Features that help users connect with and learn about AI cultures and promote healing, such as encouraging traditional tobacco use, being in community, embracing Native spirituality, and participating in cultural crafting were recommended. Some noted the need to motivate AI peoples to think about legacy and ability to care for younger generations and Indigenizing the app with Native imagery. CONCLUSIONS Themes pointed towards promotion of strengths-based factors, such as healing, cultural connectedness and traditional tobacco use, in the app. IMPLICATIONS Results will be used to culturally align a smartphone app for smoking cessation among AI peoples and may be insightful for other tribal, federal, and state public health efforts aimed at advancing health equity for AI peoples.
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Affiliation(s)
| | - Wyatt Pickner
- American Indian Cancer Foundation, Minneapolis, MN, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Dylan Jennings
- Sigurd Olsen Environmental Institute, Northland College, Ashland, WI, USA
| | | | - Ashley B Cole
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | | | - Casey Dorr
- Department of Nephrology, Hennepin Healthcare Research Institute; University of Minnesota Medical School, Minneapolis, MN, USA
| | - Carol Hernadez
- Minnesota Cancer Clinical Trials Network, Minneapolis, MN, USA
| | - Dorothy Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michael Businelle
- Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Dana Mowls Carroll
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Courtemanche Y, Poliakova N, Muckle G, Bélanger RE. Smoking cessation attempts and successes among Nunavimmiut. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:126-135. [PMID: 37410367 PMCID: PMC10831029 DOI: 10.17269/s41997-023-00790-5] [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: 09/21/2021] [Accepted: 05/25/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES The smoking rate in Canada has declined in past decades, yet smoking rates remain high in Nunavik (northern Québec), where an estimated 80% of adult respondents smoke. We investigated sociodemographic factors, smoking behaviours, harm perception, and social support as determinants of smoking cessation attempts and successes among Nunavimmiut. METHODS Past year smoking frequency, quantity smoked, and cessation attempts and aids were documented in a sample of 1326 Nunavimmiut aged 16 and over in the Qanuilirpitaa? 2017 survey. Sociodemographic indicators, social support, cessation aids, and smoking harm perception were investigated as potential determinants. All factors were modeled by logistic regressions and adjusted for age and sex. RESULTS Thirty-nine percent of smokers tried to quit smoking in the preceding year, and 6% of those were successful. Older Nunavimmiut (aOR = 0.84 [0.78, 0.90]) and those smoking 20 + cigarettes/day (aOR = 0.94 [0.90, 0.98]) were less likely to attempt to quit. Ungava coast residents (aOR = 1.87 [1.36, 2.57]), separated/widowed/divorced individuals (aOR = 2.43 [1.09, 5.38]), and occasional smokers (aOR = 2.77 [1.61, 4.76]) compared to those living on the Hudson coast, single individuals, and daily smokers, respectively, were more likely to report cessation attempts. Most used no particular cessation aid (58%), 28% relied on family/self-help/support programs, and 26% used medication. Women were more likely to rely on spirituality/traditional methods (aOR = 1.92 [1.00, 3.71]) and less likely to rely on electronic cigarettes (aOR = 0.33 [0.13, 0.84]), as were older participants (aOR = 0.67 [0.49, 0.94]). Those with more years of schooling were more likely to rely on electronic cigarettes (aOR = 1.47 [1.06, 2.02]). These estimates are prone to biases due to the relatively low participation rate in the survey (37%). CONCLUSION Despite many attempts reported by participants, regional partners of this study underlined that successful smoking cessation remains a challenge for many Nunavimmiut. Key differences were identified in approaches and determinants of smoking cessation attempts, but most smokers did not use cessation aids. These results are in line with the experience of the Inuit partners of this study and can inform targeted public health interventions to support the many Nunavimmiut trying to quit smoking, notably increasing accessibility and acceptability of cessation aids. Inuit partners of this study highlighted the importance for interventions and communication efforts to reflect Nunavik's context.
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Affiliation(s)
- Yohann Courtemanche
- Centre de Recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Natalia Poliakova
- Centre de Recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Gina Muckle
- Centre de Recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- École de Psychologie, Université Laval, Québec, Québec, Canada
| | - Richard E Bélanger
- Centre de Recherche du CHU de Québec-Université Laval, Québec, Québec, Canada.
- Département de Pédiatrie, Université Laval, Québec, Québec, Canada.
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Rawal S, Johnson BR, Young HN, Gaye B, Sattler ELP. Association of Life's Simple 7 and ideal cardiovascular health in American Indians/Alaska Natives. Open Heart 2023; 10:openhrt-2022-002222. [PMID: 37024244 PMCID: PMC10083851 DOI: 10.1136/openhrt-2022-002222] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/01/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE American Indians and Alaska Natives (AI/ANs) are an understudied population at high risk for cardiovascular diseases (CVDs); little is known about contextual factors contributing to CVDs in AI/ANs. This study examined the association of Life's Simple 7 (LS7) factors and social determinants of health (SDH) with CVD outcomes in a nationally representative sample of AI/ANs. METHODS We conducted a cross-sectional study of 8497 AI/ANs using 2017 Behavioural Risk Factor Surveillance Survey data. Individual LS7 factors were summarised as ideal and poor levels. Coronary heart disease, myocardial infarction and stroke were defined as CVD outcomes. Healthcare access measures represented SDH. Logistic regression analyses examined associations of LS7 factors and SDH with CVD outcomes. Population attributable fractions (PAFs) quantified individual contributions of LS7 factors to CVD outcomes. RESULTS N=1,297 (15%) participants with CVD outcomes were identified. Smoking, physical inactivity, diabetes, hypertension and hyperlipidaemia were LS7 factors associated with CVD outcomes. Hypertension was the largest contributor to CVD (aPAF 42%; 95% CI 37% to 51%), followed by hyperlipidaemia (aPAF 27%; 95% CI 17% to 36%) and diabetes (aPAF 18%; 95% CI 7% to 23%). Compared with individuals with poor LS7 levels, participants with ideal levels showed 80% lower odds of CVD outcomes (aOR 0.20; 95% CI 0.16 to 0.25). Access to health insurance (aOR 1.43, 95% CI 1.08 to 1.89) and a regular care provider (aOR 1.47, 95% CI 1.24 to 1.76) were associated with CVD outcomes. CONCLUSIONS Effective interventions are needed to address SDH and attain ideal LS7 factors to improve cardiovascular health among AI/ANs.
