title: Beliefs and attitudes regarding smoking cessation among American Indians: a pilot study.
abstract: BACKGROUND
  American Indians (AI) have some of the highest smoking rates in the United States. The Muscogee Nation of Oklahoma developed a culturally targeted program called "Second Wind" based on the American Cancer Society's FreshStart smoking cessation program, but it has not been formally tested.
  
  
  METHODS
  We conducted six focus groups of AI adult smokers at the Haskell Health Center (Lawrence, Kansas). Focus groups assessed beliefs, attitudes, and behaviors related to smoking cessation, as well as participants' perceptions of the "Second Wind" curriculum's appropriateness and feasibility for this diverse group. Focus groups were audiotaped, transcribed, coded, and analyzed for content themes. Participants were 41 AI adults (63% female), 21-67 years of age. Participants smoked an average of 13 cigarettes per day, half had made a quit attempt in the past year, and 63% were daily smokers. For pharmacotherapy, most preferred the nicotine patch.
  
  
  RESULTS
  Focus group responses were categorized into three major themes: traditional tobacco use, quitting and quit attempts, and the "Second Wind" program. Those who reported that traditional tobacco use is important were less inclined to use tobacco recreationally. Second Wind modifications suggested by participants included increasing use of AI imagery and addressing the meaning of tobacco to AI cultures.
  
  
  CONCLUSIONS
  American Indian smokers are unique because of their traditional use of tobacco. Our participants felt that smoking cessation can be accomplished without discouraging traditional use of tobacco. We suggest ways to improve the "Second Wind" curriculum so that it is targeted for a heterogeneous group of AI smokers.
authors.affiliation: University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA. wchoi@kumc.edu
authors.forename: Won S
authors.initials: WS
authors.lastname: Choi
authors.forename: Christine Makosky
authors.initials: CM
authors.lastname: Daley
authors.forename: Aimee
authors.initials: A
authors.lastname: James
authors.forename: Janet
authors.initials: J
authors.lastname: Thomas
authors.forename: Ryan
authors.initials: R
authors.lastname: Schupbach
authors.forename: Marcia
authors.initials: M
authors.lastname: Segraves
authors.forename: Randall
authors.initials: R
authors.lastname: Barnoskie
authors.forename: Jasjit S
authors.initials: JS
authors.lastname: Ahluwalia
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007198:Indians, North American; D007615:Kansas; D008297:Male; D008875:Middle Aged; D016540:Smoking Cessation