Development of a tobacco cessation intervention for Alaska Native youth

Abstract

Tobacco cessation treatments have not been evaluated among Alaska Native (AN) adolescents. This pilot study evaluated the feasibility and acceptability of a targeted cessation intervention developed for AN youth. Intervention components were informed by prior focus groups assessing treatment preferences among AN youth, a social cognitive theoretical framework and feedback obtained from a teen advisory group. The intervention consisted of a weekend program where youth traveled by small airplane from their villages to stay overnight with other adolescents who quit tobacco use together. The program included recreational activities, talking circles, personal stories from elders and teen advisors, and cognitive behavioral counseling. Two intervention pilots were conducted from October 2010 to January 2011 using a non-randomized, uncontrolled study design with assessments at baseline and six-week follow-up. One village in Western Alaska was selected for each pilot with a targeted enrollment of 10 adolescents each. Participants were recruited for each pilot within five days, but recruitment challenges and ‘‘lessons learned’’ are described. The first pilot enrolled nine adolescents (all female) aged 13–16 years; all nine attended the intervention program and 78% (7/9) completed follow-up. The second pilot enrolled 12 adolescents (eight females, four males) aged 12–17 years, of which seven attended the intervention program. Six of these seven participants (86%) completed follow-up. In both pilots, participants rated the intervention as highly acceptable. A targeted cessation intervention was feasible and acceptable to AN youth. The intervention will be tested for efficacy in a subsequent randomized controlled trial.

A Systematic Scoping Review of the Resilience Intervention Literature for Indigenous Adolescents in CANZUS Nations

“…A total of 16 intervention studies that evaluated programs designed to increase the resilience of Indigenous adolescents were identified. Six studies came from Australia (74-79), six from the U.S.A. (80)(81)(82)(83)(84)(85), three from New Zealand (86)(87)(88), and one from Canada (89). Studies across the four countries varied in their approach.…”

“…Diverse Indigenous populations were represented including: First Nations/Native American (80)(81)(82)(83)85) and Alaskan Native (84), Australian Aboriginal and Torres Strait Islander (74-79), Maori (86)(87)(88), and Canadian First Nations/Aboriginal (89) peoples. Twelve interventions (75%) were delivered in school settings (75, 76, 78-83, 85, 87-89); four (25%) were community-based, conducted in partnership with schools (74,77,84,86). Nine of the included studies (56%) were published between 2010 and 2015, five studies (31%) were published between 2005 and 2010, and two were published between 1995 and 2005 (12.5%).…”

“…Diverse program models (previously established programs, frameworks, and therapeutic approaches) guided interventions, including both mainstream and Indigenous models. Cognitive Behavioral Therapy (CBT) featured in four interventions (84,(87)(88)(89), three of which included cultural enhancements (84,88,89). Other mainstream program models included life skills training (76,82) and peer support/education models (76).…”

“…Other mainstream program models included life skills training (76,82) and peer support/education models (76). Social Cognitive Theory, which aims to develop peer and community connection and draw on positive role models to promote resilience while also enhancing individual self efficacy, was identified as the foundation of interventions in two studies (82,84). The Applied Humanism Model of caregiving was applied in one intervention as a framework for managing behavior while fostering student social and emotional development (81).…”

“…Several positive but non-resilience-based outcomes (those couched in the language of deficit) were also reported, including those specific to improvements in mental health measures. These included: reduced substance use (76,81,(83)(84)(85)(86), decreased depression symptoms (87,88), reduced anxiety for students with elevated anxiety (89), reduced feelings of hopelessness and decreased suicidality -Training for staff from other service providers, teachers and community members, teen advisors, and adolescents (74,84,89) -Mentoring or coaching (74,75,80,83) -Skills training for adolescents (76,81) -Suicide prevention/intervention training for adolescents (82) -Cultural competence training for staff (81) -Employment opportunities for adolescents and local community members (74,77) COMMUNITY CAPACITY BUILDING -Delivery of training to community members, service providers, and adolescents, support and mentoring to youth workers in partner organizations, and employment training and mentoring of local Aboriginal staff (74) -Establishing learning communities between local Anangu educators, skilled linguists, community members, and trained Mind Matters mental health staff to develop local language around mental health and well-being (78) (82), reduced student self-harm (85), improved social and psychiatric functioning and reduced risk of clinically significant mental health concerns (86), and anecdotal evidence of reduced violence (78). Diverse community-and school-level outcomes were also reported.…”