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Vogel EA, Benowitz NL, Skan J, Schnellbaecher M, Prochaska JJ. Correlates of the nicotine metabolite ratio in Alaska Native people who smoke cigarettes. Exp Clin Psychopharmacol 2022; 30:359-364. [PMID: 33856821 PMCID: PMC8517031 DOI: 10.1037/pha0000461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research on nicotine metabolism has primarily focused on white adults. This study examined associations between nicotine metabolism, tobacco use, and demographic characteristics among Alaska Native adults who smoke cigarettes. Participants (N = 244) were Alaska Native adults who smoked and who provided a plasma sample at baseline (70.1%) or follow-up (29.9%) of a randomized controlled trial of a cardiovascular risk behavior intervention. At baseline, participants self-reported age, sex, Alaska Native heritage, cigarettes per day, time to first cigarette upon wakening, menthol use, perceived difficulty staying quit, tobacco withdrawal symptoms, and past-month tobacco product use, binge drinking, and cannabis use. At 3-, 6-, 12-, and 18-month follow-ups, participants self-reported 7-day point prevalence abstinence from smoking. Height and weight were measured to calculate body mass index (BMI). Participants' nicotine metabolite ratio (NMR), calculated as the ratio of plasma cotinine and trans-3' hydroxycotinine, was log-transformed. The sample (52.0% male, age M = 47.0 years [SD = 13.8], 60.3% of Inupiaq heritage) averaged 12.5 cigarettes per day (SD = 10.5); 64.0% smoked within 30 min of wakening. NMR was not significantly associated with age, sex, Alaska Native heritage, BMI, cigarettes per day, time to first cigarette upon wakening, menthol use, perceived difficulty staying quit, past-month dual tobacco product use, withdrawal symptoms, past-month binge drinking, past-month cannabis use, or abstinence from smoking (all p-values > .050). Characteristics that relate to NMR in Alaska Native adults may differ from those typically identified among white adults. Specifically, results may suggest that Alaska Native adults with slower nicotine metabolism do not titrate their nicotine intake when smoking. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Erin A. Vogel
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | - Neal L. Benowitz
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Jordan Skan
- Alaska Native Tribal Health Consortium, Cardiology Department, Anchorage, AK
| | | | - Judith J. Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University
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Mills DE, Schaefer KR, Beans JA, Todd MR, Robinson RF, Thummel KE, Dillard DA, Avey JP. Retention in a 6-Month Smoking Cessation Study Among Alaska Native and American Indian People. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2022; 29:71-89. [PMID: 36178748 PMCID: PMC9552566 DOI: 10.5820/aian.2903.2022.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Participant retention in longitudinal health research is necessary for generalizable results. Understanding factors that correlate with increased retention could improve retention in future studies. Here, we describe how participant and study process measures are associated with retention in a longitudinal tobacco cessation research study performed in Anchorage, Alaska. Specifically, we conducted a secondary analysis exploring retention among 151 Alaska Native and American Indian (ANAI) people and described our study processes using study retention categories from a recent meta-analysis. We found that our study processes influence retention among ANAI urban residents more than measures collected about the participant. For study process measures, calls where a participant answered and calls participants placed to the study team were associated with higher retention. Calls where the participant did not answer were associated with lower retention. For participant measures, only lower annual income was associated with lower retention at 6 weeks. Promoting communication from participants to the study team could improve retention, and alternative communication methods could be used after unsuccessful calls. Finally, categorizing our study retention strategies demonstrated that additional barrier-reduction strategies might be warranted.
