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Sinicrope PS, Tranby BN, Young AM, Koller KR, King DK, Lee FR, Sabaque CV, Prochaska JJ, Borah BJ, Decker PA, McDonell MG, Stillwater B, Thomas TK, Patten CA. Adapting a Financial Incentives Intervention for Smoking Cessation with Alaska Native Families: Phase 1 Qualitative Research to Inform the Aniqsaaq (To Breathe) Study. Nicotine Tob Res 2024:ntae092. [PMID: 38642396 DOI: 10.1093/ntr/ntae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Alaska Native and American Indian (ANAI) peoples in Alaska currently experience a disproportionate burden of morbidity and mortality from tobacco cigarette use. Financial incentives for smoking cessation are evidence-based, but a family-level incentive structure has not been evaluated. We used a community-based participatory research and qualitative approach to culturally adapt a smoking cessation intervention with ANAI families. METHODS We conducted individual, semi-structured telephone interviews with 12 ANAI adults who smoke, 12 adult family members, and 13 Alaska Tribal Health System stakeholders statewide between November 2022-March 2023. Through content analysis, we explored intervention receptivity, incentive preferences, culturally aligned recruitment and intervention messaging, and future implementation needs. RESULTS Participants were receptive to the intervention. Involving a family member was viewed as novel and aligned with ANAI cultural values of commitment to community and familial interdependence. Major themes included choosing a family member who is supportive and understanding, keeping materials positive and encouraging, and offering cash and non-cash incentives for family members to choose (e.g., fuel, groceries, activities). Participants indicated that messaging should emphasize family collaboration and that cessation resources and support tips should be provided. Stakeholders also reinforced that program materials should encourage the use of other existing evidence-based cessation therapies (e.g., nicotine replacement, counseling). CONCLUSIONS Adaptations, grounded in ANAI cultural strengths were made to the intervention and recruitment materials based on participant feedback. Next steps include a beta-test for feasibility and a randomized controlled trial for efficacy. IMPLICATIONS This is the first study to design and adapt a financial incentives intervention promoting smoking cessation among Alaska Native or American Indian (ANAI) peoples and the first to involve the family system. Feedback from this formative work was used to develop a meaningful family-level incentive structure with ANAI people who smoke and family members and ensure intervention messaging is supportive and culturally aligned. The results provide qualitative knowledge that can inform future family-based interventions with ANAI communities, including our planned randomized controlled trial of the intervention.
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Affiliation(s)
- Pamela S Sinicrope
- Department of Psychiatry and Psychology Behavioral Health Research Program, Mayo Clinic, 200 1st St SW, Rochester, MN
| | - Brianna N Tranby
- Department of Psychiatry and Psychology Behavioral Health Research Program, Mayo Clinic, 200 1st St SW, Rochester, MN
| | - Antonia M Young
- Department of Psychiatry and Psychology Behavioral Health Research Program, Mayo Clinic, 200 1st St SW, Rochester, MN
| | - Kathryn R Koller
- Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr, Anchorage, AK
| | - Diane K King
- Center for Behavioral Health Research and Service, University of Alaska Anchorage, 3211 Providence Dr, SBB 303F, Anchorage, AK
| | - Flora R Lee
- Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr, Anchorage, AK
| | - Corinna V Sabaque
- Center for Health Equity and Community Engagement Research, Mayo Clinic, 200 1st St SW, Rochester, MN
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, 1265 Welch Road, Stanford, CA
| | - Bijan J Borah
- Health Care Policy and Research, Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st St SW, Rochester, MN
| | - Paul A Decker
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, 200 1st St SW, Rochester, MN
| | | | - Barbara Stillwater
- Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr, Anchorage, AK
| | - Timothy K Thomas
- Alaska Native Tribal Health Consortium, 4000 Ambassador Dr, Anchorage, AK
| | - Christi A Patten
- Department of Psychiatry and Psychology Behavioral Health Research Program, Mayo Clinic, 200 1st St SW, Rochester, MN
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Ohle KA, Koller KR, Walch AK, Lee FR, Palmer L, Nu J, Thomas TK. Alaska Native Parents' Decision-Making About Food, Beverages, and Screen Time for Young Children: Formative Insights From the "Got Neqpiaq?" Project. Fam Community Health 2023; 46:250-258. [PMID: 37703513 PMCID: PMC10502956 DOI: 10.1097/fch.0000000000000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
With rising childhood obesity rates, ensuring children adopt healthy habits early is imperative. Given the unique context for Alaska Native families living in rural remote communities, who are concurrently experiencing changes in traditional practices, we investigated what impacts parents' decisions as they relate to daily living before revising a preschool curriculum focused on healthy habits. The objective of this study was to explore factors influencing parents' decisions about their children's foods, beverages, and activities. In focus group discussions with AN parents of young children across 12 communities, we asked about meals, traditional foods, beverages, physical activity, and screen time. All sessions were recorded, transcribed, and analyzed using open and selective coding to allow the most important themes to emerge. As parents discussed how they make decisions, several trends emerged related to adults' and children's food and beverage preferences; the impact of adult modeling on children; and how convenience, seasonality, access, and a reluctance to engage in conflict all impact decision-making. Parents and other community members shared important perspectives on exposing children to traditional subsistence foods and activities and passing important traditional knowledge to them at an early age. These perspectives will form the basis for preschool curricula in these communities.
