Introduction
For many years, rates of tobacco abuse among American Indian youth and adults have been
much higher than rates of any other subgroup  in Oklahoma. Also of serious concern, U.S.
American Indians make fewer smoking cessation attempts as compared to other racial/
ethnic groups, and American Indians experience more disease and disability as a result
of the abuse of commercial tobacco.

Traditional Use of Tobacco
Tobacco use among Native Americans is a complex issue. Tobacco has held an important
role in cultural and spiritual life, and continues to serve ceremonial, religious and medicinal
functions in many tribes. It is important to recognize the positive social context in which
tobacco is viewed by many American Indians. Tobacco control efforts, including cessation
services, must emphasize the distinction between traditional, sacred use of tobacco and
recreational use of commercial tobacco by individuals.

Oklahoma Tobacco Helpline Quit Coaches® have received training on the traditional use
of tobacco. In follow-up evaluation surveys conducted by the University of Oklahoma,
College of Public Health, American Indian participants are asked to not report any traditional
or ceremonial use in their reporting of quit status.

Key Findings from Evaluation of the Oklahoma Tobacco Helpline
Since its launch in August 2003, the Oklahoma Tobacco Helpline has provided cessation
services to nearly 3,700 American Indians in Oklahoma.

Among registrants who identified themselves as “American Indian,” 69% reported being an
enrolled member of a tribe. Tribal members from 33 of the 39 federally recognized tribes
in Oklahoma have utilized the Helpline. In addition, numerous other tribes were represented
by Helpline registrants, including for example, Sioux, Blackfeet, Chippewa, and Oneida.

The majority of American Indian Helpline callers were female, between the ages of 25
and 54, high school graduates, or long-term, heavy tobacco users. These characteristics
are similar to what is observed for all Helpline registrants.

The majority (71%) of American Indians who call the Helpline for quitting assistance
choose to receive the multiple-call program, which consists of a series of four follow-up
telephone-based sessions over a three to four month period.

Since September 2004, when nicotine replacement therapy (NRT), including patches
and gum, became available through the Helpline, 77% (1871) of the American Indians
participating in the multiple-call program also received NRT. This is slightly higher than the
roughly 70% of all Helpline registrants who participate in the multiple-call program and
receive NRT. NRT is available through the Helpline only to the uninsured and those on
Medicare who are enrolled in the multiple call program.

Satisfaction with services among American Indian participants from August 2003
through June 2006 was very high, with 93% reporting being satisfied with the Helpline.
This satisfaction rate is similar to what is reported by all Helpline participants.

At the 4-month follow-up survey, 41.3% of American Indian participants receiving the
multiple-call Helpline program report not smoking for 30 days or longer. About seven
months after registering with the Helpline, more than one-third of American Indian
participants who receive the multiple-call program report 30-day abstinence (36.7%).
This measure of quit success does not include the use of tobacco for traditional or
ceremonial purposes. The quit rates reported here far exceed the quit rates for
“cold turkey" (approximately 5%).

Conclusions
These evaluation data demonstrate high utilization of the Helpline by American Indians
who suffer addiction to commercial tobacco. American Indian Helpline participants also
report high levels of satisfaction with the services provided. More importantly, American
Indians who received Helpline services report success in tackling their addiction.

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