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Affiliation(s)
- Smita Rawal
- Department of Clinical and Administrative Pharmacy, University of Georgia, Athens, Georgia, USA
| | - Blake Ryan Johnson
- Department of Clinical and Administrative Pharmacy, University of Georgia, Athens, Georgia, USA
| | - Henry Nolan Young
- Department of Clinical and Administrative Pharmacy, University of Georgia, Athens, Georgia, USA
| | - Bamba Gaye
- INSERM U970, Paris Cardiovascular Research Center, Paris, France
- Universite de Paris Faculte de Sante, Paris, France
| | - Elisabeth Lilian Pia Sattler
- Department of Clinical and Administrative Pharmacy, University of Georgia, Athens, Georgia, USA
- Department of Nutritional Sciences, University of Georgia, Athens, Georgia, USA
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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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Non-Pharmacologic Approaches to Tobacco Cessation. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Bhatt G, Goel S, Grover S, Medhi B, Singh G, Gill SS, Swasticharan L, Singh RJ. Development of a multi-component tobacco cessation training package utilizing multiple approaches of intervention development for health care providers and patients attending non-communicable disease clinics of Punjab, India. Front Public Health 2022; 10:1053428. [PMID: 36530680 PMCID: PMC9755677 DOI: 10.3389/fpubh.2022.1053428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
Background Providing patients with personalized tobacco cessation counseling that is culturally sensitive, and disease-specific from healthcare providers (HCPs) as part of their routine consultations is an approach that could be incorporated, using existing healthcare systems such as the Non-Communicable Disease (NCD) clinics. This paper describes the development of a multi-component culturally tailored, patient-centric, disease-specific tobacco cessation package utilizing multiple approaches of intervention development for healthcare providers and patients attending these clinics in Punjab, India, along with a proposed framework for implementation. Methods The proposed intervention package was developed in 6 stages. These included a review of literature for identifying successful cessation interventions for ethnic minority groups, co-production of the package with all stakeholders involved via a series of consultative meetings and workshops, understanding contextual factors of the state and 'factor-in' these in the package, pre-test of the package among HCPs and tobacco users using in-depth interviews, micro detailing and expansion of the package by drawing on existing theories of the Cascade Model and Trans-Theoretical Model and developing an evolving analysis plan through real-world implementation at two pilot districts by undertaking a randomized controlled trial, assessing implementer's experiences using a mixed-method with a primary focus on qualitative and economic evaluation of intervention package. Results A multi-component package consisting of a booklet (for HCPs), disease-specific pamphlets and short text messages (for patients; bilingual), and an implementation framework was developed using the 6-step process. A major finding from the in-depth interviews was the need for a specific capacity-building training program on tobacco cessation. Therefore, using this as an opportunity, we trained the in-service human resource and associated program managers at the state and district-level training workshops. Based on the feedback, training objectives were set and supported with copies of intervention package components. In addition, the role and function of each stakeholder were defined in the proposed framework. Conclusion Consideration of tobacco users' socio-cultural and patient-centric approach makes a robust strategy while developing and implementing an intervention providing an enlarged scope to improve care services for diversified socio-cultural communities.
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Affiliation(s)
- Garima Bhatt
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India,Public Health Master's Program, School of Medicine and Health Research Institute (HRI), University of Limerick, Limerick, Ireland,Faculty of Human and Health Sciences, Swansea University, Swansea, United Kingdom,*Correspondence: Sonu Goel
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gurmandeep Singh
- National Health Mission, Department of Health and Family Welfare Government of Punjab, Chandigarh, India
| | - Sandeep Singh Gill
- Department of Health and Family Welfare, Government of Punjab, Chandigarh, India
| | - Leimapokpam Swasticharan
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Rana J. Singh
- Department of Tobacco and NCD Control, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
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Rusk AM, Giblon RE, Chamberlain AM, Patten CA, Felzer JR, Bui YT, Wi CI, Destephano CC, Abbott BA, Kennedy CC. Indigenous Smoking Behaviors in Olmsted County, Minnesota: A Longitudinal Population-Based Study. Mayo Clin Proc 2022; 97:1836-1848. [PMID: 36202495 PMCID: PMC9918799 DOI: 10.1016/j.mayocp.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/03/2022] [Accepted: 03/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe smoking behaviors and pharmaceutical cessation aid uptake in a population-based Indigenous cohort compared with an age- and sex-matched non-Indigenous cohort. PATIENTS AND METHODS Using the health record-linkage system of the Rochester Epidemiology Project (January 1, 2006, to December 31, 2019), smoking data of Indigenous residents of Olmsted County in Minnesota were abstracted to define the smoking prevalence, incidence, cessation, relapse after cessation, and pharmaceutical smoking cessation aid uptake compared with a matched non-Indigenous cohort. Prevalence was analyzed with a modified Poisson regression; cessation and relapse were evaluated with generalized estimating equations. Incidence was evaluated with a Cox proportional hazards model. RESULTS Smoking prevalence was higher in the Indigenous cohort (39.0% to 47.0%; n=898) than the matched cohort (25.6% to 30.3%; n=1780). Pharmaceutical uptake was higher among the Indigenous cohort (35.8% of n=584 ever smokers vs 16.3% of n=778 ever smokers; P<.001). Smoking cessation events occurred more frequently in the Indigenous cohort (relative risk, 1.10; 95% CI, 1.06 to 1.13; P<.001). Indigenous former smokers were more likely to resume smoking (relative risk, 3.03; 95% CI, 2.93 to 3.14; P<.001) compared with the matched cohort. These findings were independent of socioeconomic status, age, and sex. CONCLUSION Smoking in this Indigenous cohort was more prevalent compared with a sex- and age-matched non-Indigenous cohort despite more smoking cessation events and higher use of smoking cessation aids in the Indigenous cohort. The relapse rate after achieving cessation in the Indigenous cohort was more than three times higher than the non-Indigenous cohort. This finding has not been previously described and represents a potential target for relapse prevention efforts in US Indigenous populations.
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Affiliation(s)
- Ann M Rusk
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Respiratory Health Equity Clinical Research Laboratory at Mayo Clinic, Rochester, MN
| | - Rachel E Giblon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christi A Patten
- Division of Behavioral Health Research, Mayo Clinic, Rochester, MN, USA
| | - Jamie R Felzer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA; Respiratory Health Equity Clinical Research Laboratory at Mayo Clinic, Rochester, MN
| | - Yvonne T Bui
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christopher C Destephano
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Division of Obstetrics and Gynecology, Mayo Clinic, Jacksonville, FL, USA
| | - Barbara A Abbott
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Cassie C Kennedy
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Respiratory Health Equity Clinical Research Laboratory at Mayo Clinic, Rochester, MN.