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Affiliation(s)
- Kathryn A Ohle
- Early Childhood Education, Grand Valley State University, Grand Rapids, Michigan (Dr Ohle); Alaska Native Tribal Health Consortium, Research Services, Anchorage, Alaska (Drs Koller and Thomas and Ms Lee); Dietetics & Nutrition, University of Alaska Anchorage (Dr Walch); RurAL Cap Head Start, Anchorage, Alaska (Ms Palmer); and Center for Alaska Native Health Research, University of Alaska Fairbanks (Ms Nu)
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Hill CM, Paschall MJ, Koller KR, Day GM, Lee FR, O’Brien DM, King DK, Palmer L, Thomas TK, Bersamin A. Obesity Prevalence and Dietary Factors Among Preschool-Aged Head Start Children in Remote Alaska Native Communities: Baseline Data from the " Got Neqpiaq?" Study. Child Obes 2023; 19:498-506. [PMID: 36473164 PMCID: PMC10541932 DOI: 10.1089/chi.2022.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: American Indian and Alaska Native preschool-aged children experience a high prevalence of obesity, yet are under-represented in obesity prevention research. This study examined obesity prevalence and dietary risk factors among Alaska Native preschool-aged children in southwest Alaska. Methods: The study used baseline data from "Got Neqpiaq?" a culturally centered multilevel intervention focused on Yup'ik Alaska Native children, aged 3-5 years, enrolled in Head Start in 12 communities in southwest Alaska (n = 155). The primary outcomes were BMI percentile, overweight, and obesity. Dietary factors of interest were measured using biomarkers: traditional food intake (nitrogen stable isotope ratio biomarker), ultraprocessed food intake (carbon stable isotope ratio biomarker), and vegetable and fruit intake (skin carotenoid status biomarker measured by the Veggie Meter). Cardiometabolic markers (glycated hemoglobin [HbA1c] and blood cholesterol) were also measured. Results: Among the Yup'ik preschool-aged children in the study, the median BMI percentile was 91, and the prevalence of overweight or obesity was 70%. The traditional food intake biomarker was negatively associated with BMI, whereas the ultraprocessed foods and vegetable and fruit biomarkers were not associated with BMI. HbA1c and blood cholesterol were within healthy levels. Conclusions: The burden of overweight and obesity is high among Yup'ik preschool-aged children. Traditional food intake is inversely associated with BMI, which underscores the need for culturally grounded interventions that emphasize traditional values and knowledge to support the traditional food systems in Alaska Native communities in southwest Alaska. Registered with ClinicalTrials.gov #NCT03601299.