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Knox M, Skan J, Benowitz NL, Schnellbaecher M, Prochaska JJ. Recruitment best practices of a cardiovascular risk reduction randomised control trial in rural Alaska Native communities. Int J Circumpolar Health 2020; 79:1806639. [PMID: 32787541 PMCID: PMC7480599 DOI: 10.1080/22423982.2020.1806639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/30/2020] [Accepted: 07/28/2020] [Indexed: 11/08/2022] Open
Abstract
Though not native to Alaska, tobacco use is common among Alaska Native people in the Norton Sound region, an area consisting of 16 communities with population size 107 to 3,695. We summarise best practices in recruiting Alaska Native adults who smoke for a randomised controlled tobacco treatment trial. Participants were Alaska Native, 19 years and older, smoking daily, with hypertension and/or high cholesterol, residing in the Norton Sound region of Alaska. Study staff travelled to the remote communities to recruit, typically staying 5 days. Screening and enrolment success was examined by day, season, and staffing level. From June 2015 - December 2018, the study team made 122 trips, screening 1089 individuals and enrolling 314 participants. In the field, days 2-3 (51%) were best for screening, while days 3-4 (53%) had the greatest enrolment. Community size correlated with enrolment (r = 0.83, p <.001). Recruitment was optimised in spring and with multiple staff in the field. Despite challenges (e.g., harsh weather, poor internet connectivity), with active outreach (e.g. tabling in busy areas, attending community events, utilising mixed media, collaborating with clinic staff), the project reached its recruitment goal. Study findings can inform community-based tobacco treatment research trials in remote areas. ABBREVIATIONS CVD: Cardiovascular disease; VTC: Video teleconferencing; ANMC: Alaska Native Medical Centre; HEALTHH: Healing and Empowering Alaskan Lives Towards Healthy Hearts; NSHC: Norton Sound Health Corporation; RERB: Research Ethics Review Board.
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Affiliation(s)
- Mariah Knox
- Cardiology Department, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Jordan Skan
- Cardiology Department, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Neal L. Benowitz
- Department of Medicine, Division of Cardiology, University of California, San Francisco, CA, USA
| | | | - Judith J. Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University
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Epperson AE, Crouch M, Skan J, Benowitz NL, Schnellbaecher M, Prochaska JJ. Cultural and demographic correlates of dual tobacco use in a sample of Alaska Native adults who smoke cigarettes. Tob Induc Dis 2020; 18:55. [PMID: 32587486 PMCID: PMC7309271 DOI: 10.18332/tid/122902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Approximately 9 million American adults use two or more tobacco products regularly, referred to as dual or poly tobacco users. In Alaska, where tobacco is not native, approximately 20% of the population smokes cigarettes, and among smokers, 10% use two or more tobacco products. Previous research suggests that dual tobacco product use may be especially high among Alaska Native people. The current study examined cultural and demographic characteristics associated with dual tobacco use. METHODS Alaska Native adults reporting daily smoking and identified with high blood pressure or cholesterol were recruited in the Norton Sound region of Alaska between 2015–2019 as part of a treatment trial targeting cardiovascular disease risk factors. Participants reported their tribal group, level of identification with their Alaska Native heritage, speaking of their tribal language, basic demographic characteristics, and past 30-day use of tobacco products in addition to smoking cigarettes. RESULTS Participants (n=299) were 48.5% female and identified as Yup’ik (31.1%), Inupiat (60.5%), and other or multiple tribal group(s) (8.4%). Most participants (85.3%) strongly identified with their Alaska Native heritage. Past 30-day dual tobacco use was reported by 10.0%, specifically 9.0% chew/snuff, 1.3% e-cigarettes, and 0.7% Iq’mik. Multivariate regression models indicated that dual tobacco use was more likely among men (OR=3.35; 95% CI: 1.30–8.64), younger participants (OR range: 10.97–12.35; 95% CI: 2.33–57.86), those identifying as Yup’ik (OR=2.86; 95% CI: 1.13–7.19), and those who identified very little or not at all with their Alaska Native heritage (OR=2.98; 95% CI: 1.14–7.77). CONCLUSIONS Young men identifying as Yup’ik were more likely to use dual forms of tobacco. Stronger identification with one’s Alaska Native heritage was associated with lower risk of dual tobacco use. The findings highlight cultural and demographic factors for further consideration and attention in tobacco cessation treatment interventions.
