The GAINS project: outcome of smoking cessation strategies in four urban Native American clinics. Giving American Indians No-smoking Strategies. A study of the use of free nicotine patches by Indigenous people. Preliminary investigation of a culturally specific smoking cessation intervention for Hispanic smokers. The effect of a culturally tailored smoking cessation for Chinese American smokers.
This study was designed to assess the capability of the Doctors Helping Smokers (DHS) model to produce an increase in smoking cessation over controls within four urban Indian Health clinics. A total of 601 Native American smokers were enrolled, surveyed, and measured for cardiovascular risk factors. Of those present in treatment clinics at 1-year follow-up, 7.1% reported being abstinent vs. 4.9% in the control group. Of those who made at least one visit to the clinic during the treatment year, 9.4% self-reported being abstinent in the treatment sites vs. 3.9% in the control group (p = .04). Cotinine validated quits for all enrollees, regardless of whether they attended the clinic during the intervention, are 6.7% (intervention) and 6.8% (control). Number of quit attempts and future quit intentions were greater in the intervention group. Recommendations for future intervention efforts include earlier contact with clinicians, clinic involvement in preplanning, developing the program around the principles and realities of each site, building in more extensive components, and utilizing additional community resources. To assess use of free nicotine patches by Indigenous people when offered a brief intervention for smoking cessation, and to assess changes in smoking behaviour at six months.
                We conducted a pre and post study in three Indigenous communities in the Northern Territory.
                Forty Indigenous smokers self-selected to receive free nicotine patches and a brief intervention for smoking cessation, and 71 chose the brief intervention only. Eighty-four per cent of participants were followed up; 14% of participants could not be located. Fifteen per cent of the nicotine patches group (10% with CO validation) and 1% (CO validated) of the brief intervention only group reported that they had quit at six months. Seventy-six per cent of the nicotine patches group and 51% of the brief intervention only group had reduced their consumption of tobacco. No participant completed a full course of patches. One possible side effect--the experience of bad dreams--was attributed in one community to the person concerned having been 'sung' or cursed.
                Free nicotine patches might benefit a small number of Indigenous smokers. Cessation rates for the use of both nicotine patches and brief intervention alone were lower than those in other populations, possibly because the study was conducted in a primary care setting and because of barriers to cessation such as widespread use of tobacco in these communities and the perception of tobacco use as non-problematic. The purpose of this study was to compare a culturally specific, multicomponent behavioral smoking cessation program for Hispanic smokers with a low-intensity, enhanced self-help control condition.
                Participants who completed pretreatment assessment were randomly assigned to treatment conditions. Smoking status was evaluated at posttreatment, 6-month follow-up, and 12-month follow-up intervals.
                The study was based in predominantly Hispanic neighborhoods in Queens, New York.
                Ninety-three Hispanic smokers participated: 48 men and 45 women.
                The multicomponent treatment involved a clinic-based group program that incorporated a culturally specific component consisting of videotaped presentations of culturally laden smoking-related vignettes. The self-help control program was enhanced by the use of an introductory group session and follow-up supportive telephone calls.
                Smoking outcomes were based on cotinine-validated abstinence and self-reported smoking rates. Predictors of abstinence were examined, including sociodemographic variables, smoking history, nicotine dependence, acculturation, partner interactions, reasons for quitting, self-efficacy, and linguistic competence.
                Significant group differences in cotinine-validated abstinence rates in favor of the multicomponent group were obtained, but only at posttreatment. With missing data included and coded for nonabstinence, validated abstinence rates at posttreatment were 21% for the multicomponent group and 6% for the self-help group. At the 6-month follow-up, the rates were 13% for the multicomponent group and 9% for the self-help group. By the 12-month follow-up, the rates declined to 8% and 7% for the multicomponent and self-help groups, respectively. A dose-response relationship between attendance at group sessions and abstinence status was shown at posttreatment and 6-month follow-up intervals.
                The results of the present study failed to show any long-term benefit from use of a clinic-based, culturally specific multicomponent smoking cessation intervention for Hispanic smokers relative to a minimal-contact, enhanced self-help control. Tobacco use is a serious public health problem among low-income Chinese Americans with limited English proficiency. Chinese men are at high risk for smoking-related morbidity and mortality. We tested the feasibility of a culturally and linguistically sensitive smoking intervention program with combined counseling and pharmacological components for Chinese smokers in New York City; identified factors and techniques that enhance the administration and appropriateness of the intervention program; and examined the overall impact of this program on quit attempts, quit rates, and overall smoking reduction.
                We were guided by the transtheoretical model and used an adapted motivational interviewing (MI) approach. The study involved a randomized sample with pretreatment assessment and multiple follow-up measures. Eligible participants (N = 122) were randomly assigned to intervention (4 individualized counselor-led MI sessions and nicotine replacement therapy [NRT]) or control groups (4 general health education sessions, self-help materials, and NRT).
                Quit rate at 6 months in the intervention group was 67% versus 32% for the control group, indicating minimal relapse and a highly successful intervention program. Increase in self-efficacy and decease in pros of smoking from baseline to 6-month follow-up were positively associated with smoking cessation. The number of cigarette smoked at baseline was inversely related to smoking cessation. Results indicate that a combined intensive behavioral counseling and pharmacological intervention can reduce smoking substantially.
                The results of this pilot will be used as a basis for a large-scale randomized trial of an intervention with combined culturally and linguistically sensitive MI and NRT components for Chinese and other Asian ethnic groups.
A significant health disparity exists, whereby Indigenous populations, a minority, are over-represented in the burden of smoking-related morbidity and mortality. This review highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non-Indigenous populations. Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results. The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence. However this evidence base is not strong with a small number of methodologically sound trials investigating these interventions. More rigorous trials are now required to assist in bridging the gap between tobacco related health disparities in Indigenous and non-Indigenous populations.