Development of a tobacco cessation intervention for Alaska Native youth

A Systematic Scoping Review of the Resilience Intervention Literature for Indigenous Adolescents in CANZUS Nations

Background: The concept of resilience offers a strengths-based framework for interventions to enhance Indigenous adolescent social and emotional well-being. Resilience interventions in or with schools encompass individual, social, and environmental factors that encourage health-promoting behaviors and assist adolescents in navigating toward resources that can sustain their health and well-being in times of adversity. This scoping review examined the literature on resilience-enhancing interventions for Indigenous adolescent students in Canada, Australia, New Zealand, and the United States (CANZUS nations). Intervention strategies, adherence to theoretical constructs, and outcomes were analyzed.

Methods: A systematic search was conducted of intervention studies aimed at improving Indigenous adolescent resilience and published in CANZUS nations between January 1990 and May 2016. Eleven peer-reviewed databases and 11 websites and clearing houses were searched for relevant studies. Following double-blinded screening, a total of 16 intervention papers were included for analysis. Study characteristics were identified and study quality was assessed using appropriate assessment tools.

Results: Twelve interventions (75%) were delivered in school settings and four (25%) were community-based, conducted in partnership with schools. Seven publications (44%) reported interventions focused exclusively on fostering individual resilience. Another seven (44%) included components that aimed to build staff, school, and/or community capacity to support adolescent resilience, and two (12.5%) had community/school capacity-building as the primary focus. Culturally based approaches to enhancing resilience were evident in most studies (81%). The publications documented the use of a range of program models, processes, and activities aligned with resilience theory. Positive outcomes were reported for improved individual assets (e.g., strengthened self-esteem and Indigenous identity), environmental resources (e.g., increased peer support and social/community connection), and increased community capacity (e.g., increased youth training and leadership opportunities). On average, study quality was assessed as moderate to high. The strongest evidence of intervention effectiveness was for improvements in mental health symptoms and outcomes.

Conclusion: Interventions indicated strong alignment with ecological and culturally based resilience theories and models. While the results of the studies indicate some positive impacts on the resilience of Indigenous adolescents, future evaluations should aim to ensure high study quality and focus on measuring strengths-based resilience outcomes.

Family and Friend Influence on Urban-Dwelling American Indian Adolescent Girl's Sexual Risk Behavior

Previous research with American Indian (AI) adolescent sexual risk behavior primarily focused on reservation-dwelling youth despite 70% of AIs living off Native lands. Using grounded theory methodology, I sampled 20 adolescent AI girls via talking circles and interviews to explore the perceptions of AI adolescent girls living in an urban, Midwest area about the influence of family and friends on their sexual behavior. Similar to research with other racial groups, participants cited their family and friends as a major influence. Five unique themes emerged related to family and friend influence. Urban-dwelling AI girls rely on their female family members and peers for information related to sex and receive varying messages from their networks of family and friends, which often overlap. AI youth have unique family groups yet have some similarities to other ethnic groups with regard to family and friend relationships that may allow for enhanced intervention development.

Effective strategies to reduce commercial tobacco use in Indigenous communities globally: A systematic review

Background

All over the world, Indigenous populations have remarkably high rates of commercial tobacco use compared to non-Indigenous groups. The high rates of commercial tobacco use in Indigenous populations have led to a variety of health issues and lower life expectancy than the general population. The objectives of this systematic review were to investigate changes in the initiation, consumption and quit rates of commercial tobacco use as well as changes in knowledge, prevalence, community interest, and smoke-free environments in Indigenous populations. We also aimed to understand which interventions had broad reach, what the common elements that supported positive change were and how Aboriginal self-determination was reflected in program implementation.

Methods

We undertook a systematic review of peer-reviewed publications and grey literature selected from seven databases and 43 electronic sources. We included studies between 1994 and 2015 if they addressed an intervention (including provision of a health service or program, education or training programs) aimed to reduce the use of commercial tobacco use in Indigenous communities globally. Systematic cross-regional canvassing of informants in Canada and internationally with knowledge of Indigenous health and/or tobacco control provided further leads about commercial tobacco reduction interventions. We extracted data on program characteristics, study design and learnings including successes and challenges.

Results

In the process of this review, we investigated 73 commercial tobacco control interventions in Indigenous communities globally. These interventions incorporated a myriad of activities to reduce, cease or protect Indigenous peoples from the harms of commercial tobacco use. Interventions were successful in producing positive changes in initiation, consumption and quit rates. Interventions also facilitated increases in the number of smoke-free environments, greater understandings of the harms of commercial tobacco use and a growing community interest in addressing the high rates of commercial tobacco use. Interventions were unable to produce any measured change in prevalence rates.

Conclusions

The extent of this research in Indigenous communities globally suggests a growing prioritization and readiness to address the high rates of commercial tobacco use through the use of both comprehensive and tailored interventions. A comprehensive approach that uses multiple activities, the centring of Aboriginal leadership, long term community investments, and the provision of culturally appropriate health materials and activities appear to have an important influence in producing desired change.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2645-x) contains supplementary material, which is available to authorized users.

Tobacco cessation treatment for Alaska native adolescents: group randomized pilot trial

INTRODUCTION

Tobacco cessation treatments have not been evaluated among Alaska Native (AN) adolescents. This pilot study evaluated the feasibility and the potential efficacy of a targeted cessation intervention for AN youth using a group randomized design.

METHODS

Eight villages in western Alaska were randomly assigned to receive the intervention (n = 4 villages) or a delayed treatment control condition (written materials only; n = 4 villages). Ten adolescents aged 12-17 years were targeted from each village with a planned enrollment of 80. The intervention was held over a weekend, and youth traveled from their villages to quit tobacco use with other teens. The intervention comprised 8 hr of group-based counseling. Talking circles, personal stories from elders, and recreational activities were included to enhance cultural acceptability and participation. Newsletters were mailed weekly for 5-weeks postprogram. Assessments were conducted at baseline, week 6 (end-of-treatment), and 6 months. Self-reported tobacco abstinence was confirmed with salivary cotinine.

RESULTS

Recruitment targets were met in the intervention (41 enrolled) but not in control villages (27 enrolled). All intervention participants attended the weekend program. Retention was high; 98% of intervention and 86% of control participants completed 6-month follow-up. The 7-day point-prevalence self-reported tobacco abstinence rates for intervention and control participants were 10% (4/41) and 0% (0/27) at both week 6 and 6 months (p = .15). Only 1 adolescent in the intervention condition was biochemically confirmed abstinent at week 6 and none at 6 months.

CONCLUSION

The intensive individual-focused intervention used in this study was feasible but not effective for tobacco cessation among AN youth. Alternative approaches are warranted.