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Affiliation(s)
- Anna E Epperson
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, United States
| | - Maria Crouch
- Cardiology Department, Alaska Native Tribal Health Consortium, Anchorage, United States
| | - Jordan Skan
- Cardiology Department, Alaska Native Tribal Health Consortium, Anchorage, United States
| | - Neal L Benowitz
- Program in Clinical Pharmacology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, United States
| | | | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, United States
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Ocvirk S, Wilson AS, Posma JM, Li JV, Koller KR, Day GM, Flanagan CA, Otto JE, Sacco PE, Sacco FD, Sapp FR, Wilson AS, Newton K, Brouard F, DeLany JP, Behnning M, Appolonia CN, Soni D, Bhatti F, Methé B, Fitch A, Morris A, Gaskins HR, Kinross J, Nicholson JK, Thomas TK, O'Keefe SJD. A prospective cohort analysis of gut microbial co-metabolism in Alaska Native and rural African people at high and low risk of colorectal cancer. Am J Clin Nutr 2020; 111:406-419. [PMID: 31851298 PMCID: PMC6997097 DOI: 10.1093/ajcn/nqz301] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Alaska Native (AN) people have the world's highest recorded incidence of sporadic colorectal cancer (CRC) (∼91:100,000), whereas rural African (RA) people have the lowest risk (<5:100,000). Previous data supported the hypothesis that diet affected CRC risk through its effects on the colonic microbiota that produce tumor-suppressive or -promoting metabolites. OBJECTIVES We investigated whether differences in these metabolites may contribute to the high risk of CRC in AN people. METHODS A cross-sectional observational study assessed dietary intake from 32 AN and 21 RA healthy middle-aged volunteers before screening colonoscopy. Analysis of fecal microbiota composition by 16S ribosomal RNA gene sequencing and fecal/urinary metabolites by 1H-NMR spectroscopy was complemented with targeted quantification of fecal SCFAs, bile acids, and functional microbial genes. RESULTS Adenomatous polyps were detected in 16 of 32 AN participants, but not found in RA participants. The AN diet contained higher proportions of fat and animal protein and less fiber. AN fecal microbiota showed a compositional predominance of Blautia and Lachnoclostridium, higher microbial capacity for bile acid conversion, and low abundance of some species involved in saccharolytic fermentation (e.g., Prevotellaceae, Ruminococcaceae), but no significant lack of butyrogenic bacteria. Significantly lower concentrations of tumor-suppressive butyrate (22.5 ± 3.1 compared with 47.2 ± 7.3 SEM µmol/g) coincided with significantly higher concentrations of tumor-promoting deoxycholic acid (26.7 ± 4.2 compared with 11 ± 1.9 µmol/g) in AN fecal samples. AN participants had lower quantities of fecal/urinary metabolites than RA participants and metabolite profiles correlated with the abundance of distinct microbial genera in feces. The main microbial and metabolic CRC-associated markers were not significantly altered in AN participants with adenomatous polyps. CONCLUSIONS The low-fiber, high-fat diet of AN people and exposure to carcinogens derived from diet or environment are associated with a tumor-promoting colonic milieu as reflected by the high rates of adenomatous polyps in AN participants.
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Affiliation(s)
- Soeren Ocvirk
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Gastrointestinal Microbiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Annette S Wilson
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joram M Posma
- Section of Bioinformatics, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College, London, United Kingdom
| | - Jia V Li
- Section of Nutritional Research, Division of Digestive Diseases, Department of Metabolism, Digestion, and Reproduction, Imperial College, London, United Kingdom
- Centre for Digestive and Gut Health, Institution of Global Health Innovation, Imperial College, London, United Kingdom
| | - Kathryn R Koller
- Clinical & Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Gretchen M Day
- Clinical & Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Christie A Flanagan
- Clinical & Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Jill Evon Otto
- Clinical & Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Pam E Sacco
- Clinical & Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Frank D Sacco
- Clinical & Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Flora R Sapp
- Clinical & Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Amy S Wilson
- Clinical & Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Keith Newton
- Division of Gastroenterology, University of KwaZulu-Natal, Durban, South Africa
| | - Faye Brouard
- Manguzi Hospital, Manguzi, KwaZulu-Natal, South Africa
| | - James P DeLany
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, FL, USA
| | - Marissa Behnning
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Corynn N Appolonia
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Devavrata Soni
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Faheem Bhatti
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Barbara Methé
- Center for Medicine and the Microbiome, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam Fitch
- Center for Medicine and the Microbiome, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alison Morris
- Center for Medicine and the Microbiome, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - H Rex Gaskins
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - James Kinross
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Jeremy K Nicholson
- Centre for Digestive and Gut Health, Institution of Global Health Innovation, Imperial College, London, United Kingdom
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Timothy K Thomas
- Clinical & Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Stephen J D O'Keefe
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Age of initiation of cigarette smoking and smokeless tobacco use among western Alaska Native people: Secondary analysis of the WATCH study. Addict Behav Rep 2019; 9:100143. [PMID: 31193747 PMCID: PMC6541901 DOI: 10.1016/j.abrep.2018.100143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/29/2018] [Accepted: 11/08/2018] [Indexed: 12/28/2022] Open
Abstract
