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All Nations Breath of Life

A Randomized Trial of Smoking Cessation for American Indians
  • Won S. Choi
    Correspondence
    Address correspondence to: Won S. Choi, PhD, MPH, Department of Preventive Medicine and Public Health, University of Kansas Medical Center, MS 1008, 3901 Rainbow Boulevard, Kansas City KS 66160[issn]/$36#36.00?>$^doi_string?>
    Affiliations
    Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas

    Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas
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  • Laura A. Beebe
    Affiliations
    Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
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  • Niaman Nazir
    Affiliations
    Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas

    Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas
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  • Baljit Kaur
    Affiliations
    Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas

    Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas
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  • Michelle Hopkins
    Affiliations
    Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
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  • Myrietta Talawyma
    Affiliations
    Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas

    Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas

    Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
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  • Theresa I. Shireman
    Affiliations
    School of Public Health, Brown University, Providence, Rhode Island
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  • Hung-Wen Yeh
    Affiliations
    Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas

    Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas
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  • K. Allen Greiner
    Affiliations
    Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas

    Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma

    Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas
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  • Christine M. Daley
    Affiliations
    Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas

    Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas

    Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas

    American Indian Health Research and Education Alliance, Inc., Kansas City, Kansas
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      Introduction

      American Indians have the highest cigarette smoking prevalence of any racial/ethnic group in the U.S. There is currently no effective empirically based smoking-cessation program for American Indians. The purpose of this study was to determine if a culturally tailored smoking-cessation program, All Nations Breath of Life (ANBL), is more effective than a non-tailored cessation program among American Indian smokers.

      Design

      A multisite RCT was conducted from September 2009 to July 2014; analysis was conducted in 2015.

      Setting/Participants

      Participants were rural or reservation-based American Indian smokers aged ≥18 years.

      Intervention

      Smokers were group randomized to either the culturally tailored ANBL or non-tailored current best practices (CBP) for a total enrolled sample size of 463 (ANBL, n=243; CBP, n=220).

      Main Outcome Measures

      The primary outcome of interest was salivary cotinine−verified 7-day point prevalence smoking abstinence at 6 months. Results for both responder-only and intent-to-treat analyses for self-reported and cotinine-verified abstinence are presented.

      Results

      Intention-to-treat, imputing all non-responses as smokers, the self-reported point prevalence abstinence rates at 12 weeks were 27.9% in the ANBL arm and 17.4% in the CBP arm (p=0.028). There was a statistically significant difference in self-reported 6-month intent-to-treat point prevalence abstinence rates between ANBL (20.1%) and CBP (12.0%) arms (p=0.029). None of the cotinine-verified results were statistically significant.

      Conclusions

      The culturally tailored smoking-cessation program ANBL may or may not be an effective program in promoting cessation at 12 weeks and 6 months. Participants in the culturally tailored ANBL program were approximately twice as likely to quit smoking at 6 months compared with the CBP program, using self-reported abstinence.
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