Project Leader: Spero M. Manson, Ph.D.
Mortality and hospitalizations due to cardiovascular and respiratory diseases are lower among American Indians and Alaska Natives (AI/ANs) than their US All Races counterparts, but are increasing at an alarming rate. Increased smoking has been cited as a major contributor to this overall trend. Several studies reveal that the prevalence of smoking among AI men (33%) and women (27%) significantly exceeds that of non-Indians. Moreover, although AIs smoke less heavily than smokers in the general population, they often inhale unfiltered, king-sized cigarettes. Yet, few tobacco use interventions have been reported in AIs, especially with elders. Important cultural factors (e.g., ceremonial vs. secular uses of tobacco, different assumptions about personal control, cause/effect, and addiction), not accounted for in past efforts, also may influence the format, effectiveness, content, delivery, and assessment of interventions. Since quitting smoking is the single behavior with the most impact on reducing morbidity and premature mortality, the need to develop, implement, and evaluate cessation interventions for AI populations is compelling.
This study will address the following specific aims:
- Adapt a nicotine replacement/education smoking cessation intervention effective in the general population for AIs;
- Modify and augment measures of psychosocial constructs targeted by the above interventions as mediators (e.g., expectations, cultural affiliation, alcohol use, depressive/anxiety symptoms) and outcomes (e.g., quantity/frequency of smoking, cotinine concentrations);
- Deliver the culturally adapted interventions to AI elders who currently smoke and rigorously evaluate the effects, using culturally relevant measures, within an experimental, pre- and post-test design.