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Affiliation(s)
- Courtney M. Hill
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Mallie J. Paschall
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Kathryn R. Koller
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Gretchen M. Day
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Flora R. Lee
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Diane M. O’Brien
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Diane K. King
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, AK, USA
| | - Lea Palmer
- Head Start Program, Rural Alaska Community Action Program, Inc., Anchorage, AK, USA
| | - Timothy K. Thomas
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
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Patten CA, Koller KR, King DK, Prochaska JJ, Sinicrope PS, McDonell MG, Decker PA, Lee FR, Fosi JK, Young AM, Sabaque CV, Brown AR, Borah BJ, Thomas TK. Aniqsaaq (To Breathe): Study protocol to develop and evaluate an Alaska Native family-based financial incentive intervention for smoking cessation. Contemp Clin Trials Commun 2023; 33:101129. [PMID: 37091507 PMCID: PMC10120296 DOI: 10.1016/j.conctc.2023.101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 04/05/2023] Open
Abstract
Background Alaska Native and American Indian (ANAI) communities in Alaska are disproportionately affected by commercial tobacco use. Financial incentive interventions promote cigarette smoking cessation, but family-level incentives have not been evaluated. We describe the study protocol to adapt and evaluate the effectiveness and implementation of a remotely delivered, family-based financial incentive intervention for cigarette smoking among Alaskan ANAI people. Methods The study has 3 phases: 1) qualitative interviews with ANAI adults who smoke, family members, and stakeholders to inform the intervention, 2) beta-test of the intervention, and 3) randomized controlled trial (RCT) evaluating intervention reach and effectiveness on verified, prolonged smoking abstinence at 6- and 12-months post-treatment. In the RCT, adult dyads (ANAI person who smokes [index participant] and family member) recruited throughout Alaska will be randomized to a no-incentives control condition (n = 328 dyads) or a 6-month incentive intervention (n = 328 dyads). All dyads will receive cessation support and family wellness materials. Smoking status will be assessed weekly for four weeks and at three and six months. Intervention index participants will receive escalating incentives for verified smoking abstinence at each time point (maximum $750 total); the family member will receive rewards of equal value. Results A community advisory committee contributed input on the study design and methods for relevance to ANAI people, particularly emphasizing the involvement of families. Conclusion Our study aligns with the strength and value AIAN people place on family. Findings, processes, and resources will inform how Indigenous family members can support smoking cessation within incentive interventions. Clinical Trials Registry NCT05209451.
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Koller KR, Wilson A, Normolle DP, Nicholson JK, Li JV, Kinross J, Lee FR, Flanagan CA, Merculieff ZT, Iyer P, Lammers DL, Thomas TK, O'Keefe SJD. Dietary fibre to reduce colon cancer risk in Alaska Native people: the Alaska FIRST randomised clinical trial protocol. BMJ Open 2021; 11:e047162. [PMID: 34452959 PMCID: PMC8404459 DOI: 10.1136/bmjopen-2020-047162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 08/09/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Diet, shown to impact colorectal cancer (CRC) risk, is a modifiable environmental factor. Fibre foods fermented by gut microbiota produce metabolites that not only provide food for the colonic epithelium but also exert regulatory effects on colonic mucosal inflammation and proliferation. We describe methods used in a double-blinded, randomised, controlled trial with Alaska Native (AN) people to determine if dietary fibre supplementation can substantially reduce CRC risk among people with the highest reported CRC incidence worldwide. METHODS AND ANALYSES Eligible patients undergoing routine screening colonoscopy consent to baseline assessments and specimen/data collection (blood, urine, stool, saliva, breath and colon mucosal biopsies) at the time of colonoscopy. Following an 8-week stabilisation period to re-establish normal gut microbiota post colonoscopy, study personnel randomise participants to either a high fibre supplement (resistant starch, n=30) or placebo (digestible starch, n=30) condition, repeating stool sample collection. During the 28-day supplement trial, each participant consumes their usual diet plus their supplement under direct observation. On day 29, participants undergo a flexible sigmoidoscopy to obtain mucosal biopsy samples to measure the effect of the supplement on inflammatory and proliferative biomarkers of cancer risk, with follow-up assessments and data/specimen collection similar to baseline. Secondary outcome measures include the impact of a high fibre supplement on the oral and colonic microbiome and biofluid metabolome. ETHICS AND DISSEMINATION Approvals were obtained from the Alaska Area and University of Pittsburgh Institutional Review Boards and Alaska Native Tribal Health Consortium and Southcentral Foundation research review bodies. A data safety monitoring board, material transfer agreements and weekly study team meetings provide regular oversight throughout the study. Study findings will first be shared with AN tribal leaders, health administrators, providers and community members. Peer-reviewed journal articles and conference presentations will be forthcoming once approved by tribal review bodies. TRIAL REGISTRATION NUMBER NCT03028831.
