Tailoring tobacco treatment to meet the needs of American Indians

Progress in curbing smoking has bypassed many racial and ethnic groups, including American Indians. About 1 in 3 American Indians currently smokes, compared with a much lower rate of 1 in 5 among all US adults.

The Wiidookaawishin (Help Me) QUITPLAN Center was developed by the Fond du Lac (FDL) Reservation in 2004 to address the lack of cessation programs tailored to American Indian culture and traditional values. The American Lung Association’s “Freedom from Smoking” program was adapted with the guidance of local stakeholders to help the community understand the difference between sacred tobacco use and commercial tobacco abuse. The programs incorporated the history and culture of the American Indian community, including Ojibwe stories and teachings on how to use tobacco as a sacred item in ceremonies and prayers.

The FDL program integrates a range of programs, including community outreach and education, clinical referrals, individual and group counseling, and free access to nicotine replacement therapy (NRT) and prescription mediations.

With the assistance of tribal clinic staff and providers, 303 individuals were enrolled in the intervention between September 2007 and August 2009. More than half (65%) were female; 37% were unmarried; 70 were between 25-54 years. Among the 97% of participants who reported currently smoking, 80% indicated that they intended to quit within a month, with their primary reasons being health (75%), family 14%), and financial cost (7%).

Nearly two-thirds (63%) of the participants attended all four counseling sessions. Prescriptions for pharmacotherapy were provided to 67% of participants.

After completing the program, almost one-third self-reported 7-day abstinence and 47% of this group self-reported abstinence 90 days after program completion. Of those still smoking, the number of cigarettes smoked per day declined from 17 at baseline to 9 at exit and followup; smoking within 30 minutes of waking decreased from 73% at baseline to 42% at exit.

Post-intervention surveys identified high levels of engagement and reported satisfaction, and 90% indicated that they recommended the program to friends and family.

The study reinforces the increased effectiveness of culturally specific programs and the value of providing no-cost pharmacotherapy.

The research, “Evaluation of a Tailored Approach for Tobacco Dependence Treatment for American Indians” was conducted by Joanne D’Silva, MPH; Barbara A. Schillo, PhD; Nathan R. Sandman, BASc; Theresa L. Leonard, MPH; Raymond G. Boyle, PhD, MPH.  It was published in the American Journal of Health Promotion , May/June 2011, Vol. 25, No. 5 Supplement and its full text is freely available http://www.ajhpcontents.org/doi/full/10.4278/ajhp.100611-QUAN-180