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Santiago-Torres M, Mull KE, Sullivan BM, Kwon DM, Nez Henderson P, Nelson LA, Patten CA, Bricker JB. Efficacy and Utilization of Smartphone Applications for Smoking Cessation Among American Indians and Alaska Natives: Results From the iCanQuit Trial. Nicotine Tob Res 2022; 24:544-554. [PMID: 34644389 PMCID: PMC8887580 DOI: 10.1093/ntr/ntab213] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION There is tremendous need for efficacious and accessible interventions for smoking cessation among American Indians and Alaska Natives. We tested the efficacy of an Acceptance and Commitment Therapy (ACT)-based smartphone application (iCanQuit) versus US Clinical Practice Guidelines-based smartphone application (QuitGuide) for smoking cessation among American Indians and Alaska Natives. AIMS AND METHODS We compared cessation, changes in ACT-based processes, engagement and satisfaction between American Indian and Alaska Native iCanQuit (n = 89) and QuitGuide (n = 80) participants enrolled in the iCanQuit trial. The primary outcome was self-reported, complete-case, 30-day point-prevalence abstinence. Follow-up timepoints were 12, 6, and 3 months. RESULTS Randomized American Indians and Alaska Natives from 31 US states (70% urban, 30% rural, with 25% of participants residing on tribal land). The outcome data retention rates were 93%, 92%, and 90% at the 12-, 6-, and 3-month follow-ups, respectively, with no differential retention between arms. The 30-day point-prevalence abstinence for iCanQuit versus QuitGuide was 30% versus 18% at 12 months (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 0.90 to 4.26) 25% versus 11% at 6 months (OR = 2.62; 95% CI: 1.06 to 6.45), and 15% versus 6% at 3 months (OR = 2.93; 95% CI: 0.90 to 9.59). Increases in acceptance of internal cues to smoke mediated the effect of treatment on smoking cessation at 12 months. iCanQuit arm participants were also significantly more engaged and satisfied with their assigned application. CONCLUSIONS In a nationwide sample with high data retention and participant engagement, this is the first study to show that a digital intervention may be efficacious for helping American Indians and Alaska Natives quit smoking. IMPLICATIONS This is the first study to provide evidence of an efficacious, accessible, and engaging treatment for helping American Indians and Alaska Natives quit smoking. Compared to a US Clinical Practice Guidelines-based smartphone application (QuitGuide), an ACT-based smartphone application (iCanQuit) was more efficacious, engaging, and satisfactory among American Indians and Alaska Natives nationwide. Our results will inform the tailoring of the iCanQuit smartphone application for American Indian and Alaska Native tribal communities and organizations with potential for broad dissemination and high impact.
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Affiliation(s)
| | - Kristin E Mull
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Brianna M Sullivan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Diana M Kwon
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA,USA
| | | | - Lonnie A Nelson
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
- Washington State University College of Nursing, Spokane, WA, USA
| | - Christi A Patten
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, Rochester, MN, USA
| | - Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA,USA
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12
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Narcisse MR, Shah SK, Felix HC, Dobbs PD, McElfish PA. Association of psychological distress and current cigarette smoking among Native Hawaiian and Pacific Islander adults and compared to adults from other racial/ethnic groups: Data from the National Health Interview Survey, 2014. Prev Med Rep 2022; 25:101660. [PMID: 34950562 PMCID: PMC8671122 DOI: 10.1016/j.pmedr.2021.101660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Cigarette smoking is the leading cause of preventable deaths worldwide. Research has documented an association between psychological distress and smoking among certain racial/ethnic groups but has not examined this association among Native Hawaiian and Pacific Islander (NHPI) adults. Data from the 2014 general and the NHPI-specific National Health Interview Surveys were analyzed at the University of Arkansas for Medical Sciences Regional Campus (Fayetteville, AR) in April 2021 to determine the association between current cigarette smoking and levels of psychological distress among NHPI adults and to assess the difference in the magnitude of that association among NHPI adults compared to adults of other racial/ethnic groups in the United States. The final analytic sample (n = 34,782) included 1,916 NHPI, 20,430 White, 4,725 Black, 2,001 Asian, and 5,710 Hispanic adults. A significant association between current cigarette smoking and psychological distress levels was found among NHPI adults as well as among adults from other racial/ethnic groups. There was no significant difference in the magnitude of the detected association among NHPI adults compared to the magnitude of the same association detected among adults of other racial/ethnic groups. However, this finding indicates race/ethnicity does not moderate the association between psychological distress and current cigarette smoking. Future studies should explore factors that may further explain the variation in current cigarette smoking within and across all racial/ethnic groups.
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Affiliation(s)
- Marie-Rachelle Narcisse
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Sumit K. Shah
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Holly C. Felix
- University of Arkansas for Medical Sciences, Fay W. Boozman College of Public Health, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Page D. Dobbs
- University of Arkansas, Department of Health, Human Performance and Recreation, 751 W. Maple St., Fayetteville, AR 72701, USA
| | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703, USA
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13
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Yzer M, Rhodes K, Nagler RH, Joseph A. Effects of culturally tailored smoking prevention and cessation messages on urban American Indian youth. Prev Med Rep 2021; 24:101540. [PMID: 34976614 PMCID: PMC8683983 DOI: 10.1016/j.pmedr.2021.101540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
American Indian youth participated in a community-engaged experiment. Participants viewed a comparison message or one of two antismoking messages. Antismoking messages either used a culturally relevant argument or a health outcomes argument. The message with a cultural argument moved AI youth who had ever smoked to a more negative stance towards smoking. Cultural arguments are useful for encouraging American Indian youth not to smoke.
American Indians (AI) face significant disparities in smoking-related diseases. In addition, smoking prevalence increases exponentially between ages 11 and 18. Smoking prevention and cessation efforts aimed at AI youth therefore are important. In order to strengthen understanding of evidence-based message strategies for smoking prevention and cessation among AI youth. The objective of this study was to test whether a message that was tailored to AI cultural values associated with the sacredness of traditional tobacco can change variables that behavioral theories have identified as predictors of smoking (i.e., instrumental and experiential attitudes, injunctive and descriptive norms, perceived capacity and autonomy, and intention with respect to smoking). We conducted a randomized field experiment among 300 never-smoking and ever-smoking urban AI youth in Minneapolis-Saint Paul between May 18 and July 27, 2019. We used a 3 (message condition: cultural benefits of not smoking cigarettes, health benefits of not smoking cigarettes, comparison message about benefits of healthy eating) × 2 (smoking status: ever-smoked, never-smoked) between-subjects design. Multivariate analysis of variance showed that for ever-smokers, the cultural consequences of smoking message significantly lowered instrumental attitude (partial eta2 = 0.029), experiential attitude (partial eta2 = 0.041), perceived capacity (partial eta2 = 0.051), and smoking intention (partial eta2 = 0.035) compared to the healthy eating comparison message and the health consequences of smoking message. This was not observed among never-smokers, who already had very negative smoking perceptions. We conclude that messages that tailor to AI culture may be effective tools for discouraging smoking among AI youth.
