Building a Tailored Text Messaging System for Smoking Cessation in Native American Populations

When starting new and healthy habits or encouraging vigilance against returning to poor habits, a simple text message can be beneficial. Text messages also have the advantage of being easily accessible for lower-income populations spread over a rural area, who may not be able to afford smartphones with apps or data plans. Users benefit the most from text messages that are customized for them, but personalization requires time and effort on part of the user and the counselor. However, personalization that focuses on the cultural background of a pool of recipients, in addition to general personal preferences, can be a low-cost method of ensuring the best experience for patients interested in taking up new habits. In this paper, we discuss the development of a system for motivating users to quit smoking designed for Native American users in South Dakota, using text messaging as a daily intervention method for patients. Our results show that focusing on modular message customization options and messages with a conversational tone best helps our goal of providing users with customization options that help motivate them to live happy and healthy lifestyles

Smoking cessation and tobacco prevention in Indigenous populations

This article systematically reviews 91 smoking cessation and tobacco prevention studies tailored for Indigenous populations around the world, with a particular focus on Aboriginal and Torres Strait Islander populations in Australia. We identified several components of effective interventions, including the use of multifaceted programs that simultaneously address the behavioural, psychological and biochemical aspects of addiction, using resources culturally tailored for the needs of individual Indigenous populations. Pharmacotherapy for smoking cessation was effective when combined with culturally tailored behavioural interventions and health professional support, though it is generally underused in clinical practice. From a policy perspective, interventions of greater intensity, with more components, were more likely to be effective than those of lower intensity and shorter duration. For any new policy it is important to consider community capacity building, development of knowledge, and sustainability of the policy beyond guided implementation. Future research should address how the intervention can be supported into standard practice, policy, or translation into the front-line of clinical care. Investigations are also required to determine the efficacy of emerging therapies (such as e-cigarettes and the use of social media to tackle youth smoking), and under-researched interventions that hold promise based on non-Indigenous studies, such as the use of Champix. We conclude that more methodologically rigorous investigations are required to determine components of the less-successful interventions to aid future policy, practice and research initiatives. Evidence Base, issue 3, 201

Pro-tobacco marketing and anti-tobacco campaigns aimed at vulnerable populations: A review of the literature.

INTRODUCTION:We reviewed research literature on pro-tobacco marketing and anti-tobacco campaigns targeting eight vulnerable populations to determine key findings and research gaps. Results can inform tobacco policy and control efforts and the design of public education campaigns for these groups. METHODS:Five journal databases in medicine, communication, and science, were used to identify 8875 peer-reviewed, original articles in English, published in the period 2004-2018. There were 144 articles that met inclusion criteria on pro-tobacco marketing or anti-tobacco campaigns aimed at eight US groups: women of reproductive age, racial/ethnic minority groups (African American, Hispanic/Latino, Asian/Pacific Islander and American Indian/Alaska Native), Lesbian/Gay/Bisexual/Transgender (LGBT) populations, groups with low socioeconomic status, rural/inner city residents, military/veterans, and people with mental health or medical co-morbidities. We summarized the number of articles for each population, type of tobacco, and pro-tobacco or anti-tobacco focus. Narrative summaries were organized by population and by pro-tobacco or anti-tobacco focus, with key strategies and gaps by group. RESULTS:There were more studies on pro-tobacco marketing rather than anti-tobacco campaigns, and on cigarettes rather than other tobacco products. Major gaps included studies on Asian Americans, American Indian/Alaska Natives, pregnant women, LGBT populations, and those with mental health or medical co-morbidities. Gaps related to tobacco products were found for hookah, snus, and pipe/roll-your-own tobacco in the pro-tobacco studies, and for all products except cigarettes in anti-tobacco studies. Common tobacco industry methods used were tailoring of product and package design and messages that were used to reach and appeal to different sociodemographic groups. Studies varied by research design making it difficult to compare results. CONCLUSIONS:We found major research gaps for specific groups and tobacco products. Public education campaigns need a stronger foundation in empirical studies focused on these populations. Research and practice would benefit from studies that permit comparisons across studies

Motivational and Intervention Systems and Monitoring with mHealth Tools

Use of mobile and telecommunication technologies has become widespread in the last decade. With this development, use of mobile devices in healthcare (mHealth) is also increasing. Mobile phones, smartphones, and other mobile devices are affordable tools for different health-related services. In my research, with my research team, I have helped to develop several mHealth tools to address the quality of life of cancer survivors, cancer patients, and individuals at increased risk for cancer. Tobacco smoking is the major cause of several types of often-fatal cancers and cardio-respiratory diseases. Optimally, we hypothesize that the most effective mHealth tools should be customized and personalized. For smokers, the goal is to encourage cessation. For cancer survivors, one goal is to increase physical activity, which is associated with decreased rates of recurrent disease. In patients with incurable cancers, efficient and current monitoring of symptoms should contribute to better palliation. This dissertation explores multiple issues in use of mHealth tools with these medical populations. We discuss a general framework for collecting and managing healthcare data and mathematical models for data analysis. The specific contributions of this dissertation are: 1.) The design and development of a culturally tailored customized text messaging system for motivation and intervention; 2.) The design and development of a data collection system for an mHealth intervention, and; 3.) A model for monitoring pain levels using mobile devices

