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Randomized Controlled Trial
. 2019 Jun:81:28-33.
doi: 10.1016/j.cct.2019.04.007. Epub 2019 Apr 13.

A randomized trial to reduce smoking among American Indians in South Dakota: The walking forward study

Mark B Dignan  1 , Kate Jones  2 , Linda Burhansstipanov  3 , Sheikh I Ahamed  4 , Linda U Krebs  5 , Drew Williams  6 , G M Tanimul Ahsan  7 , Ivor Addo  8 , Michele Sargent  9 , Kristin Cina  10 , Kim Crawford  11 , Doris Thibeault  12 , Simone Bordeaux  13 , Shalini Kanekar  14 , Daniel Petereit  15
Affiliations
Randomized Controlled Trial

A randomized trial to reduce smoking among American Indians in South Dakota: The walking forward study

Mark B Dignan et al. Contemp Clin Trials. 2019 Jun.

Abstract

Background: Lung cancer is an important public health issue, particularly among American Indians (AIs). The reported decline in tobacco use for most racial/ethnic groups is not observed among AIs. This project was designed to address the research question, "Why don't more Northern Plains American Indians alter tobacco use behaviors known to increase the risk of cancer?"

Methods: Guided by the Theory of Planned Behavior, a multi-component intervention study was implemented. Adult AIs, age 18 years or older and currently smoking, were enrolled. Eligible subjects were randomized to one of 15 groups and exposed to either a MINIMAL or an INTENSE level of 4 intervention components. The intervention was delivered face-to-face or via telephone by Patient Navigators (PN). The primary outcome was self-reported abstinence from smoking verified by carbon monoxide measurement.

Results: At 18 months post-quit date, 88% of those who were still in the study were abstinent. This included 6% of all participants who enrolled in the study (14/254) and 13% of those who made it to the quit date (14/108). No intervention groups were found to have significant proportions of participants who were abstinent from smoking at the quit date (visit 5) or primary outcome visit (18 months post-quit date, visit 11), but use of pharmacologic support for abstinence was found to be an effective strategy for individuals who continued participation throughout the study. Those who remained in the study received more visits and were more likely to be abstinent.

Conclusions: Use of NRT increased the odds of not smoking, as assessed at the 18-month follow-up visit, but no other interventions were found to significantly contribute to abstinence from smoking. Although the intervention protocol included numerous points of contact between CRRs and participants (11 visits) loss to follow-up was extensive with only 16/254 remaining enrolled. Additional research is needed to improve understanding of factors that influence enrollment and retention in smoking cessation interventions for AI and other populations.

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Conflict of interest statement

Conflicts of interest

The authors declare no potential conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Areas where the study was implemented.
Fig. 2.
Fig. 2.
Mean number of text message replies by smoking status at each visit and level of intensity of text message delivery.
See this image and copyright information in PMC

References

    1. U.S. Department of Health and Human Services, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, 2014.
    1. Cobb N, Espey D, King J, Health behaviors and risk factors among American Indians and Alaska Natives, 2000–2010, Am. J. Public Health 104 (Suppl. 3) (2014. June) S481–S489. - PMC - PubMed
    1. Plescia M, Henley SJ, Pate A, Underwood JM, Rhodes K, Lung cancer deaths among American Indians and Alaska natives, 1990–2009, Am. J. Public Health 104 (Suppl. 3) (2014) S388–S395 June. - PMC - PubMed
    1. White MC, Espey DK, Swan J, Wiggins CL, Eheman C, Kaur JS, Disparities in cancer mortality and incidence among American Indians and Alaska Natives in the United States, Am. J. Public Health 104 (Suppl. 3) (2014. June) S377–S387. - PMC - PubMed
    1. Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Data, (2016).

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