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14
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Wedekind LE, Mitchell CM, Andersen CC, Knowler WC, Hanson RL. Epidemiology of Type 2 Diabetes in Indigenous Communities in the United States. Curr Diab Rep 2021; 21:47. [PMID: 34807308 PMCID: PMC8665733 DOI: 10.1007/s11892-021-01406-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW The present review focuses on the epidemiology of type 2 diabetes (T2D) in Indigenous communities in the continental United States (U.S.)-including disease prevention and management-and discusses special considerations in conducting research with Indigenous communities. RECENT FINDINGS Previous studies have reported the disparately high prevalence of diabetes, especially T2D, among Indigenous peoples in the U.S. The high prevalence and incidence of early-onset T2D in Indigenous youth relative to that of all youth in the U.S. population pose challenges to the prevention of complications of diabetes. Behavioral, dietary, lifestyle, and genetic factors associated with T2D in Indigenous communities are often investigated. More limited is the discussion of the historical and ongoing consequences of colonization and displacement that impact the aforementioned risk factors. Future research is necessary to assess community-specific needs with respect to diabetes prevention and management across the diversity of Indigenous communities in the U.S.
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Affiliation(s)
- Lauren E Wedekind
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
- Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Cassie M Mitchell
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - Coley C Andersen
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - William C Knowler
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA.
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Aluckal E, Pulayath C, Chithra P, Balakrishna MS, Luke AM, Mathew S. Tobacco Cessation Behavior Among Smoking and Smokeless Form Tobacco Users in the Indigenous Population of Ernakulam, India. J Pharm Bioallied Sci 2020; 12:S194-S198. [PMID: 33149455 PMCID: PMC7595517 DOI: 10.4103/jpbs.jpbs_58_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/01/2020] [Accepted: 03/13/2020] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Eby Aluckal
- Department of Public Health Dentistry, Mar Baselios Dental College, Kothamangalam, Kerala, India
| | - Civy Pulayath
- Department of Public Health Dentistry, Malabar Dental College and Research Centre, Malappuram, Kerala, India
| | - P Chithra
- Department of Oral Medicine and Radiology, Malabar Dental College and Research Centre, Malappuram, Kerala, India
| | - M S Balakrishna
- Department of Oral and Maxillofacial Surgery, Malabar Dental College and Research Centre, Malappuram, Kerala, India
| | - Alexander M Luke
- Department of Surgical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates
| | - Simy Mathew
- Department of Growth and Development, College of Dentistry, Ajman University, Ajman, United Arab Emirates
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16
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Potnek MF. Urban American Indian Clinic Smoking Cessation Program. J Dr Nurs Pract 2020; 13:164-172. [PMID: 32817506 DOI: 10.1891/jdnp-d-19-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cigarette-smoking disparities continue to exist among minority groups of adults, particularly American Indians, who had the highest prevalence of cigarette smoking at 24% in 2017. OBJECTIVE Implement a nurse practitioner-led smoking cessation pilot program at an urban American Indian health center. METHODS The cessation program is based on the "Treating Tobacco Use and Dependence" clinical practice guideline with incorporation of motivational interviewing, and is guided by the Transtheoretical Model of Health Behavior Changes. The program consisted of ten sessions: one in-person visit and nine telephone sessions over the course of eight weeks. Evaluation of project objectives was achieved through the collection of qualitative and quantitative data via weekly phone counseling sessions and a final follow-up phone call. RESULTS Among program participants (n = 5), three achieved complete cessation, one decreased their smoking behavior, and one experienced no change in smoking behavior. CONCLUSIONS Although the program is effective among participants who completed the program, attrition was a significant issue requiring potential future changes to the program design.
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17
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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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18
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Yuan NP, Schultz JL, Nair US, Bell ML. Predictors of Tobacco Cessation Among American Indian/Alaska Native Adults Enrolled in a State Quitline. Subst Use Misuse 2019; 55:452-459. [PMID: 31694464 PMCID: PMC9710533 DOI: 10.1080/10826084.2019.1683204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: High rates of smoking are documented among some American Indian and Alaska Native (AI/AN) communities, with potential variability by region and urban/rural settings. Quitlines are a cost-effective strategy for providing evidence-based cessation treatment, but little is known about the effectiveness of quitline services for the AI/AN population. Objectives: This study compared demographic characteristics, tobacco use, and cessation and program utilization behaviors between AI/AN (n = 297) and Non-Hispanic White (NHW; n = 13,497) quitline callers. The study also identified predictors of 30-day cessation at 7-month follow-up among AI/AN callers and determined if predictors were different between AI/AN and NHW callers. Methods: Data from callers to the Arizona Smokers' Helpline between January 2011 and June 2016 were analyzed. Results: At enrollment, AI/AN callers were less likely to use tobacco daily and were less dependent on nicotine compared to NHW callers. Both groups reported similar rates of 30-day cessation at 7-month follow-up (37.3% and 39.7% for AI/AN and NHW callers, respectively). For AI/AN callers, 30-day cessation was significantly associated with tobacco cessation medication use (OR = 2.24, 95% CI: 1.02-4.93), number of coaching sessions (OR = 1.14, 95% CI: 1.04-1.26), and other smokers in the home (OR = 0.41, 95% CI: 0.19-0.91). The effect of other smokers in the home was significantly different between AI/AN and NHW callers (p = .007). Conclusions: Different individual characteristics and predictors of cessation among AI/AN callers compared to NHW callers were documented. Findings may be used to inform the development of culturally-tailored strategies and protocols for AI/AN quitline callers.
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Affiliation(s)
- Nicole P. Yuan
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Jennifer L. Schultz
- Arizona Smokers’ Helpline, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Uma S. Nair
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
- Arizona Smokers’ Helpline, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Melanie L. Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
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Cadham CJ, Jayasekera JC, Advani SM, Fallon SJ, Stephens JL, Braithwaite D, Jeon J, Cao P, Levy DT, Meza R, Taylor KL, Mandelblatt JS. Smoking cessation interventions for potential use in the lung cancer screening setting: A systematic review and meta-analysis. Lung Cancer 2019; 135:205-216. [PMID: 31446996 DOI: 10.1016/j.lungcan.2019.06.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/27/2019] [Accepted: 06/26/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Current guidelines recommend delivery of smoking cessation interventions with lung cancer screening (LCS). Unfortunately, there are limited data to guide clinicians and policy-makers in choosing cessation interventions in this setting. Several trials are underway to fill this evidence gap, but results are not expected for several years. METHODS AND MATERIALS We conducted a systematic review and meta-analysis of current literature on the efficacy of smoking cessation interventions among populations eligible for LCS. We searched PubMed, Medline, and PsycINFO for randomized controlled trials of smoking cessation interventions published from 2010-2017. Trials were eligible for inclusion if they sampled individuals likely to be eligible for LCS based on age and smoking history, had sample sizes >100, follow-up of 6- or 12-months, and were based in North America, Western Europe, Australia, or New Zealand. RESULTS Three investigators independently screened 3,813 abstracts and identified 332 for full-text review. Of these, 85 trials were included and grouped into categories based on the primary intervention: electronic/web-based, in-person counseling, pharmacotherapy, and telephone counseling. At 6-month follow-up, electronic/web-based (odds ratio [OR] 1.14, 95% CI 1.03-1.25), in-person counseling (OR 1.46, 95% CI 1.25-1.70), and pharmacotherapy (OR 1.53, 95% CI 1.33-1.77) interventions significantly increased the odds of abstinence. Telephone counseling increased the odds but did not reach statistical significance (OR 1.21, 95% CI 0.98-1.50). At 12-months, in-person counseling (OR 1.28 95% CI 1.10-1.50) and pharmacotherapy (OR 1.46, 95% CI 1.17-1.84) remained efficacious, although the decrement in efficacy was of similar magnitude across all intervention categories. CONCLUSIONS Several categories of cessation interventions are promising for implementation in the LCS setting.
