Background: American Indian (AI) adolescents report greater prevalence of tobacco use than any other ethnic or racial group in the U.S. A key barrier to smoking cessation among AI smokers is the lack of access to culturally relevant cessation programs. There is a clear need for evidence-based smoking cessation interventions that are culturally relevant and acceptable to California AIs. AI organizations have independently developed smoking cessation programs or adapted general-audience interventions, but few of these programs have been evaluated, and many are not based on known models of effective smoking cessation. California has produced significant reductions in tobacco use and tobacco-related disease over the past 50 years. Unfortunately, certain populations have not benefitted equally from this tobacco control success. American Indians (AI) are an example of a population that has been left behind in tobacco control and still suffers disproportionately from tobacco-related disease.
Methods: To promote tobacco use cessation among American Indian teens, we will compare the efficacy of Project EX-AI (a modified version of Project EX culturally targeted to AI teens) versus Project EX-standard. We will recruit 300 AI adolescents from 24 American Indian Education Centers (AIECs), which provide tutoring, cultural activities, and other youth services to over 3,000 AI youth throughout California. Hypothesis 1: AI youth who receive Project EX-AI will report less tobacco use at immediate posttest and 3- and 6-month follow-up, relative to youth who receive the standard Project EX program. Hypothesis 2: AI youth who receive Project EX will report less tobacco use than those in the control condition. Hypothesis 3: EX program effects will be mediated by changes in knowledge, motivation to quit, and behavioral coping skills. EX-AI program effects will be mediated by changes in these variables, plus increased knowledge of the distinction between commercial and ceremonial tobacco use, enhanced ethnic identity, and increased awareness of tobacco companies’ use of AI imagery to sell commercial tobacco. Exploratory research question: Although we do not have a priori expectations about differential program effects, we will examine moderation by gender, individual tobacco use (including type of tobacco used and frequency of use) at pretest, and urban vs. rural area of residence. We will examine number of cigarettes smoked in the last 7-days for the immediate posttest, to minimize overlaps with program delivery. We will also examine outcomes other than complete cessation, including reduction in number of tobacco use occasions per day (multilevel linear regression with the same predictor variables), and time to relapse (survival analysis).
Conclusion: This information will provide valuable, additional input into what is needed in effective teen tobacco use cessation programming for AI youth. With few tobacco cessation programs focusing on AI populations, this study will provide promising potential for an AI specific teen tobacco use cessation program.