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Multilevel prevention of commercial tobacco-related harms on rural California Tribal lands

Institution: PIRE California, Inc.
Investigator(s): Roland Moore,
Award Cycle: 2019 (Cycle 30) Grant #: T30IR0933 Award: $1,102,650
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: High Impact Research Project Award

Initial Award Abstract
We propose to assess the effectiveness of combining clinic-based cessation for commercial tobacco with environmental prevention strategies to reduce availability of and exposure to commercial nicotine products for youth in nine contiguous rural reservation-based California Indian Tribes. Representatives of these Tribes on the clinic board have expressed concern about adolescent use of new and emerging nicotine products. To date there have been no systematic tobacco prevention programs on the nine reservations. Incomplete Tribal clinic records suggest that 20-25% of adult patients are current tobacco users, indicating a risk for youth exposure to secondhand smoke. The clinic as yet has no formal smoking cessation program, nor are all patients screened. Prior collaborative efforts with this clinic have shown the combination of individual treatment and environmental prevention to be effective in reducing harmful alcohol use among underage youth in this population. We propose to adapt these strategies for tobacco prevention, utilizing a community-based participatory research framework to deeply engage with both grassroots community members and with Tribal leaders. For our community-level environmental prevention, we will (1) implement a Reward and Reminder program to encourage reservation area tobacco retailers to comply with State of California standards prohibiting sales of nicotine and commercial tobacco products to youth under 21; and (2) For our individual-level, clinic-based cessation program we propose to (1) consistently screen adult clinic patients for commercial tobacco use and dependence, and exposure to commercial tobacco use; (2) train clinic staff in smoking cessation counseling and nicotine-replacement therapy (NRT); and (3) assess the effectiveness of these strategies in reducing tobacco use and dependence in a sample of adults. We will develop youth advisory councils to conduct a youth participatory action research component to identify and develop culturally- and age-appropriate program implementation and encourage Tribal resolutions in support of smoke-free Tribal homes and service facilities. We will evaluate the effectiveness of our translational strategies through assessment of reward and reminder outcomes in stores, adoption of smoke-free policies by local tribes, and both enrollment and quit rates from the smoking cessation program.