American Indian tribal college students have the highest smoking rates of any racial/ethnic group in the young adult population and also are disproportionately burdened by smoking-related morbidity and mortality. There are very few effective culturally-tailored smoking cessation programs for AI smokers. Our research group has worked with the American Indian community for the past 8 years to develop a culturally-tailored smoking cessation program (All Nations Breath of Life - ANBL), for AI adult smokers. All Nations Breath of Life was developed using the community-based participatory research approach and is an in-person group based program that incorporates cultural issues throughout the program. We have produced 30% cessation rates at 6-month follow-up with adult American Indian smokers from tribes and nations in the Midwest. Due to limited studies with the tribal college population, we have already conducted a cross-sectional internet-based survey to collect information on their smoking behaviors as well as other health behaviors. This research experience and strong collaboration with the AI community leaves us well poised to adapt the ANBL program for the tribal college smoking population. However, this current program needs substantial modifications to meet the unique needs of the tribal college student population. It recognizes the sacred role of tobacco among many American Indians and how culture affects smoking cessation among AIs, while still addressing recreational smoking. However, preliminary data from our recent studies indicate that the internet may be more favorable and appropriate delivery method for reaching this younger and more mobile tribal college population due to the web interactivity, immediacy of feedback, and wide reach and accessibility. This current proposal reflects a natural progression to addressing the significant problem of smoking among tribal college students using our successful methods. In this study, we will adapt and test a culturally tailored internet-based smoking cessation (I-ANBL) program based on ANBL, which was developed through CBPR methods. For the current proposal, we will conduct an individual randomized controlled trial (N=242) to test the effectiveness of an internet-based culturally-tailored smoking cessation program (I-ANBL) in a tribal college student population. Data will be collected at baseline, 3 months and 6 months using salivary cotinine, as well as comprehensive set of environmental and psychosocial measures. We hypothesize that AI tribal college students randomized to the culturally-tailored smoking cessation internet arm (I-ANBL) will have significantly higher continuous abstinence rates at 6 months than those receiving the heart healthy diet intervention (I-FV), focusing on increasing fruit and vegetable consumption. We will also examine the costs of delivering the tailored intervention program and potential mediators and moderators of the intervention-cessation relationship. Such a high-reach, low-cost strategy for promoting smoking cessation in this at-risk and underserved population could have great potential for adoption on a larger scale and thus help reduce existing health disparities.

Public Health Relevance

American Indians (AI) have the highest rates of cigarette smoking of any major racial/ethnic group in the US, approaching 40% to 50%. Despite the overall decline in adult smoking prevalence during the past several decades, the young adult (18-29 year olds) age group has the highest prevalence of smoking. We will conduct a randomized trial to test the effectiveness of an internet-based culturally-tailored smoking cessation program among tribal college students.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-DKUS-D (55))
Program Officer
Land, Stephanie R
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Kansas
Public Health & Prev Medicine
Schools of Medicine
Kansas City
United States
Zip Code