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Affiliation(s)
- Christopher J Cadham
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Jinani C Jayasekera
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA.
| | - Shailesh M Advani
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA; The National Human Genome Research Institute, National Institutes of Health, 31 Center Drive, Bethesda, MD, USA
| | - Shelby J Fallon
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Jennifer L Stephens
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Dejana Braithwaite
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Jihyoun Jeon
- University of Michigan, School of Public Health, Ann Arbor, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Pianpian Cao
- University of Michigan, School of Public Health, Ann Arbor, 1415 Washington Heights, Ann Arbor, MI, USA
| | - David T Levy
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Rafael Meza
- University of Michigan, School of Public Health, Ann Arbor, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Kathryn L Taylor
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Jeanne S Mandelblatt
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
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Walls ML, Hautala D, Gonzalez M, Greenfield B, Aronson BD, Onello E. Perceptions and Prevalence of Alcohol and Cigarette Use Among American Indian Adults With Type 2 Diabetes. Clin Diabetes 2019; 37:260-268. [PMID: 31371857 PMCID: PMC6640875 DOI: 10.2337/cd18-0078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IN BRIEF This study examined community perceptions and prevalence of alcohol use and cigarette smoking among American Indian adults with type 2 diabetes. Results revealed normative rates and perceptions of smoking and negative views and low rates of alcohol use. Participants reported high levels of household indoor smoking and comorbid high-risk drinking and smoking. The high smoking rate among the adult American Indians in this study is especially problematic given the increased risk of cardiovascular problems related to both smoking and type 2 diabetes. The results underscore the importance of considering substance use behaviors and beliefs as a component of overall health and well-being for people with diabetes.
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Affiliation(s)
- Melissa L. Walls
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
| | - Dane Hautala
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
| | - Miigis Gonzalez
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
| | - Brenna Greenfield
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
| | - Benjamin D. Aronson
- Department of Pharmacy Practice, Ohio Northern University Raabe College of Pharmacy, Ada, OH
| | - Emily Onello
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
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21
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Hartmann‐Boyce J, Hong B, Livingstone‐Banks J, Wheat H, Fanshawe TR. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database Syst Rev 2019; 6:CD009670. [PMID: 31166007 PMCID: PMC6549450 DOI: 10.1002/14651858.cd009670.pub4] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pharmacotherapies for smoking cessation increase the likelihood of achieving abstinence in a quit attempt. It is plausible that providing support, or, if support is offered, offering more intensive support or support including particular components may increase abstinence further. OBJECTIVES To evaluate the effect of adding or increasing the intensity of behavioural support for people using smoking cessation medications, and to assess whether there are different effects depending on the type of pharmacotherapy, or the amount of support in each condition. We also looked at studies which directly compare behavioural interventions matched for contact time, where pharmacotherapy is provided to both groups (e.g. tests of different components or approaches to behavioural support as an adjunct to pharmacotherapy). SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the ICTRP in June 2018 for records with any mention of pharmacotherapy, including any type of nicotine replacement therapy (NRT), bupropion, nortriptyline or varenicline, that evaluated the addition of personal support or compared two or more intensities of behavioural support. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in which all participants received pharmacotherapy for smoking cessation and conditions differed by the amount or type of behavioural support. The intervention condition had to involve person-to-person contact (defined as face-to-face or telephone). The control condition could receive less intensive personal contact, a different type of personal contact, written information, or no behavioural support at all. We excluded trials recruiting only pregnant women and trials which did not set out to assess smoking cessation at six months or longer. DATA COLLECTION AND ANALYSIS For this update, screening and data extraction followed standard Cochrane methods. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically-validated rates, if available. We calculated the risk ratio (RR) and 95% confidence interval (CI) for each study. Where appropriate, we performed meta-analysis using a random-effects model. MAIN RESULTS Eighty-three studies, 36 of which were new to this update, met the inclusion criteria, representing 29,536 participants. Overall, we judged 16 studies to be at low risk of bias and 21 studies to be at high risk of bias. All other studies were judged to be at unclear risk of bias. Results were not sensitive to the exclusion of studies at high risk of bias. We pooled all studies comparing more versus less support in the main analysis. Findings demonstrated a benefit of behavioural support in addition to pharmacotherapy. When all studies of additional behavioural therapy were pooled, there was evidence of a statistically significant benefit from additional support (RR 1.15, 95% CI 1.08 to 1.22, I² = 8%, 65 studies, n = 23,331) for abstinence at longest follow-up, and this effect was not different when we compared subgroups by type of pharmacotherapy or intensity of contact. This effect was similar in the subgroup of eight studies in which the control group received no behavioural support (RR 1.20, 95% CI 1.02 to 1.43, I² = 20%, n = 4,018). Seventeen studies compared interventions matched for contact time but that differed in terms of the behavioural components or approaches employed. Of the 15 comparisons, all had small numbers of participants and events. Only one detected a statistically significant effect, favouring a health education approach (which the authors described as standard counselling containing information and advice) over motivational interviewing approach (RR 0.56, 95% CI 0.33 to 0.94, n = 378). AUTHORS' CONCLUSIONS There is high-certainty evidence that providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking increases quit rates. Increasing the amount of behavioural support is likely to increase the chance of success by about 10% to 20%, based on a pooled estimate from 65 trials. Subgroup analysis suggests that the incremental benefit from more support is similar over a range of levels of baseline support. More research is needed to assess the effectiveness of specific components that comprise behavioural support.