SMS PARENT ACTION INTERVENTION (SPAN): A PILOT STUDY TO ASSESS THE FEASIBILITY OF USING TEXT MESSAGING TO PROMOTE CHILD HEALTH ON AN AMERICAN INDIAN RESERVATION

Abstract Purpose: Childhood obesity and its associated health risks are widely recognized as a major public health crisis in the United States (Johnson & Johnson, 2014; Proctor, 2008; Rogers et al, 2013; Vinci et al, 2016) and worldwide (Elías-Boneta, Toro, Garcia, Torres, & Palacios, 2015). Among children in low-income families, American Indian/Alaska Native (AIAN) children have the highest prevalence of obesity (21.1%) compared to other racial/ethnic groups (14.74% overall) (Pan et al, 2015). Parents play an important role in introducing healthy foods and encouraging physical activity in young children (Birch & Ventura, 2009; Lindsay et al., 2006; Natale et al., 2014). Text messaging is an attractive means of communication because it is portable, cost-effective, accessible, and able to reach across demographic spheres to serve underserved and rural populations (Terry, 2008), and populations with poor health (Fjeldsoe, Marshall, & Miller, 2009). The primary purpose of this pilot study was to assess the feasibility of the SMS (Short Messaging System or text messaging) Parent Action iNtervention (SPAN) obesity prevention intervention for rural white and AI children. Methods: This 5-week quasi-experimental pre- to posttest pilot study took place on a rural, American Indian (AI) Reservation. Participants were parents whose children were 3 to 5 years old. The intervention consisted of participants receiving three text messages on a particular topic each week that described health behaviors to reduce risk of childhood obesity. The topics included childhood nutrition, physical activity and sleep requirements, and recommendations for limiting screen time and sugary beverage consumption. The main study measures were descriptions of study feasibility (recruitment and retention rates, receipt and response to text messages, satisfaction with message content, timing, frequency, and duration). We also collected information on pre- to posttest changes in participant knowledge/desires for their children related to healthy behaviors and parent-reported child behaviors. Results: Over 8 weeks, 24 parents of young children expressed interest in participating in the study; following screening, 71% (17/24) met eligibility criteria and were consented to the study. At the end of the 5-week intervention, 100% (17/17) completed the texting intervention and final assessments. All intervention texts (n=289) sent to participants were successfully delivered. Of the 85 survey question texts that requested a response, 95% (81/85) were responded to with any answer, while 91% (78/85) were responded to by answering the survey question. All participants (17/17) reported they found the texts easy to understand and they liked the timing - what time of day they received the messages. Ninety-four percent (16/17) of participants reported enjoying the frequency (3 per week) with which they received messages, and participants either reported 5 weeks was a good amount of time or too short. At the end of the 5-week intervention, improvements were observed in some of the child behaviors. Conclusion: Findings suggest it is feasible to deliver a text messaging-based childhood obesity prevention intervention to parents living on a rural, AI Reservation. Text messages were well received by parents of young children and texting parents may influence child behavior. Our study targets gaps in the literature and helps guide future research using text messaging to promote child health and prevent obesity

Tobacco where you live : native communities

The goal of Tobacco Where You Live is to empower tobacco control program managers, staff, and partners to understand how commercial tobacco use varies within their communities, overcome challenges, and reduce disparities. Each Tobacco Where You Live brief will cover a topic important to reduce commercial tobacco use in communities with the highest prevalence.The Native Communities brief focuses on how to reduce commercial tobacco use disparities among American Indian and Alaska Native (AI/AN) populations. This brief provides information to help you:\u2022 Develop strong relationships with Native leaders and members\u2022 Communicate the harms of commercial tobacco and respect the use of traditional tobacco\u2022 Work with tribes to tailor strategies to reflect their unique cultures, capacities, and challengesIn this brief, use of the term Native applies to both American Indian and Alaska Native people, unless otherwise indicated.The Best Practices User Guides project is funded by CDC contract 75D30120C09195. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. References to non-CDC sites and the use of advertisements and images do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at external sites. URL addresses listed were current as of the date of publication.Suggested citation: Centers for Disease Control and Prevention. Tobacco Where You Live: Native Communities. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2022.native-communities-508.pdfCDC contract 75D30120C0919

Tobacco use and cessation: What matters to Southeast Alaska Native young adults?

