BackgroundAmerican Indian women have high rates of cardiovascular disease largely because of their high prevalence of hypertension, diabetes, and obesity. This population has high rates of cardiovascular disease-related behaviors, including physical inactivity, harmful tobacco use, and a diet that promotes heart disease. Culturally appropriate interventions are needed to establish health behavior change to reduce cardiovascular disease risk.Community ContextThis study was conducted in Robeson County, North Carolina, the traditional homeland of the Lumbee Indian tribe. The study’s goal was to develop, deliver, and evaluate a community-based, culturally appropriate cardiovascular disease program for American Indian women and girls.MethodsFormative research, including focus groups, church assessments, and literature reviews, were conducted for intervention development. Weekly classes during a 4-month period in 4 Lumbee churches (64 women and 11 girls in 2 primary intervention churches; 82 women and 8 girls in 2 delayed intervention churches) were led by community lay health educators. Topics included nutrition, physical activity, and tobacco use cessation and were coupled with messages from the Proverbs 31 passage, which describes the virtuous, godly woman. Surveys collected at the beginning and end of the program measured programmatic effects and change in body mass index.OutcomeChurches were very receptive to the program. However, limitations included slow rise in attendance, scheduling conflicts for individuals and church calendars, and resistance to change in cultural traditions.InterpretationChurches are resources in developing and implementing health promotion programs in Christian populations. Through church partnerships, interventions can be tailored to suit the needs of targeted groups.

Objective This study assessed college student health providers’ use of Motivational Interviewing (MI) with tobacco users, as well as their beliefs about the use of brief interventions to help college student tobacco users quit. MI is recommended by the USPHS to increase tobacco users’ willingness to quit. Participants Participants included 83 clinicians from health clinics at seven different universities in North Carolina. Methods Paper-and-pencil baseline survey from a cluster randomized trial of college student health clinicians. Results Twenty-two percent of respondents reported always or usually using MI during the past month for tobacco using patients not ready to make a quit attempt. Student health providers also reported information with regards to their beliefs about tobacco cessation treatment, barriers to intervening with patients, and confidence in motivating students to consider quitting. Conclusions Results highlight the need to encourage clinician use of motivationally focused interventions with student tobacco users.

Background Waterpipe tobacco (WT) smoking is associated with misperceptions of harm, especially among users. WT packaging contains imagery, flavor descriptors, and text claims that may contribute to misperceptions. The study goal was to characterize visual and text elements of WT packaging. Methods Using data from the U.S. Population Assessment on Tobacco and Health Study Wave 2 (October 2014-October 2015), we identified the 10 most popular WT brands. For each brand, we identified available flavors, including flavor collections with unique packaging elements. We randomly selected 10 flavors per brand for purchase (March-April, 2018). We conducted descriptive content analysis to code all textual and visual design elements of each package. Results Over half (54%) of WT packages had modified risk tobacco product (MRTP) claims prohibited by federal law, including substance-free MRTP claims (43%) and the descriptor “natural” (11%). No MRTP reduced exposure or reduced risk claims were found. Over a quarter (26%) of packaging including one or more of terms that may imply reduced harm including “fresh,” “premium,” “quality,” and “pure.” All packages included a text-only warning, yet none appeared on the primary display panel. Almost all packaging (99%) included imagery, with 72% including flavor imagery. The majority of packages (72%) included a smoking cue. The most popular marketing appeals were “well-made” (57%), “enjoyable” (55%), and “patriotic” (47%). Conclusions Prohibited MRTP claims, other descriptors, and flavor imagery are common on WT packaging, despite federal law. Future research is needed to evaluate if this marketing contributes to misperceptions of reduced harm.