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Affiliation(s)
- Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Bosun Hong
- Birmingham Dental HospitalOral Surgery Department5 Mill Pool WayBirminghamUKB5 7EG
| | - Jonathan Livingstone‐Banks
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Hannah Wheat
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Thomas R Fanshawe
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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22
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Orr MF, Burduli E, Hirchak KA, Walsh Dotson JA, Young SL, Nelson L, Lennstrom E, Slaney T, Bush T, Gillaspy SR, Roll JM, Buchwald D, McPherson SM. Culturally-tailored text-messaging intervention for smoking cessation in rural American Indian communities: Rationale, design, and methods. Contemp Clin Trials Commun 2019; 15:100363. [PMID: 31049463 PMCID: PMC6484287 DOI: 10.1016/j.conctc.2019.100363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/23/2019] [Accepted: 04/12/2019] [Indexed: 10/27/2022] Open
Abstract
Background American Indian (AI) and Alaska Native (AN) communities experience disproportionately high rates of tobacco use when compared to the overall U.S. population, especially among rural populations. Methods We implemented a single-blind, randomized clinical trial of a text messaging-based smoking cessation intervention through the tobacco quitlines of five states (Alaska, Minnesota, New Mexico, Oklahoma, and Wisconsin) with high percentages of AI residents. We partnered with state quitlines and Optum, a multi-state entity that manages quitlines. Participants who called the quitlines and identified as AI/AN were given the option to enroll in this trial. Upon consent, they were randomly assigned to either the standard quitline program (control) or a program culturally tailored for AI/ANs (intervention), which used a text messaging intervention to encourage smoking cessation. We adapted the text messages based on key informant and focus group input. Baseline data was analyzed for differences across age, sex, and the Fagerström Test for Nicotine Dependence. Results We recruited n = 487 AIs into the trial. Participants had an average age of 41.9 years (SD = 11.7) and 66% were female. The average Fagerström Test for Nicotine Dependence score was 5.38 (SD = 2.37). The intervention and control arms did not significantly differ across any of the baseline characteristics. Conclusion Implementation of this trial illustrated important lessons in adapting, implementing, and evaluating trials in collaboration with AI communities and local and national organizations. This work will inform future efforts to implement culturally-tailored interventions with AI/ANs and advance our knowledge about adapting and implementing smoking cessation interventions.
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Affiliation(s)
- Michael F Orr
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99210-1495, USA.,Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, 99210-1495, USA.,College of Nursing, Washington State University, Spokane, WA, 99210-1495, USA
| | - Ekaterina Burduli
- Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, 99210-1495, USA.,College of Nursing, Washington State University, Spokane, WA, 99210-1495, USA
| | - Katherine A Hirchak
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99210-1495, USA.,Initiative for Research and Education to Advance Community Health, Washington State University (IREACH), Spokane, WA, 99210-1495, USA.,Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, 99210-1495, USA
| | - Jo Ann Walsh Dotson
- Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, 99210-1495, USA.,College of Nursing, Washington State University, Spokane, WA, 99210-1495, USA
| | - Sara L Young
- Montana State University, Bozeman, MT, 59717-2220, USA
| | - Lonnie Nelson
- Initiative for Research and Education to Advance Community Health, Washington State University (IREACH), Spokane, WA, 99210-1495, USA.,College of Nursing, Washington State University, Spokane, WA, 99210-1495, USA
| | - Emma Lennstrom
- Initiative for Research and Education to Advance Community Health, Washington State University (IREACH), Spokane, WA, 99210-1495, USA
| | - Trevor Slaney
- Initiative for Research and Education to Advance Community Health, Washington State University (IREACH), Spokane, WA, 99210-1495, USA
| | - Terry Bush
- Optum 11000 Optum Circle, Eden Prairie, MN, 55344, USA
| | - Stephen R Gillaspy
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99210-1495, USA.,Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, 99210-1495, USA.,College of Nursing, Washington State University, Spokane, WA, 99210-1495, USA
| | - Dedra Buchwald
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99210-1495, USA.,Initiative for Research and Education to Advance Community Health, Washington State University (IREACH), Spokane, WA, 99210-1495, USA
| | - Sterling M McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99210-1495, USA.,Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, 99210-1495, USA
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23
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Dignan MB, Jones K, Burhansstipanov L, Ahamed SI, Krebs LU, Williams D, Ahsan GMT, Addo I, Sargent M, Cina K, Crawford K, Thibeault D, Bordeaux S, Kanekar S, Petereit D. A randomized trial to reduce smoking among American Indians in South Dakota: The walking forward study. Contemp Clin Trials 2019; 81:28-33. [PMID: 30986536 DOI: 10.1016/j.cct.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/27/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Lung cancer is an important public health issue, particularly among American Indians (AIs). The reported decline in tobacco use for most racial/ethnic groups is not observed among AIs. This project was designed to address the research question, "Why don't more Northern Plains American Indians alter tobacco use behaviors known to increase the risk of cancer?" METHODS Guided by the Theory of Planned Behavior, a multi-component intervention study was implemented. Adult AIs, age 18 years or older and currently smoking, were enrolled. Eligible subjects were randomized to one of 15 groups and exposed to either a MINIMAL or an INTENSE level of 4 intervention components. The intervention was delivered face-to-face or via telephone by Patient Navigators (PN). The primary outcome was self-reported abstinence from smoking verified by carbon monoxide measurement. RESULTS At 18 months post-quit date, 88% of those who were still in the study were abstinent. This included 6% of all participants who enrolled in the study (14/254) and 13% of those who made it to the quit date (14/108). No intervention groups were found to have significant proportions of participants who were abstinent from smoking at the quit date (visit 5) or primary outcome visit (18 months post-quit date, visit 11), but use of pharmacologic support for abstinence was found to be an effective strategy for individuals who continued participation throughout the study. Those who remained in the study received more visits and were more likely to be abstinent. CONCLUSIONS Use of NRT increased the odds of not smoking, as assessed at the 18-month follow-up visit, but no other interventions were found to significantly contribute to abstinence from smoking. Although the intervention protocol included numerous points of contact between CRRs and participants (11 visits) loss to follow-up was extensive with only 16/254 remaining enrolled. Additional research is needed to improve understanding of factors that influence enrollment and retention in smoking cessation interventions for AI and other populations.
