Native American Tobacco Education Project (NATE)

1. Native American Tobacco Education Project (NATE) Funded by a grant from the CDPHE State Tobacco Education and Prevention Partnership (STEPP)

2. Partners Native American Cancer Research (NACR) Ute Mountain Ute Tribe

3. NACR Staff Dr. Burhansstipanov - Project Director Lisa Harjo - Project Coordinator Terri Rattler - Native Sister Rose Lee - Native Sister (Navigators)

4. Native American Tobacco Education (NATE) Multi-Agency project using Community-Based Participatory Research (CBPR) methodology to develop a sustainable infrastructure for the local tobacco control movement in the Indian community in Denver and at Ute Mountain Ute.

5. Two Advisory Coalitions • one in the Denver Metropolitan Area • one within Ute Mountain Ute Reservation.

6. Purpose • to develop an infrastructure that will allow both Native communities to assess local needs and potential strategies to prevent and reduce habitual tobacco use or exposure to secondhand smoke by Native American adolescents and adults, ages 12 to 85.

7. Expected Outcomes • two functional Native Tobacco Coalitions (one in each site) • baseline data from local focus and working groups to help the Coalitions prioritize issues; and

8. Expected Outcomes cont. (3)a list of recommendations based on the focus and working group input by the respective Coalitions for tribal- and geographically-specific tobacco interventions they feel need to be developed in the near future to appropriately address the priorities in culturally respectful manners.

9. NATE Project Goal • To increase Native communities’ capacity for tobacco control by developing two well educated Native American Tobacco Education Coalitions in Denver and Ute Mountain Ute Reservation.

10. Strategy 1 Educate both of the Native tobacco control coalitions on the latest, most appropriate tobacco prevention and control information and interventions effective within Native and non-Native communities (includes evidence–based and native-specific strategies.)

11. Strategy 2 The NATE Coalitions will each recruit community members to take part in FG held in March and April in two different geographic locations in their respective communities (4 FG in Denver and 2 FG in Towaoc).

12. Strategy 3 • The NATE Coalition from each site will review the expanded prioritized tobacco topics for their respective area (i.e., two different priority lists which are likely to have some overlap, yet issues specific to the rural or urban communities) and organize the priorities into a strategic plan.

13. Strategic Plan • This strategic plan will include • (a) goals for next 3 years; • (b) measurable objectives to attain those goals; • (c) culturally acceptable and innovative strategies to attain the objectives;

14. Strategic Plan cont. • (d) participant interactive activities to reinforce the behaviors specified within each objective; • (e) evaluation strategies specific to each objective; and • (f) dissemination of recommendations plan (to local communities, State funders and others as needed).

15. Strategic Plan • This outline will be the beginning of a strategic plan for subsequent funding to develop interventions inclusive of these components that are culturally specific and designed to prevent, reduce, or control habitual tobacco use among Native Americans.

16. Advisory Coalition • Meets every other month for 2 hours • Training in beginning and during project. • Provides guidance and leadership during gathering of information from community, and development, implementation and dissemination of the plan to the community • Continues with Project during subsequent funding to provide leadership

17. Focus Groups • Conducted to gather more information directly from community members • Four groups in each site: 2 all ages, 1 youth, and 1 elders. • Questions from TAB and Coalition and 2-3 discussion questions • 2 hours in duration, 8 participants, $20 each

18. Overview of Training Ceremonial tobacco use vs. habitual tobacco use Strategies for teambuilding Tobacco Initiatives in Indian Country Stages of Change in and out of Indian Country Tobacco Facts and Fallacies in Indian country

19. Overview of Training cont. • Overview of AIAN Tobacco Surveys • Social Norm Strategies • ARS – Audience Response System

20. Second Phase • Goal: To continue the work established in the First Phase and add new levels of focus.

21. Second Phase • Strategy 1: Maintenance of a community advisory coalition and expanded partners to guide development, field testing, and implementation efforts for all age groups and sectors in the American Indian Community regarding Tobacco Control.

22. Second Phase • Strategy 2: Develop, refine, and implement age-specific culturally appropriate tobacco use interventions will reduce second hand smoke (SHS), reduce first time starts with tobacco, and increase cessation activities among American Indians.

23. Second Phase • Strategy 3: Develop Native-specific anti-habitual tobacco use messages that can be used in public awareness campaigns to help initiate community members' consideration of new ideas, behavior, and actions.

24. Second Phase • Strategy 4: QUITLINE and QUITNET (Native Adults) Determine cultural appropriateness and sensitivity of the proposed tobacco interventions, especially telephone counseling.

25. Second Phase • Strategy 5: Policy is an essential component of a comprehensive Tobacco Control Movement as it creates environments and opportunities for new behaviors and actions.