Objective This study examined self-reported age of tobacco initiation (cigarette smoking and smokeless tobacco [ST] use) and explored potential sex and generational group influences on tobacco use onset among Alaska Native (AN) adult ever tobacco users. Methods Secondary analysis of consolidated data from the Western Alaska Tribal Collaborative for Health (WATCH) study comprised 2800 AN adult ever tobacco users (1490 women, 1310 men; mean age = 39.2 years) from two rural western Alaska regions. ST use data were limited to one region. Logistic regression was used to examine potential sex and generational group (age 18–29, 30–49, ≥50) effects on initiation at ≤13 years of age. Results Thirty-seven percent of the sample reported using any tobacco product by age 13 years. Initiation of any ST use by age 13 was greater than for cigarette smoking (52.7% vs. 18.2%), and women were more likely than men to report initiation of any ST use at ≤13 years (52.6% vs. 38.4%). Nearly one-third of ever smokers (31%) initiated in young adulthood (ages 18–29). For ST use, logistic regression analyses revealed significant sex differences (women more likely to initiate by 13 years of age than men) and generational group effects with younger and middle age groups more likely to report initiation ≤13 years compared to the eldest participants. For smoking, no sex differences were observed but the youngest generational group was more likely to report initiation by age 13 compared to the eldest group. Conclusions Earlier age of tobacco initiation is found among younger generations of AN people. Findings highlight the need to focus prevention efforts on initiation of smoking in young adulthood and uptake of ST use among girls. Younger Alaska Native (AN) adults reported earlier tobacco initiation than older adults. Women reported earlier age of smokeless tobacco (ST) initiation than men. Almost one third of ever smokers (29%) had initiated in young adulthood (age 18–29). Prevention efforts are needed for ST use in AN girls and smoking in young adults.
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Patten CA, Bronars CA, Scott M, Boyer R, Lando H, Clark MM, Resnicow K, Decker PA, Brockman TA, Roland A, Hanza M. Tobacco use and preferences for wellness programs among health aides and other employees of an Alaska Native Health Corporation in Western Alaska. Prev Med Rep 2017; 6:228-235. [PMID: 28377849 PMCID: PMC5377012 DOI: 10.1016/j.pmedr.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/18/2017] [Accepted: 03/13/2017] [Indexed: 11/01/2022] Open
Abstract
This study assessed health behaviors and preferences for wellness programs among employees of a worksite serving Alaska Native-people. Village-based Community Health Aides/Practitioners (CHA/Ps) were compared with all other employees on health indicators and program preferences. Using a cross-sectional design, all 1290 employees at the Yukon Kuskokwim Health Corporation (YKHC) in Western Alaska were invited in 2015 to participate in a 30-item online survey. Items assessed health behaviors, perceived stress, resiliency, and preferences for wellness topics and program delivery formats. Respondents (n = 429) were 77% female and 57% Alaska Natives. CHA/Ps (n = 46) were more likely than all other employees (n = 383) to currently use tobacco (59% vs. 36%; p = 0.003). After adjusting for covariates, greater stress levels were associated (p = 0.013) with increased likelihood of tobacco use. Employees reported lower than recommended levels of physical activity; 74% had a Body Mass Index (BMI) indicating overweight or obese. Top preferences for wellness topics were for eating healthy (55%), physical activity (50%), weight loss (49%), reducing stress (49%), and better sleep (41%). CHA/Ps reported greater interest in tobacco cessation than did other employees (37% vs. 21%; p = 0.016). Preferred program delivery format among employees was in-person (51%). The findings are important because tailored wellness programs have not been previously evaluated among employees of worksites serving Alaska Native people. Promoting healthy lifestyles among CHAP/s and other YKHC employees could ultimately have downstream effects on the health of Alaska Native patients and communities.
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Affiliation(s)
| | | | - Matthew Scott
- Yukon-Kuskokwim Health Corporation, Box 528, Bethel, AK 99559, USA
| | - Rahnia Boyer
- Yukon-Kuskokwim Health Corporation, Box 528, Bethel, AK 99559, USA
| | - Harry Lando
- University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN 55454, USA
| | | | - Kenneth Resnicow
- University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Paul A. Decker
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Agnes Roland
- Yukon-Kuskokwim Health Corporation, Box 528, Bethel, AK 99559, USA
| | - Marcelo Hanza
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Hiratsuka VY, Trinidad SB, Avey JP, Robinson RF. Application of the PEN-3 Model to Tobacco Initiation, Use, and Cessation Among American Indian and Alaska Native Adults. Health Promot Pract 2016; 17:471-81. [PMID: 27178836 DOI: 10.1177/1524839916648909] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
American Indian (AI) and Alaska Native (AN) communities confront some of the highest rates of tobacco use and its sequelae. As part of a formative research project investigating stakeholder understandings, preferences, and needs surrounding the use of pharmacogenetics toward tobacco cessation treatment, we sought to characterize sociocultural issues related to tobacco use and cessation. We used the PEN-3 cultural model to frame the research question and analysis of stakeholder interviews with 20 AI/AN patients, 12 health care providers, and 9 tribal leaders. Our study found high knowledge levels of the negative health effects of tobacco use; however, most patient participants ascribed negative health effects only to regular, heavy tobacco use and not to light use, which is more common in the population. The majority of patient participants did not endorse use of tobacco cessation treatment despite evidence of efficacy among AI/AN adults. Health promotion messaging to target low-tobacco consuming AI/AN people is needed. Additionally, messaging to promote tobacco cessation treatment using successful AI/AN former tobacco users to improve community perception of tobacco cessation treatment is recommended.