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Affiliation(s)
- Mark B Dignan
- Prevention Research Center, University of Kentucky, Lexington, KY 40522, USA.
| | - Kate Jones
- Prevention Research Center, University of Kentucky, Lexington, KY 40522, USA
| | - Linda Burhansstipanov
- Native American Cancer Initiatives, Inc., 3022 South Nova Road, Pine, CO 880470-7830, United States of America.
| | - Sheikh I Ahamed
- Ubicomp research lab Marquette University, P.O. Box 1881, 1313 W. Wisconsin Avenue, Milwaukee, WI 53201, United States of America.
| | - Linda U Krebs
- Native American Cancer Initiatives, Inc., 3022 South Nova Road, Pine, CO 880470-7830, United States of America.
| | - Drew Williams
- Ubicomp research lab Marquette University, P.O. Box 1881, 1313 W. Wisconsin Avenue, Milwaukee, WI 53201, United States of America
| | - G M Tanimul Ahsan
- Computer Science, University of Wisconsin - Green Bay, Green Bay, WI 54311, United States of America.
| | - Ivor Addo
- College of Business, University of Wisconsin - Oshkosh, Oshkosh, WI 54901, United States of America.
| | - Michele Sargent
- Avera Research Institute, Avera Health, 4940 5(th) Street Suite 1C, Rapid City, SD 57701, United States of America.
| | - Kristin Cina
- Avera Research Institute, Avera Health, 4940 5(th) Street Suite 1C, Rapid City, SD 57701, United States of America.
| | - Kim Crawford
- Avera Research Institute, Avera Health, 4940 5(th) Street Suite 1C, Rapid City, SD 57701, United States of America
| | - Doris Thibeault
- Avera Research Institute, Avera Health, 4940 5(th) Street Suite 1C, Rapid City, SD 57701, United States of America.
| | - Simone Bordeaux
- Avera Research Institute, Avera Health, 4940 5(th) Street Suite 1C, Rapid City, SD 57701, United States of America.
| | - Shalini Kanekar
- Regional Cancer Care Institute, Rapid City Regional Hospital, 353 Fairmount Blvd, Rapid City, SD 57701, USA; Clinical Affairs, Prometic Biotherapeutics Inc., Rockville, MD 20850, United States of America
| | - Daniel Petereit
- Regional Cancer Care Institute, Rapid City Regional Hospital, 353 Fairmount Blvd, Rapid City, SD 57701, USA.
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24
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Popova L, Majeed B, Owusu D, Spears CA, Ashley DL. Who are the smokers who never plan to quit and what do they think about the risks of using tobacco products? Addict Behav 2018; 87:62-68. [PMID: 29958136 PMCID: PMC6109416 DOI: 10.1016/j.addbeh.2018.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Smoking cigarettes is the most harmful way to use tobacco. Smokers who do not plan to quit present a particular challenge in reducing the morbidity and mortality from tobacco use. Switching to a lower harm product might encourage them to end their use of combusted cigarettes. This study aimed to better understand smokers who do not intend to quit (including their demographic and worldviews as indicators of their social, cultural, and political dispositions) and their perceived risks of cigarettes and possible lower-risk products such as e-cigarettes. METHODS Participants were 2572 current smokers. Data were pooled from 2015 and 2016 cross-sectional surveys of national probability samples of U.S. adults and analyzed with multivariable logistic regressions. RESULTS Smokers who never plan to quit comprise 14.3% of current U.S. smokers and are more likely to be older (24.2% among 65+ years old vs. 9.8% among 18-24) and less likely to have ever used e-cigarettes. A one-unit increase in hierarchical worldview (measured on a 1-6 scale) was associated with a 20% increase in the odds of never planning to quit. Those who denied that cigarettes cause disease or death (aORs between 1.6 and 2.0) or were uncertain (aORs: 2.5-2.7) were more likely to never plan to quit compared to those who agreed. They did not view risks of e-cigarettes substantially different compared to smokers who plan to quit. CONCLUSION One in seven U.S. smokers never plans to quit and might benefit from interventions which reflect their hierarchical worldviews and increase their risk perceptions of combustible cigarettes.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA.
| | - Ban Majeed
- Department of Population Health Sciences, Medical College of Georgia, 1120 15th Street, Augusta, Georgia 30912, USA
| | - Daniel Owusu
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA
| | - Claire Adams Spears
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA
| | - David L Ashley
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA
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Daley CM, Daley SM, Pacheco CM, Smith TE, Talawyma M, McCloskey C, Choi WS, Nazir N, Filippi MK, McKinney D, Gunville J, Greiner KA. Feasibility of Implementing the All Nations Breath of Life Culturally Tailored Smoking Cessation Program for American Indians in Multi-Tribal Urban Communities. Nicotine Tob Res 2018; 20:552-560. [PMID: 28177511 DOI: 10.1093/ntr/ntx030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 01/30/2017] [Indexed: 11/14/2022]
Abstract
Introduction Prevalence of cigarette smoking is highest among American Indians, yet few culturally appropriate smoking cessation programs have yet been developed and tested for multi-tribal American Indian adult populations. This study examined implementation of the All Nations Breath of Life culturally tailored smoking cessation program in multi-tribal urban and suburban American Indian communities in seven locations across five states (N = 312). Methods This single-arm study used community-based participatory research to conduct a 12-week intervention whose primary purpose was to curb commercial tobacco use among American Indians. Participants were followed through month 6 in person and month 12 via telephone. The primary outcome was continuous abstinence from recreational cigarette smoking at 6 months post-baseline, verified through voluntary provision of salivary cotinine levels. Results At program completion (12 weeks post-baseline), 53.3% of program completers remained abstinent; labeling those lost to follow-up as smokers resulted in a 41.4% quit rate. At 6 months post-baseline (primary endpoint), 31.1% of retained participants quit smoking (p < .0001 compared to the highest quit rates among multi-tribal populations reported in the literature, 7%); final quit rate was 22.1% labeling those lost to follow-up as smokers (p = .002). Retention rate at endpoint was 71.2%. 12-month follow-up was attempted with all participants and had a retention rate of 49.0%. Of those participants reached, 34.0% were smoke-free. Conclusions All Nations Breath of Life shows promise as a smoking cessation program for multi-tribal urban American Indian communities. It can be successfully implemented in a variety of urban settings. Implications This is the first large feasibility study of a culturally tailored smoking cessation program for American Indians with good cessation and retention rates in a multi-tribal urban American Indian population. It shows that All Nations Breath of Life can be implemented in multiple urban settings across five states. To our knowledge, this is the first program of its kind to be implemented across multiple heterogeneous urban locations and to include salivary cotinine testing for verification of self-report data across these locations.
