American Indians (AI) have the highest rates of smokeless tobacco (SLT) use of any major ethnic group in the U.S. at 9% versus 4% among whites. This is likely an underestimate due to the wide variation in SLT use by region of the country and tribal affiliation. AI in the Southern and Northern Plains have the highest SLT use rates, reaching 25% among some tribes, contributing to higher and rising incidence and disproportionate mortality in SLT-related cancers, including oral, esophageal, and pancreatic cancers. In addition, over the last three decades rates of SLT use have been rising in some tribal communities with historically low rates. Our overall objective for this proposal is the development and pilot testing of a culturally tailored SLT cessation program for a heterogeneous AI population using community-based participatory research (CBPR). We hypothesize that (1) Participants in our program will have higher cotinine-verified 7-day point prevalence abstinence from SLT at 6-months post-baseline compared to currently reported rates of abstinence among individuals of any ethnic group not using a program (5%-10%);and (2) Participants in our program will have increased interest in quitting, more quit attempts, and reduction in all recreational tobacco use at 6-months post-baseline compared to baseline. We will address the following specific aims: (1) To develop a culturally tailored, group-based SLT cessation program for AI using CBPR;(2) To develop and assess for scientific accuracy, readability, and cultural-appropriateness accompanying educational materials;and (3) To pilot test, determine the feasibility and acceptability, and estimate the cessation rate of a culturally tailored SLT cessation program for AI. We will address the following secondary aims: (1) To identify factors that enhance dissemination of a culturally tailored SLT cessation program and contribute to program success or failure;and (2) To examine nicotine metabolism in AI SLT users. This study will take place in three phases. During Phase 1, we will develop the program using the same CBPR techniques that we have used in the past to develop our successful smoking cessation program for AI. We will also conduct a series of 9 focus groups of AI SLT users, stratified by age (15-18-year-olds will be separate) and status as a college student for those over age 18 because of their higher rates of SLT use for input on program development (N=45). During Phase 2, we will assess all materials and website for scientific accuracy using a panel of three experts, for readability using the Suitability Assessment of Materials (SAM), for cultural appropriateness using a series of interviews with AI SLT users and youth who have tried SLT (N=25). Finally, during Phase 3, we will pilot test the program with 128 AI SLT users age 19 and over and 20 AI SLT users age 15-18 and make final modifications to the program during the pilot. We will also examine nicotine metabolism in our participants because this has not yet been characterized.

Public Health Relevance

American Indians (AI) suffer greater smokeless tobacco (SLT)-related health disparities than any other ethnic group in the United States due to rates of SLT use that twice as high as other ethnic groups. This study has the potential to help reduce SLT use among AI and could ultimately help reduce rates of associated cancers, including oral, esophageal, and pancreatic cancers. The program, if successful, will be ready for a full-scale test to ultimately disseminate the program and reduce SLT use and related cancers throughout the AI population.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Study Section
Special Emphasis Panel (ZMD1-DRI (01))
Program Officer
Alvidrez, Jennifer L
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University of Kansas
Family Medicine
Schools of Medicine
Kansas City
United States
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Rollins, Kathryn; Lewis, Charley; Goeckner, Ryan et al. (2017) American Indian Knowledge, Attitudes, and Beliefs About Smokeless Tobacco: A Comparison of Two Focus Group Studies. J Community Health 42:1133-1140