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Affiliation(s)
- Kathryn R Koller
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Annette Wilson
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel P Normolle
- Hillman Cancer Center Biostatistics Facility, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeremy K Nicholson
- Australian National Phenome Center, Murdoch University, Perth, Western Australia, Australia
| | - Jia V Li
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - James Kinross
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Flora R Lee
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Christie A Flanagan
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Zoe T Merculieff
- Wellness and Prevention, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Priya Iyer
- Hillman Cancer Center Biostatistics Facility, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniela L Lammers
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Timothy K Thomas
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Stephen J D O'Keefe
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Koller KR, Flanagan CA, Nu J, Lee FR, Desnoyers C, Walch A, Alexie L, Bersamin A, Thomas TK. Storekeeper perspectives on improving dietary intake in 12 rural remote western Alaska communities: the "Got Neqpiaq?" project. Int J Circumpolar Health 2021; 80:1961393. [PMID: 34350814 PMCID: PMC8344255 DOI: 10.1080/22423982.2021.1961393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Low intake of fruits and vegetables and high intake of sugar-sweetened beverages persists as a public health concern in rural remote Alaska Native (AN) communities. Conducting key informant interviews with 22 storekeepers in 12 communities in the Yukon-Kuskokwim region of Alaska, we explored potential factors impeding or facilitating dietary change towards healthier food choices. We selected these sites as part of a multi-level intervention aimed at introducing more traditional AN subsistence foods, increasing fruit and vegetable intake, and decreasing SSB consumption among young children enrolled in Head Start (preschool) programmes (Clinicaltrials.gov #NCT03601299). Storekeepers in these communities agreed that seasonality and flight schedules were primary factors determining commercial foods’ availability. Several storekeepers noted that federal food assistance programmes that specify which food items may be purchased with funds received from the programme and community policies that set limits on less healthy items promote customer purchases of healthier products. The fact that storekeepers are comfortable enforcing government assistance programme guidelines, company policies, and tribal resolutions suggests an important role storekeepers play in improving nutritional intake in their communities.
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Affiliation(s)
- Kathryn R Koller
- Research Nurse Supervisor,Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Christie A Flanagan
- Research Program Manager, Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Jennifer Nu
- Research Associate, Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| | - Flora R Lee
- Research Nurse, Alaska Native Tribal Health Consortium Research Services Anchorage, Alaska, USA
| | - Christine Desnoyers
- Research Coordinator, Yukon-Kuskokwim Health Corporation, Bethel Alaska, USA
| | - Amanda Walch
- Assistant Professor of Dietetics & Nutrition, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Lucinda Alexie
- Associate Research Coordinator, Yukon-Kuskokwim Health Corporation Research Department, Bethel, Alaska, USA
| | - Andrea Bersamin
- Associate Professor, Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| | - Timothy K Thomas
- Director,Alaska Native Tribal Health Consortium, Research Services, Anchorage, Alaska, USA
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Chen CC, Pei KJC, Lee FR, Tzeng MP, Chang TC. Avian pox infection in a free-living crested serpent eagle (Spilornis cheela) in southern Taiwan. Avian Dis 2011; 55:143-6. [PMID: 21500652 DOI: 10.1637/9510-082610-case.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Avian pox viruses (APVs) have been reported to cause infection in diverse avian species worldwide. Herein we report the first case of APV infection in a free-living bird, a subadult crested serpent eagle (Spilornis cheela), in Taiwan. In addition to the typical wart-like lesions distributed on the cere, eyelid, and face, there were also yellowish nodules below the tongue and on the hard palate. Phylogenetic analysis of the 4b core protein gene showed that the APV is very close to that found in white-tailed sea eagle (Haliaeetus albicilla) in Japan recently. Because both cases are located on the same major flyway for migratory birds, the impact of this virus with regard to the wild and migratory raptor species along the East Asian-Australasian Flyway and West Pacific Flyway requires immediate investigation.
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Affiliation(s)
- C C Chen
- Pingtung Rescue Center for Endangered Wild Animals, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
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