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Hiratsuka VY, Avey JP, Trinidad SB, Beans JA, Robinson RF. Views on electronic cigarette use in tobacco screening and cessation in an Alaska Native healthcare setting. Int J Circumpolar Health 2015; 74:27794. [PMID: 26487575 PMCID: PMC4612470 DOI: 10.3402/ijch.v74.27794] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/17/2015] [Accepted: 09/22/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND American Indian (AI) and Alaska Native (AN) communities confront some of the highest rates of tobacco use and its sequelae. METHODS This formative research project sought to identify the perspectives of 41 stakeholders (community members receiving care within the healthcare system, primary care providers, and tribal healthcare system leaders) surrounding the use of pharmacogenetics toward tobacco cessation treatment in the setting of an AI/AN owned and operated health system in south central Alaska. RESULTS Interviews were held with 20 adult AI/AN current and former tobacco users, 12 healthcare providers, and 9 tribal leaders. An emergent theme from data analysis was that current tobacco screening and cessation efforts lack information on electronic cigarette (e-cigarette) use. Perceptions of the use of e-cigarettes role in tobacco cessation varied. CONCLUSION Preventive screening for tobacco use and clinical cessation counseling should address e-cigarette use. Healthcare provider tobacco cessation messaging should similarly address e-cigarettes.
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Affiliation(s)
| | - Jaedon P Avey
- Research Department, Southcentral Foundation, Anchorage, AK, USA
| | - Susan B Trinidad
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA
| | - Julie A Beans
- Research Department, Southcentral Foundation, Anchorage, AK, USA
| | - Renee F Robinson
- Research Department, Southcentral Foundation, Anchorage, AK, USA
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Hiratsuka VY, Suchy-Dicey AM, Garroutte EM, Booth-LaForce C. Patient and Provider Factors Associated With American Indian and Alaska Native Adolescent Tobacco Use Screening. J Prim Care Community Health 2015; 7:2-9. [PMID: 26319931 DOI: 10.1177/2150131915602469] [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: 11/16/2022] Open
Abstract
INTRODUCTION Tobacco use is the leading behavioral cause of death among adults 25 years or older. American Indian (AI) and Alaska Native (AN) communities confront some of the highest rates of tobacco use and of its sequelae. Primary care-based screening of adolescents is an integral step in the reduction of tobacco use, yet remains virtually unstudied. We examined whether delivery of tobacco screening in primary care visits is associated with patient and provider characteristics among AI/AN adolescents. METHODS We used a cross-sectional analysis to examine tobacco screening among 4757 adolescent AI/AN patients served by 56 primary care providers at a large tribally managed health system between October 1, 2011 and May 31, 2014. Screening prevalence was examined in association with categorical patient characteristics (gender, age, clinic visited, insurance coverage) and provider characteristics (gender, age, tenure) using multilevel logistic regressions with individual provider identity as the nesting variable. RESULTS Thirty-seven percent of eligible patients were screened. Gender of both providers and patients was associated with screening. Male providers delivered screening more often than female providers (odds ratio [OR] 1.6, 95% confidence interval [CI] 0.7-3.9). Male patients had 20% lower odds of screening receipt (OR 0.8, 95% CI 0.7-0.9) than female patients, independent of patient age and provider characteristics. Individual provider identity significantly contributed to variability in the mixed-effects model (variance component 2.2; 95% CI 1.4-3.4), suggesting individual provider effect. CONCLUSIONS Low tobacco screening delivery by female providers and the low receipt of screening among younger, male patients may identify targets for screening interventions.
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