the proposed research will evaluate the efficacy of two culturally-tailored technology- mediated disease prevention interventions for supporting change in multiple risk behaviors in rural Alaska Native (AN) men and women. Directly informed by the research team's fieldwork over the past 6 years in rural Alaska, continued community partnership with the tribes, and ethnographic research, the interventions will be tailored to AN health needs and values to target 5 of the American Heart Association's 7 Strategic Impact Goals for 2020. In a randomized controlled 2-group design, the trial will compare two active treatment conditions: Group 1 targets tobacco and physical activity;Group 2 targets control of hypertension and hypercholesterolemia (HTN-HCL) through medication adherence and nutritional changes. Both conditions utilize trans theoretical model-tailored, computerized interventions, delivered via telemedicine by Indigenous-focused counselors located in Anchorage reaching AN people in their rural home villages. Computerized intervention contacts occur at baseline, 3-, 6- and 12-months with final assessment at 18-months. Study design provides an equivalent contact time and technology comparison;facilitates individual-level randomization within communities, as all participants receive highly individualized counseling and intervention materials;and allows for comparison of traditional risk factor (HTN-HCL) versus risk behavior (tobacco/ physical activity) interventions. Participants (N=300) will be daily smokers with at least one additional cardiovascular disease risk factor (e.g., inactivity, overweight, HTN, HCL) or established vascular disease. The trial aims to reach AN people regardless of residential location or intention to change. The primary hypothesis is that Group 1 will achieve significantly greater biochemically- confirmed tobacco abstinence than Group 2 through 18-months follow-up and secondarily will significantly increase their physical activity. Secondary hypotheses are that Group 2 will achieve significantly greater control of HTN and HCL than Group 1 through (i) medication compliance and (ii) dietary change. Tertiary aims will: (a) compare the interventions on overall behavior change;(b) model cost-effectiveness and budgetary impact of each intervention;and (c) examine moderators/mediators of treatment outcome, including the trans-3'-hydroxycotinine to cotinine ratio, a noninvasive measure of nicotine metabolism rate. The proposal combines technology, pharmacology, behavioral science, and health economics for advancing the health of AN people who face significant health disparities with limited access to interventions given their isolated geographics.

Public Health Relevance

Native American populations face significant disparities in cardiovascular health. This proposal seeks to identify effective and cost-effective interventions for tobacco use and other cardiovascular risk behaviors and will inform advances in personalized medicine approaches with Alaska Native people.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Application #
Study Section
Special Emphasis Panel (ZRG1-HDM-V (51))
Program Officer
Wells, Barbara L
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Stanford University
Internal Medicine/Medicine
Schools of Medicine
United States
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Prochaska, Judith J; Benowitz, Neal L (2016) The Past, Present, and Future of Nicotine Addiction Therapy. Annu Rev Med 67:467-86
Prochaska, Judith J; Sanders-Jackson, Ashley (2016) Patient Decision Aids for Discouraging Low-Value Health Care Procedures: Null Findings and Lessons Learned. JAMA Intern Med 176:41-2
Brown-Johnson, Cati G; Oppezzo, Marily; Benowitz, Neal L et al. (2016) ""You have the right to protect your health"": Perceptions of Secondhand Smoke and Exposure Mitigation Strategies in Low-Income Patients With Heart Disease, San Francisco, 2011-2012. Prev Chronic Dis 13:E116
Ladapo, Joseph A; Prochaska, Judith J (2016) Paying Smokers to Quit: Does It Work? Should We Do It? J Am Coll Cardiol 68:786-8
Maglalang, Dale Dagar; Brown-Johnson, Cati; Prochaska, Judith J (2016) Associations with E-cigarette use among Asian American and Pacific Islander young adults in California. Prev Med Rep 4:29-32
Brown-Johnson, Cati G; Burbank, Andrea; Daza, Eric J et al. (2016) Online Patient-Provider E-cigarette Consultations: Perceptions of Safety and Harm. Am J Prev Med 51:882-889
Sheridan, Stacey L; Sutkowi-Hemstreet, Anne; Barclay, Colleen et al. (2016) A Comparative Effectiveness Trial of Alternate Formats for Presenting Benefits and Harms Information for Low-Value Screening Services: A Randomized Clinical Trial. JAMA Intern Med 176:31-41
Prochaska, Judith J; Benowitz, Neal L (2015) Smoking cessation and the cardiovascular patient. Curr Opin Cardiol 30:506-11
Young-Wolff, Kelly C; Karan, Lori D; Prochaska, Judith J (2015) Electronic cigarettes in jails: a panacea or public health problem? JAMA Psychiatry 72:103-4
Prochaska, Judith J (2015) Nicotine Replacement Therapy as a Maintenance Treatment. JAMA 314:718-9

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