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

Since its launch in August 2003 through June 2011, the Oklahoma Tobacco Helpline has provided cessation services to nearly 18,000 American Indians in Oklahoma.

Among registrants who identified themselves as “American Indian,” 78% reported being an enrolled member of a tribe. Tribal members from 37 of the 38 federally-recognized tribes in Oklahoma have utilized the Helpline. In addition, numerous other tribes were represented by Helpline registrants, including for example, Navajo, Sioux, Blackfoot, Chippewa, and Oneida.

The majority of American Indian Helpline callers were female (65%), between the ages of 25 and 54 (72%), high school graduates (75%), and long-term tobacco users (94%). These characteristics are similar to what is observed for all Helpline registrants.

The majority (78%) 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, nearly 12,000 of the American Indians participating in the multiple call program also received NRT.

Satisfaction with services among American Indian participants from August 2003 through June 2011 was very high, with 94% reported being satisfied with the Helpline. This satisfaction rate is similar to what is reported by all Helpline participants.

At the 7-month follow-up survey, 33.3% of American Indian participants in the multiple call Helpline program report not smoking for 30 days or longer. 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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