Abstract A07: Creation of a culturally tailored quit smokeless tobacco program for American Indians
Authors: Lewis Charley S. , Hale Jason W. , Goeckner Ryan T. , Smith T Edward , Valliere Stephen , Gunville Jordyn A. , Wilkie Crisandra , Rollins Kathryn L. , Choi Won S. , Daley Christine M. 
Published: March 2017

Abstract
American Indians (AI) have the highest rates of smokeless tobacco (SLT) use of any major ethnic group in the US at 9% versus 4% among whites. This is likely an underestimate due to the wide variation in SLT use by region of the country and tribal affiliation. AI in the Southern and Northern Plains have the highest SLT use rates, reaching 25% among some tribes, contributing to higher and rising incidence and disproportionate mortality in SLT-related cancers, including oral, esophageal, and pancreatic cancers. In addition, over the last three decades rates of SLT use have been rising in some tribal communities with historically low rates. Our overall objective for this project is the development and pilot testing of a culturally tailored SLT cessation program for a heterogeneous AI population using community-based participatory research (CBPR). Here, we describe program development using a CBPR approach and program components of the All Nations Snuff Out Smokeless (ANSOS) program. Program development includes a series of focus groups used to determine program components and cultural tailoring and assessments of the program curriculum for scientific accuracy, readability, and cultural appropriateness. We conducted 6 focus groups with smokeless tobacco users or recent users to determine what they thought would be important in a quit smokeless tobacco program for AI. Based on these focus groups and a smoking cessation program we previously developed and tested with success (All Nations Breath of Life), we created a program and accompanying educational curriculum. Program components include both in-person group counseling sessions and telephone individual counseling, culturally tailored program incentives designed to assist with the quitting process and enhance retention, and a culturally tailored curriculum. To assess the curriculum for scientific accuracy, we used a panel of four experts in tobacco cessation. To assess the curriculum for readability, we used the Fry readability formula, combined with the SMOG readability formula. Using the two formulas allowed us to look at multiple aspects of readability, such as word length and sentence length. To assess the curriculum for cultural appropriateness, we conducted 22 interviews with AI, stratified by gender. We present here results of our focus groups, assessments, and interviews, along with a basic description of program components.
Citation Format: Charley S. Lewis, Jason W. Hale, Ryan T. Goeckner, T Edward Smith, Stephen Valliere, Jordyn A. Gunville, Crisandra Wilkie, Kathryn L. Rollins, Won S. Choi, Christine M. Daley. Creation of a culturally tailored quit smokeless tobacco program for American Indians. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A07.