Feasibility of Implementing the All Nations Breath of Life Culturally Tailored Smoking Cessation Program for American Indians in Multi-Tribal Urban Communities.
Prevalence of cigarette smoking is highest among American Indians, yet few culturally appropriate smoking cessation programs have yet been developed and tested for multi-tribal American Indian adult populations. This study examined implementation of the All Nations Breath of Life culturally tailored smoking cessation program in multi-tribal urban and suburban American Indian communities in seven locations across five states (N = 312).



This single-arm study used community-based participatory research to conduct a 12-week intervention whose primary purpose was to curb commercial tobacco use among American Indians. Participants were followed through month 6 in person and month 12 via telephone. The primary outcome was continuous abstinence from recreational cigarette smoking at 6 months post-baseline, verified through voluntary provision of salivary cotinine levels.



At program completion (12 weeks post-baseline), 53.3% of program completers remained abstinent; labeling those lost to follow-up as smokers resulted in a 41.4% quit rate. At 6 months post-baseline (primary endpoint), 31.1% of retained participants quit smoking (p < .0001 compared to the highest quit rates among multi-tribal populations reported in the literature, 7%); final quit rate was 22.1% labeling those lost to follow-up as smokers (p = .002). Retention rate at endpoint was 71.2%. 12-month follow-up was attempted with all participants and had a retention rate of 49.0%. Of those participants reached, 34.0% were smoke-free.



All Nations Breath of Life shows promise as a smoking cessation program for multi-tribal urban American Indian communities. It can be successfully implemented in a variety of urban settings.



This is the first large feasibility study of a culturally tailored smoking cessation program for American Indians with good cessation and retention rates in a multi-tribal urban American Indian population. It shows that All Nations Breath of Life can be implemented in multiple urban settings across five states. To our knowledge, this is the first program of its kind to be implemented across multiple heterogeneous urban locations and to include salivary cotinine testing for verification of self-report data across these locations.
Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS.
Christine Makosky
CM
Daley
Department of Anthropology, Center for American Indian Studies, Johnson County Community College, Overland Park, KS.
Sean M
SM
Daley
Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS.
Christina M
CM
Pacheco
Department of Anthropology, Center for American Indian Studies, Johnson County Community College, Overland Park, KS.
T Edward
TE
Smith
Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS.
Myrietta
M
Talawyma
Mental Health Clinic, Kansas City VA Medical Center, Kansas City, MO.
Charlotte
C
McCloskey
Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS.
Won S
WS
Choi
Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS.
Niaman
N
Nazir
Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS.
Melissa K
MK
Filippi
Department of Defense Programs Office, Lincoln University, Jefferson City, MO.
Dona
D
McKinney
Department of Anthropology, Center for American Indian Studies, Johnson County Community College, Overland Park, KS.
Jordyn
J
Gunville
Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS.
K Allen
KA
Greiner
D000293:Adolescent; D000328:Adult; D000368:Aged; D000073865:Cigarette Smoking / Q000208:ethnology / Q000628:therapy; D054521:Cultural Competency; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D016540:Smoking Cessation / Q000379:methods*; D014505:Urban Population; D055815:Young Adult