native american tobacco education project (nate) funded by a grant from the cdphe state tobacco...

Native American Tobacco Education Project (NATE)

Funded by a grant from the CDPHE State Tobacco Education

and Prevention Partnership (STEPP)

Partners

Native American Cancer Research (NACR)

Ute Mountain Ute Tribe

NACR Staff

Dr. Burhansstipanov - Project Director

Lisa Harjo - Project Coordinator

Terri Rattler - Native Sister Rose Lee - Native Sister

(Navigators)

Native American Tobacco Education (NATE)

Multi-Agency project using Community-Based Participatory Research (CBPR) methodology to develop a sustainable infrastructure for the local tobacco control movement in the Indian community in Denver and at Ute Mountain Ute.

Two Advisory Coalitions

one in the Denver Metropolitan Area

one within Ute Mountain Ute Reservation.

Purpose

to develop an infrastructure that will allow both Native communities to assess local needs and potential strategies to prevent and reduce habitual tobacco use or exposure to secondhand smoke by Native American adolescents and adults, ages 12 to 85.

Expected Outcomes

(1)two functional Native Tobacco Coalitions (one in each site)

(2)baseline data from local focus and working groups to help the Coalitions prioritize issues; and

Expected Outcomes cont.

(3)a list of recommendations based on the focus and working group input by the respective Coalitions for tribal- and geographically-specific tobacco interventions they feel need to be developed in the near future to appropriately address the priorities in culturally respectful manners.

NATE Project Goal

To increase Native communities’ capacity for tobacco control by developing two well educated Native American Tobacco Education Coalitions in Denver and Ute Mountain Ute Reservation.

Strategy 1

Educate both of the Native tobacco control coalitions on the latest, most appropriate tobacco prevention and control information and interventions effective within Native and non-Native communities (includes evidence–based and native-specific strategies.)

Strategy 2

The NATE Coalitions will each recruit community members to take part in FG held in March and April in two different geographic locations in their respective communities (4 FG in Denver and 2 FG in Towaoc).

Strategy 3

The NATE Coalition from each site will review the expanded prioritized tobacco topics for their respective area (i.e., two different priority lists which are likely to have some overlap, yet issues specific to the rural or urban communities) and organize the priorities into a strategic plan.

Strategic Plan

This strategic plan will include (a) goals for next 3 years;

(b) measurable objectives to attain those goals;

(c) culturally acceptable and innovative strategies to attain the objectives;

Strategic Plan cont.

(d) participant interactive activities to reinforce the behaviors specified within each objective;

(e) evaluation strategies specific to each objective; and

(f) dissemination of recommendations plan (to local communities, State funders and others as needed).

Strategic Plan

This outline will be the beginning of a strategic plan for subsequent funding to develop interventions inclusive of these components that are culturally specific and designed to prevent, reduce, or control habitual tobacco use among Native Americans.

Advisory Coalition

Meets every other month for 2 hours

Training in beginning and during project.

Provides guidance and leadership during gathering of information from community, and development, implementation and dissemination of the plan to the community

Continues with Project during subsequent funding to provide leadership

Focus Groups

Conducted to gather more information directly from community members

Four groups in each site: 2 all ages, 1 youth, and 1 elders.

Questions from TAB and Coalition and 2-3 discussion questions

2 hours in duration, 8 participants, $20 each

Overview of Training

Ceremonial tobacco use vs. habitual tobacco use

Strategies for teambuilding

Tobacco Initiatives in Indian Country

Stages of Change in and out of Indian Country

Tobacco Facts and Fallacies in Indian country

Overview of Training cont.

Overview of AIAN Tobacco Surveys

Social Norm Strategies

ARS – Audience Response System

Second Phase

Goal: To continue the work established in the First Phase and add new levels of focus.

Second Phase

Strategy 1: Maintenance of a community advisory coalition and expanded partners to guide development, field testing, and implementation efforts for all age groups and sectors in the American Indian Community regarding Tobacco Control.