Thesis (Ph.D.) University of Alaska Fairbanks, 2013Background: The smoking rate among young Alaska Native adults (ages 19-29) in Southeast Alaska is 70% as compared to the statewide adult smoking rate of 21%, the Alaska Native adult rate of 41%, and the overall young adult rate of 32%. Southeast Alaska Regional Health Consortium (SEARHC), the non-profit tribal health consortium serving Southeast Alaska, commissioned this research to inform development of a young adult-specific, social marketing-based smoking cessation intervention. Methods: Using purposive sampling, 23 individuals were recruited for five focus groups and four individual interviews in Juneau, Alaska. Following a social marketing framework, the research assessed participant beliefs about the benefits and negative impacts of smoking, barriers to quitting, and preferred quit support methods, as well as participant reactions to particular anti-smoking advertisements and quit support methods. Results: Almost all participants reported an interest in quitting smoking. Stress relief, boredom relief, relaxation, and oral satisfaction were the main benefits of smoking. Downsides to smoking included negative short-term health impacts, negative impacts on children in the extended family, and negative cosmetic impacts. Barriers to quitting included loss of listed benefits, addiction and habit, fatalism, and the high prevalence of smoking among family and friends. The preferred method of quitting was cold turkey (unassisted quitting), with very few participants reporting use of counseling or pharmacotherapy. Participants preferred high emotional level anti-smoking advertisements with either strongly negative emotional valence (e.g., fear and disgust) or strongly positive emotional valence (e.g., joy, happiness). Reaction to quit support methods was most favorable to texting support and a smart phone app, and most negative toward a smart phone video game. Reaction to counseling was strongly supportive among those who had tried it and largely but not totally negative among those who had not. Conclusion: Young Alaska Native adults in Juneau who smoke are interested in quitting but prefer cold turkey to counseling and pharmacotherapy. They are more concerned about short-term than long-term health impacts, and they are sensitive to the impact of smoking on their appearance and on children in their extended family. Findings formed a foundation for a proposed social-marketing based intervention

Do health education initiatives assist socioeconomically disadvantaged populations? : a systematic review and meta-analyses

Background: Health education interventions are considered critical for the prevention and management of conditions of public health concern. Although the burden of these conditions is often greatest in socio-economically disadvantaged populations, the effectiveness of interventions that target these groups is unknown. We aimed to identify and synthesize evidence of the effectiveness of health-related educational interventions in adult disadvantaged populations. Methods: We pre-registered the study on Open Science Framework https://osf.io/ek5yg/. We searched Medline, Embase, Emcare, and the Cochrane Register from inception to 5/04/2022 to identify studies evaluating the effectiveness of health-related educational interventions delivered to adults in socio-economically disadvantaged populations. Our primary outcome was health related behaviour and our secondary outcome was a relevant biomarker. Two reviewers screened studies, extracted data and evaluated risk of bias. Our synthesis strategy involved random-effects meta-analyses and vote-counting. Results: We identified 8618 unique records, 96 met our criteria for inclusion – involving more than 57,000 participants from 22 countries. All studies had high or unclear risk of bias. For our primary outcome of behaviour, meta-analyses found a standardised mean effect of education on physical activity of 0.05 (95% confidence interval (CI) = -0.09–0.19), (5 studies, n = 1330) and on cancer screening of 0.29 (95% CI = 0.05–0.52), (5 studies, n = 2388). Considerable statistical heterogeneity was present. Sixty-seven of 81 studies with behavioural outcomes had point estimates favouring the intervention (83% (95% CI = 73%-90%), p < 0.001); 21 of 28 studies with biomarker outcomes showed benefit (75% (95%CI = 56%-88%), p = 0.002). When effectiveness was determined based on conclusions in the included studies, 47% of interventions were effective on behavioural outcomes, and 27% on biomarkers. Conclusions: Evidence does not demonstrate consistent, positive impacts of educational interventions on health behaviours or biomarkers in socio-economically disadvantaged populations. Continued investment in targeted approaches, coinciding with development of greater understanding of factors determining successful implementation and evaluation, are important to reduce inequalities in health

Best Practices User Guide: Health Communications in Tobacco Prevention and Control

This user guide was created to help tobacco control staff and partners implement evidence-based best practices by translating research into practical guidance. The user guides focus on strategies (e.g., programs and interventions) that have shown strong or promising evidence of effectiveness. Recommendations in this guide are suggestions for programs implementing health communications strategies.https://openscholarship.wustl.edu/cphss/1075/thumbnail.jp