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Affiliation(s)
- Christine Makosky Daley
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Sean M Daley
- Department of Anthropology, Center for American Indian Studies, Johnson County Community College, Overland Park, KS
| | - Christina M Pacheco
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - T Edward Smith
- Department of Anthropology, Center for American Indian Studies, Johnson County Community College, Overland Park, KS
| | - Myrietta Talawyma
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | | | - Won S Choi
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Niaman Nazir
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Melissa K Filippi
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Dona McKinney
- Department of Defense Programs Office, Lincoln University, Jefferson City, MO
| | - Jordyn Gunville
- Department of Anthropology, Center for American Indian Studies, Johnson County Community College, Overland Park, KS
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
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26
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Bar-Zeev Y, Bovill M, Bonevski B, Gruppetta M, Reath J, Gould GS. Assessing and Validating an Educational Resource Package for Health Professionals to Improve Smoking Cessation Care in Aboriginal and Torres Strait Islander Pregnant Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1148. [PMID: 28961160 PMCID: PMC5664649 DOI: 10.3390/ijerph14101148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 11/16/2022]
Abstract
Australian Aboriginal pregnant women have a high smoking prevalence (45%). Health professionals lack adequate educational resources to manage smoking. Resources need to be tailored to ensure saliency, cultural-sensitivity and account for diversity of Indigenous populations. As part of an intervention to improve health professionals' smoking cessation care in Aboriginal pregnant women, a resource package was developed collaboratively with two Aboriginal Medical Services. The purpose of this study was to assess and validate this resource package. A multi-centred community-based participatory 4-step process (with three Aboriginal Medical Services from three Australian states), included: (1) Scientific review by an expert panel (2) 'Suitability of Materials' scoring by two Aboriginal Health Workers (3) Readability scores (4) Focus groups with health professionals. Content was analysed using six pre-determined themes (attraction, comprehension, self-efficacy, graphics and layout, cultural acceptability, and persuasion), with further inductive analysis for emerging themes. Suitability of Material scoring was adequate or superior. Average readability was grade 6.4 for patient resources (range 5.1-7.2), and 9.8 for health provider resources (range 8.5-10.6). Emergent themes included 'Getting the message right'; 'Engaging with family'; 'Needing visual aids'; and 'Requiring practicality under a tight timeframe'. Results were presented back to a Stakeholder and Consumer Aboriginal Advisory Panel and resources were adjusted accordingly. This process ensured materials used for the intervention were culturally responsive, evidence-based and useful. This novel formative evaluation protocol could be adapted for other Indigenous and culturally diverse interventions. The added value of this time-consuming and costly process is yet to be justified in research, and might impact the potential adaption by other projects.
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Affiliation(s)
- Yael Bar-Zeev
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Michelle Bovill
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Maree Gruppetta
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Jennifer Reath
- Department of General Practice, Western Sydney University, Campbelltown, NSW 2560, Australia.
| | - Gillian S Gould
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
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Ismail S, Abdul Rahman H, Abidin EZ, Isha ASN, Abu Bakar S, Zulkifley NA, Fuad AFA. The effect of faith-based smoking cessation intervention during Ramadan among Malay smokers. Qatar Med J 2017; 2016:16. [PMID: 28293538 PMCID: PMC5344073 DOI: 10.5339/qmj.2016.16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/31/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives: To study the effects of a faith-based smoking cessation intervention during Ramadan among Malay male smokers working in public offices. Methods: This was a quasi-experimental study conducted during Ramadan 2015. The intervention was developed based on the constructs within the Theory of Planned Behaviour. The intervention intended to increase the intention and the perceived behaviour control to stop smoking among Muslim smokers during Ramadan. The outcomes measured were changes in the Fagerstrom Test for Nicotine Dependence score and saliva cotinine levels. Data were collected at baseline (5 days before Ramadan), during Ramadan (21st day of Ramadan) and post-Ramadan (21 days after Ramadan). Statistical tests to examine changes within and between groups were carried out and the significance level was set at p < 0.05. Results: During Ramadan, the saliva cotinine level decreased significantly in both groups (p = 0.001 in the control group and p = < 0.001 in the intervention group). However, after Ramadan, it remained significant only in the intervention group (p = 0.025). A significant change between the groups was only noticed during Ramadan (p = 0.049). Conclusion: The reduction in the saliva cotinine level was found to be more sustainable post-Ramadan in the intervention group. This finding could indicate the positive effect of using this culturally-competent intervention to encourage smoking cessation during Ramadan.
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Affiliation(s)
- Suriani Ismail
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Hejar Abdul Rahman
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Emelia Zainal Abidin
- Department of Occupational and Environmental Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Ahmad Sharul Nizam Isha
- Department of Management & Humanities, University Technology Petronas, Tronoh, Perak, Malaysia
| | | | - Nur Aishah Zulkifley
- Student, Master of Science in Health Promotion, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Ahmad Farhan Ahmad Fuad
- Student, Master of Public Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
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Choi WS, Beebe LA, Nazir N, Kaur B, Hopkins M, Talawyma M, Shireman TI, Yeh HW, Greiner KA, Daley CM. All Nations Breath of Life: A Randomized Trial of Smoking Cessation for American Indians. Am J Prev Med 2016; 51:743-751. [PMID: 27436332 PMCID: PMC5067178 DOI: 10.1016/j.amepre.2016.05.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 05/16/2016] [Accepted: 05/16/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION American Indians have the highest cigarette smoking prevalence of any racial/ethnic group in the U.S. There is currently no effective empirically based smoking-cessation program for American Indians. The purpose of this study was to determine if a culturally tailored smoking-cessation program, All Nations Breath of Life (ANBL), is more effective than a non-tailored cessation program among American Indian smokers. DESIGN A multisite RCT was conducted from September 2009 to July 2014; analysis was conducted in 2015. SETTING/PARTICIPANTS Participants were rural or reservation-based American Indian smokers aged ≥18 years. INTERVENTION Smokers were group randomized to either the culturally tailored ANBL or non-tailored current best practices (CBP) for a total enrolled sample size of 463 (ANBL, n=243; CBP, n=220). MAIN OUTCOME MEASURES The primary outcome of interest was salivary cotinine-verified 7-day point prevalence smoking abstinence at 6 months. Results for both responder-only and intent-to-treat analyses for self-reported and cotinine-verified abstinence are presented. RESULTS Intention-to-treat, imputing all non-responses as smokers, the self-reported point prevalence abstinence rates at 12 weeks were 27.9% in the ANBL arm and 17.4% in the CBP arm (p=0.028). There was a statistically significant difference in self-reported 6-month intent-to-treat point prevalence abstinence rates between ANBL (20.1%) and CBP (12.0%) arms (p=0.029). None of the cotinine-verified results were statistically significant. CONCLUSIONS The culturally tailored smoking-cessation program ANBL may or may not be an effective program in promoting cessation at 12 weeks and 6 months. Participants in the culturally tailored ANBL program were approximately twice as likely to quit smoking at 6 months compared with the CBP program, using self-reported abstinence.
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Affiliation(s)
- Won S Choi
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas.
| | - Laura A Beebe
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Niaman Nazir
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas
| | - Baljit Kaur
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas
| | - Michelle Hopkins
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Myrietta Talawyma
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas; Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | | | - Hung-Wen Yeh
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas; Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas
| | - K Allen Greiner
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas; Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma; Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Christine M Daley
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas; Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas; American Indian Health Research and Education Alliance, Inc., Kansas City, Kansas
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