Second Phase

Strategy 2: Develop, refine, and implement age-specific culturally appropriate tobacco use interventions will reduce second hand smoke (SHS), reduce first time starts with tobacco, and increase cessation activities among American Indians.

Second Phase

Strategy 3: Develop Native-specific anti-habitual tobacco use messages that can be used in public awareness campaigns to help initiate community members' consideration of new ideas, behavior, and actions.

Second Phase

Strategy 4: QUITLINE and QUITNET (Native Adults) Determine cultural appropriateness and sensitivity of the proposed tobacco interventions, especially telephone counseling.

Second Phase

Strategy 5: Policy is an essential component of a comprehensive Tobacco Control Movement as it creates environments and opportunities for new behaviors and actions.

Successes

Sustainable Infrastructure for Tobacco Control Initiatives – Capacity-Building

Tribal and Native Tobacco Policy and Movement Training

Youth Intervention for Tobacco exposure reduction and cessation

Colorado Quitline

Established a relationship for future work

Participated in cultural competency training…….

Critiqued Cultural Training

Established plan to improve cultural sensitivity training for providing support to American Indian callers.

Challenges

Lack of knowledge and experience in the American Indian tobacco control movement.

remedied by training and networking at regional Indian tobacco control leadership workshops and seminars.

Challenges

Continued competition for the attention of Indian people who smoke.

remedied by interventions that are fun and based on some traditional beliefs and practices.

Challenges

Ute Mountain Ute Tribe – Working with a tribal nation yielded several challenges that continue to be addressed including:

Challenges

Lack of support for the program – Low priority in relationship to other efforts related to education, employment, health, tribal business, etc.

Lack of internal stability and coordination with tribal program leadership changes and facility limitations.

Challenges

Lack of participation in the advisory council by tribal program representatives and leaders.

Responses

The NATE staff at both locations worked to recruit and keep participants in the Ute Advisory Council to provide leadership and support to the program.

ResponsesActions taken:

The NATE Program worked to take the Advisory Council members including a Ute Mountain Ute Tribal council person to training with other Tribes and Indian people to uplift the issue and educate them on what other tribes are doing and how their efforts can help their community.

Responses

NATE staff raised the issue of changing and limited office space to the Tribe on many occasions.

Results

NATE staff in Denver provided on-going training to the Ute Mountain Ute staff on the ARS, tobacco control issues, and other topics to support the program in their efforts to get the community involved and participating in the program.

Results

The NATE staff in Ute Mountain Ute now has a permanent office and is housed in the Substance Abuse Program.

Future Activities…

Sustain Advisory CouncilPilot and implement Youth InterventionPromote SHS Reduction and Prevention Strategies including personal policy developmentWork with Quitline-established cessation programCreate culturally sensitive media

Preliminary NATE “Survey” findings

Survey Items Evolved from: o CO TAB instrument o Native American Tobacco Prevention

Network (survey tools) o National Health Interview Survey (2 items)o California Health Interview Survey o 4 National Cancer Institute Native tobacco

surveyso NATE Coalition Guidance

Includes NATE Coalition and focus group (FG) data from both Denver and Ute Mountain Ute Tribe (FG still in process)

Different numbers of responses on selected items as the items were refined to be culturally acceptable to the Native community members

Administered via ARS

Preliminary NATE “Survey” findings

Examples of Preliminary NATE “Survey” findings

“Preliminary Data” Comprise total of

o 52 Denver Natives

o 25 Ute Mountain Ute Tribal Members

Examples of demographics:

o ~41% males

o ~59% females

Typical tobacco survey breakout in Indian Country is ~75% respondents are female

Examples of Preliminary NATE “Survey” Demographics

Denver Ute Mt. Ute

N=52 answered the item

21 males (40.4%)

31 females (59%)

N=21 answered the item

8 males (30.3%)

13 females (60.7%)

Gender


Denver Ute Mt. Ute

52 (n=53; 98.1%) 15 (n=17;88%)

American Indians

The number of people who answered the item


Denver Ute Mt. Ute

27 (n=53; 50.9%) 15 (n=17;88%)

