It's Your Life - It's Our Future

Smoking is a significant problem in Indian communities. The 2000 National Health Interview Survey (NHIS) found that American Indians/Alaska Natives had the highest smoking rates (36%) among racial/ethnic groups. Other NHIS data show that American Indians/Alaska Natives were the only group for whom smoking rates did not decline from 1978 to 1995.

Studies have shown that smoking rates decrease when physicians advise patients not to smoke. For this reason, smoking cessation advice from physicians and health providers, along with a motivational videotape and follow-up by a community health representative, play an important part in It's Your Life -- It's Our Future, a smoking cessation program designed specifically for American Indians in California.

The program consists of three parts: (1) identification of the clinic client as a smoker, (2) delivery of a stop-smoking message from the physician to the smoker, and (3) a follow-up visit from a community health representative, who provides educational materials and support to help the smoker quit and remain a non-smoker. To accomplish the smoking cessation goal, the program materials were developed with guidance from local clinic staff, artists, and American-Indian advisors.

Implementation of this program consists of a 15-minute Train-the-Trainer video, the It's Your Life -- It's Our Future smoking cessation video (15 minutes), and a follow-up visit by a community health representative 6 months after the smoking cessation intervention. The educational materials were provided by the CHR as part of the intervention.

Study participants were American Indians and Alaska natives residing in Northern California.

The program can be administered in community health clinics.

Required resources include the motivational video (It's Your Life) and a self-help guide provided by a community health representative.

The It's Your Life - It's Our Future project consisted of five phases: (1) working with the American-Indian community to identify needs and barriers related to smoking cessation, (2) designing or revising quit-smoking materials, (3) conducting the prevalence survey, (4) implementing the program, and (5) evaluating the program. These steps were used to gather support from the American-Indian communities, to provide the most practical and efficient smoking cessation methods, and to ensure that the project was culturally appropriate and accessible to the community.

In order to identify culturally appropriate messages, the researchers used targeted focus groups and questionnaires. Three topics were found to be the most culturally appropriate: 1) cultural identity, 2) responsibility to family and tribe, and 3) respect for tobacco products for ritual use.

Results of the study include the following:

• The percent of smokers who quit smoking after the intervention was 6.8%, compared with 3.4% of those who received standard clinic care.
• Smokers were more likely to quit if they were younger, female, did not have a smoker in the house, smoked fewer than 12 cigarettes a day, did not smoke within 30 minutes of waking up, and were highly motivated to quit.
• After 6 months, the program had a greater effect among those who were interested in quitting at baseline than among those who were not.
• The program had a greater effect on light smokers than on heavy smokers.