26. Successes • Sustainable Infrastructure for Tobacco Control Initiatives – Capacity-Building • Tribal and Native Tobacco Policy and Movement Training • Youth Intervention for Tobacco exposure reduction and cessation

27. Colorado Quitline • Established a relationship for future work • Participated in cultural competency training……. • Critiqued Cultural Training • Established plan to improve cultural sensitivity training for providing support to American Indian callers.

28. Challenges • Lack of knowledge and experience in the American Indian tobacco control movement. • remedied by training and networking at regional Indian tobacco control leadership workshops and seminars.

29. Challenges • Continued competition for the attention of Indian people who smoke. • remedied by interventions that are fun and based on some traditional beliefs and practices.

30. Challenges • Ute Mountain Ute Tribe – Working with a tribal nation yielded several challenges that continue to be addressed including:

31. Challenges • Lack of support for the program – Low priority in relationship to other efforts related to education, employment, health, tribal business, etc. • Lack of internal stability and coordination with tribal program leadership changes and facility limitations.

32. Challenges • Lack of participation in the advisory council by tribal program representatives and leaders.

33. Responses • The NATE staff at both locations worked to recruit and keep participants in the Ute Advisory Council to provide leadership and support to the program.

34. Responses Actions taken: • The NATE Program worked to take the Advisory Council members including a Ute Mountain Ute Tribal council person to training with other Tribes and Indian people to uplift the issue and educate them on what other tribes are doing and how their efforts can help their community.

35. Responses • NATE staff raised the issue of changing and limited office space to the Tribe on many occasions.

36. Results • NATE staff in Denver provided on-going training to the Ute Mountain Ute staff on the ARS, tobacco control issues, and other topics to support the program in their efforts to get the community involved and participating in the program.

37. Results • The NATE staff in Ute Mountain Ute now has a permanent office and is housed in the Substance Abuse Program.

38. Future Activities… • Sustain Advisory Council • Pilot and implement Youth Intervention • Promote SHS Reduction and Prevention Strategies including personal policy development • Work with Quitline-established cessation program • Create culturally sensitive media

39. Preliminary NATE “Survey” findings • Survey Items Evolved from: • CO TAB instrument • Native American Tobacco Prevention Network (survey tools) • National Health Interview Survey (2 items) • California Health Interview Survey • 4 National Cancer Institute Native tobacco surveys • NATE Coalition Guidance

40. Preliminary NATE “Survey” findings • Includes NATE Coalition and focus group (FG) data from both Denver and Ute Mountain Ute Tribe (FG still in process) • Different numbers of responses on selected items as the items were refined to be culturally acceptable to the Native community members • Administered via ARS

41. Examples of Preliminary NATE “Survey” findings • “Preliminary Data” Comprise total of • 52 Denver Natives • 25 Ute Mountain Ute Tribal Members • Examples of demographics: • ~41% males • ~59% females Typical tobacco survey breakout in Indian Country is ~75% respondents are female

42. Examples of Preliminary NATE “Survey” Demographics Denver Ute Mt. Ute Gender N=52 answered the item 21 males (40.4%) 31 females (59%) N=21 answered the item 8 males (30.3%) 13 females (60.7%)

43. Examples of Preliminary NATE “Survey” Demographics Denver Ute Mt. Ute American Indians 52 (n=53; 98.1%) 15 (n=17;88%) The number of people who answered the item

44. Examples of Preliminary NATE “Survey” Demographics Denver Ute Mt. Ute High school or less education 27 (n=53; 50.9%) 15 (n=17;88%)

45. Examples of Preliminary NATE “Survey” Demographics Denver Ute Mt. Ute Primarily raised on reservation 9 (n=29; 31%) 17 (n= ; 62.4%)

46. Examples of Preliminary NATE “Survey” Tobacco Behaviors Denver Ute Mt. Ute Use tobacco for ceremonies 24 (n=36; 52.2%) 8 (n=23; 35.4%)

47. Examples of Preliminary NATE “Survey” Tobacco Behaviors Denver Ute Mt. Ute Not smoke at all 27 (n=44; 61.4%) 13 (n=23; 55%)

48. Examples of Preliminary NATE “Survey” Tobacco Behaviors Denver Ute Mt. Ute Yes, smoke when drink alcohol 17 (n=45; 37.8%) 11 (n=24; 47.8%)

49. Examples of Preliminary NATE “Survey” Tobacco Behaviors Denver Ute Mt. Ute Not use chew at all 41 (n=45; 91.10%) 26 (n=26; 100%)

50. Examples of Preliminary NATE “Survey” Tobacco Behaviors Denver Ute Mt. Ute Never allow smoking in home 30 (n=36; 83.3%) 18 (n=26; 67.5%) Allow smoking in home only for special people 1 (n=36; 2.8%) 4 (n=26; 16.3%)