High school or less education


Denver Ute Mt. Ute

9 (n=29; 31%) 17 (n= ; 62.4%)

Primarily raised on reservation

Examples of Preliminary NATE “Survey” Tobacco Behaviors

Denver Ute Mt. Ute

24 (n=36; 52.2%) 8 (n=23; 35.4%)

Use tobacco for ceremonies


Denver Ute Mt. Ute

27 (n=44; 61.4%) 13 (n=23; 55%)

Not smoke at all


Denver Ute Mt. Ute

17 (n=45; 37.8%) 11 (n=24; 47.8%)

Yes, smoke when drink alcohol


Denver Ute Mt. Ute

41 (n=45; 91.10%) 26 (n=26; 100%)

Not use chew at all


Denver Ute Mt. Ute

30 (n=36; 83.3%) 18 (n=26; 67.5%)

Never allow smoking in home

Allow smoking in home only for special people

1 (n=36; 2.8%) 4 (n=26; 16.3%)


Denver Ute Mt. Ute

21 (n=45; 46.7%) 12 (n=27; 43.5%)

No habitual smoking in home at any age


Denver Ute Mt. Ute

22 (n=45; 48.9%) 11 (n=27; 40.6%)

No smoking or chewing in home <18 years

Examples of Preliminary NATE “Survey” NHIS

Denver Ute Mt. Ute

29 (n=45; 64.4%) 16 (n=25; 63.3%)

Yes, always wear seat belt

Strong correlation between consistent seat belt use and likelihood of adhering to tobacco cessation

Examples of Preliminary NATE “Survey” Tobacco Cessation

Denver Ute Mt. Ute

30 (n=37; 81.1%) 22 (n=22; 100%)

Culturally Appropriate Tobacco Quit Programs(“none”, “none that I know of”, “don’t know”)

Examples of Preliminary NATE “Survey” Tobacco Cessation

Denver Ute Mt. Ute

27 (n=45; 60%) 18 (n=30; 57.5%)

Yes, I’ve heard of CO Quitline / Quitnet

NATE Staff

Lisa Harjo, MA [Choctaw]Terri Rattler [Oglala Lakota]

Rose Lee [Navajo]Linda Burhansstipanov [Cherokee]

Native American Cancer Research1835 Franklin StreetDenver, CO 80218

phone: 303-837-8137fax: 303-837-7115

Native Cancer Survivors' Support Network: 1-800-537-8295

web page: http://www.NatAmCancer.org

email: [email protected]

What is NATE?

NATE is the Native American Tobacco Education Project. It is a community-based initiative to raise awareness in the Denver American Indian community about tobacco.

The NATE project is coordinated through Native American Cancer Research (NACR). It is funded through a grant from Colorado’s State Tobacco Education and Prevention Partnership (STEPP)

RespectTobacco

Denver, ColoradoSeptember 2006

Youth / Children

Based on the responses of the American Indians who participated in the Focus

Groups and surveys:

41% first tried tobacco between 14 and 16 years of age

68% were introduced to tobacco by their friends or peers

33% began using tobacco habitually before 20 years of age

57% believe that enforcement for minors is not adequate

87% believe that store owners should have a license to sell tobacco

62% of youth believe that enforcement for minors is not adequate

13% of youth currently smoke tobacco daily

What we Learned from our Community

12% of youth use tobacco with alcohol two times a week or less

25% of youth were exposed to second hand smoke in their home

What they said

“I thought it was cool … every movie you went to, someone was blowing smoke … it looked sophisticated.”

“My boyfriend got me to smoke. He was always smoking cigarettes and he said come on, smoke a cigarette… So, I smoked a cigarette. Now I’m hooked.”

“Our coach used to smoke … Wow, a coach is smoking and this guy is athletic and everything.”

Focus Groups and Surveys

NATE conducted a series of Focus Groups and surveys in the Denver Metro Area with American Indian people of all ages during the Spring and Summer of 2006 to learn more about attitudes, beliefs, and behaviors related to tobacco.

Who Participated?

59 American Indians who reside in Denver, CO

40% males

60% females

NATE Staff




phone: 303-837-8137fax: 303-837-7115




What is NATE?



RespectTobacco


Ceremonial Use


How is Traditional Tobacco Used?



Who Participated?


40% males

60% females


Groups and surveys:

60% use tobacco for ceremonial purposes

45% use traditional, non-commercial tobacco for ceremonial purposes

Over 50% of American Indians use both traditional tobacco and commercially prepared tobacco for ceremonial purposes

47% use tobacco for non-ceremonial purposes

For healing with headaches, fevers, chills, earaches and other illnesses

For pain relief from childbirth pains, headaches, and toothaches

For relief from symptoms of asthma, stomach aches, and rheumatism

As a remedy for wounds

As a bug repellant

To honor and welcome guests

To communicate with the Creator

To bind agreements

To bless events, buildings, homes, and people

NATE Staff




phone: 303-837-8137fax: 303-837-7115




What is NATE?



RespectTobacco


General Information



Groups and surveys:

41% currently smoke cigarettes

6% currently chew tobacco

38% smoke tobacco when they drink alcohol

58% have smoked more than 100 cigarettes in their life

41% first tried tobacco between 14 and 16 years of age

68% were introduced to tobacco by their friends or peers

% began using tobacco habitually before 20 years of age

60% use tobacco for ceremonial purposes

45% use traditional, non-commercial tobacco for ceremonies

18% allow smoking in their home

26% stated a desire to quit smoking

57% believe that enforcement for minors is not adequate

87% believe that store owners should have a license to sell tobacco



Who Participated?


40% males

60% females

What people said

“I don’t think Indians want to quit smoking”

“I think tobacco isn’t a risk for us (American Indians) because it was a gift to us from the Creator

NATE Staff




phone: 303-837-8137fax: 303-837-7115




What is NATE?



RespectTobacco


Quitting



Groups and surveys:

41% currently smoke cigarettes

6% currently chew tobacco

38% smoke tobacco when they drink alcohol

58% have smoked more than 100 cigarettes in their life

26% stated a desire to quit smoking

18% would use the Cold Turkey method of quitting without help or counseling

33% began using tobacco habitually before 20 years of age



Who Participated?


40% males

60% females

64% were not aware of tobacco quitting programs in the Denver American Indian community

60% had heard of the Quitline or Quitnet (1-800-639-QUIT) or http://co.quitnet.com

91% have never contact the Quitline or Quitnet

26% stated that they would like to quit using tobacco in the next six months

97% were aware of the harm second hand smoke can cause to children and youth, homes, and people

Pregnant females who smoke increase their chances of having a low birth weight baby by up to 39%

CO Quitline “Tobacco Use in Colorado” fact sheet, October 2001

Smoking during pregnancy “Facts”

Low birth weight may cause stillbirths and newborn deaths.

CO Quitline “Tobacco Use in Colorado” fact sheet, October 2001

Within 20 minutes of quitting, blood pressure and pulse rate decrease.

Most Smokers regret the day they started smoking. CO Quitline 1-800-639-QUIT or http://co.quitnet.com

Benefits of Quitting “Facts”

Within 8 hours of quitting, carbon monoxide and oxygen levels in the blood return to normal.


Within 1 day of quitting, the likelhood of heart attack decreases.


Within 2 days of quitting, nerve endings regenerate; sense of smell and taste improve.



Within 2 weeks, circulation improves and lug function increases.


After quitting for 1-9 months, coughing, sinus congestion, fatigue and shortness of breath decrease.


Within 1 year of quitting, the likelihood of heart attack is cut in half.



Within 5 years of quitting stroke risk is reduced to the same levels as a non-smoker..


Within 10 years of quitting, risk of dying from lung cancer is about half that of a current smoker.



Within 15 years of quitting, risk of coronary heart disease and death become roughly equivalent to those who have never smoked.


native american tobacco education project (nate) funded by a grant from the cdphe state tobacco...

Documents

nativespecific strategies

native communities capacity

strategic plan

native american adolescents

specific tobacco interventions

nate coalitions

ute mountain ute reservation

local tobacco control