southeast alaska regional health consortium, sitka, … · slide 2 presenter ... the following...

APHA 2013 K. ANDERSON: YOUNG ADULT TOBACCO, SE AK [email protected] 1

Slide 1 TOBACCO USE AND CESSATION: WHAT MATTERS TO SOUTHEAST ALASKA NATIVE YOUNG ADULTS?

Kathryn Anderson, MPH, PhD-c

Department of Psychology

University of Alaska Fairbanks, Anchorage, AK

Andrea Thomas, BS

Tobacco Department,

Southeast Alaska Regional Health Consortium, Sitka, AK

Edy Rodewald, PhD

Tobacco Department,

Southeast Alaska Regional Health Consortium, Juneau, AK

Ellen Lopez, MPH, PhD ,

Center for Alaska Native Health Research

University of Alaska Fairbanks, Fairbanks, AK

Monica Skewes, MA, PhD

Center for Alaska Native Health Research

University of Alaska Fairbanks, Fairbanks, AK

APHA November, 2013

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 2 Presenter Disclosures

(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Kathryn Anderson

No relationships to disclose

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________


Slide 3 Study-at-a-glance

3

Overarching goal:Reduce smoking rates

for young adult SEARHC beneficiaries

GOALS:

1. Determine if/how to modify current program

2. Determine what quit-support methods and what marketing messages appeal to young adults

3. Develop baseline research protocol for potential reuse

Phase 1:Inform phase 2

Phase 2:Qualitative research

Social Marketing Foundation

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 4 Seven research questions

4

1) Benefits ofsmoking?

3) Barriersto quitting?

4) How do you quit?

5) What ads work?

7) How do you communicate?

6) What quit aids might work?

*potentially differs from literature

2) Benefits of quitting?

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________


Slide 5 Alaska/US Smoking Rates*

5

Alaska BRFSS, 2010CDC, 2012

Why is this important?

*US data is 2011, Alaska 2010**US: ages 18-24; AK 18-29

***Study is ages 19-29

70%

41%

32%

21%

0

31%

28%

19%

0% 50% 100%

SE Alaska Native Young Adults

Am. Indian/AK Native

All young adults

All adults

US Alaska

*****

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 6 Best Practices in Cessation1

• Brief counseling

• Intensive counseling

• Nicotine Replacement Therapy (NRT)

• Prescription drugs (e.g. varenicline/Chantix®)

6


1Fiore, Jaén, Baker, & et al., 2008

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________


Slide 7 Prevalence and success by quit method

7

Method Prevalence Success

Cold turkey 64.2% < 5%1

Pharmaceuticals only (NRT, Rx)

25.4% Pooled OR: 2, NRT vs. placebo2

Pooled OR: 3, Varenicline vs placebo2

Adjusted OR: 6, Varenicline vs cold turkey1

Behavioral & pharmaceuticals

5.9% Marginally > NRT alone3

Behavioral only 2.4% Pooled RR: 1.4, full counselingvs. minimal contact3

1Kasza et al., 2012 3Mills, Wu, Spurden, Ebbert, & Wilson, 2009 3Lancaster & Stead, 2008


___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 8 Quitting smoking in the US

8

1Fiore, Jaen, Baker et al., 2008 3CDC MMWR 2011 5Schiffman et al., 20082American Cancer Society 4Pleis et al .,2009 6Weinstein et al ., 2004

People want to quit

But it’s difficult

Yet, they’re optimistic

And many succeed51% of everyone who has smoked has quit4

69% of adult smokers want to quit3

43% make a quit attempt in any one year5

Even those with > 10 quit attempts believe the odds of success next time are 50%4

2%-7% success rate on any one quit attempt, independent of method1,2

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________


Slide 9 SEARHC Tobacco Cessation Program

9

•All four best-practices are included

•Young adults are under-represented


___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 10 Social marketing

A process that uses marketing principles and techniques to influence target audience behaviors that will benefit society as

well as the individual.1

101Lee & Kotler (2011)

Distinctive Features:

•Behavioral Goals•Consumer orientation•Audience segmentation•Notion of exchange

benefits>costs?

Marketing Mix (4Ps)

•Price•Product•Place•Promotion

Why is this trustworthy?

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________


Slide 11 Research Design

11

Phase 1 Objective: Inform Phase 2 Design•6 key informant interviews

•Informed consent•Demographic questionnaire•Recruiting methods•Semi-structured interview guide

Phase 2 Objective: Answer Seven Research Questions •4 Individual Interviews, 5 Focus Groups, n=23

1. Benefits of smoking2. Benefits of quitting3. Barriers to quitting4. Quit methods attitude & experience5. Tobacco countermarketing6. Quit support program ideas7. e-Communication habits


___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 12 Phase 2 Methods

• Referrals and same-day on-location recruiting1

• Varied venues for participant diversity

• $30 iTunes gift card incentive

• Visual aids incorporated into discussion

• Standard qualitative data analysis techniques2

121 Krueger and Casey, 2009 2 Boeije, 2002


___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________


Slide 13 Phase 2 Demographics

13

Demographic Split or range n or mean

Gender male/female 14/9

Employment employed/student/unemployed 11/4/10

Meet financial needs hard time/meet needs/exceed 4/11/5

Education ≤high school/some college 14/8

Average age (range 19-29) 22.0

Average age of initiation (range 8-21) 13.7

Marital status married or living with partner /single 14/9

Children in home yes/no 6/13

Smoking status everyday/some days/none 6/8/9

Chew tobacco currently yes/no 2/20

What did we find?

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 14 RQ1: Benefits of smoking

• Stress and boredom relief

• Oral satisfaction

SEARHC Young Adult Tobacco, K Anderson 1/13 14

What did we find?

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________


Slide 15 RQ2: Benefits of quitting

• Immediate health impacts

• Social benefits

• Impact on children

• Note: small concern for expense of smoking

SEARHC Young Adult Tobacco, K Anderson 1/13

15

What did we find?

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 16 RQ3: Barriers to quitting

• Addiction

• Habit

• Other people smoking


16

What did we find?

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________


Slide 17 RQ4: Experience with quitting: General

• Strongly prefer cold turkey– Their own experience

– Others, particularly family members

• NRT has a bad reputation– Some based on hearsay/second-

hand

• Almost no experience with varenicline (Chantix®)


17

What did we find?

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 18 RQ4: Experience with quitting: Counseling

• In both mall groups, strong negative reaction to the word “counseling”

• Those who had used SEARHC quit program highly

recommended it


18

What did we find?

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________


Slide 19 Findings: Research Questions 1-3

19

Research Question

Similar to literature Different from literature

RQ1: Benefits of smoking

•Stress relief

•Boredom relief (younger)

•Oral satisfaction

•Little emphasis on social connection

RQ2: Benefits of quitting

•Little emphasis on long-term health benefits

•Positive impact on immediate family, esp. children

•Low priority on cost savings

•More emphasis on short-term health benefits

•More emphasis on social consequences (e.g. smell, teeth)

•Positive impact on extended family

RQ3: Barriers to quitting

•Habit, addiction

•Social norms

•Fatalism

•[none]

What did we find?

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________


20

Research Question Similar to literature Different from literature

RQ4: Methods of cessation

•Strong preference for cold turkey

•Aversion to “counseling”

•Suspicious of pharmacotherapy

•Little willingness to learn more about pharmacotherapy

RQ5: Attitudetoward countermarketing advertisements

•Preference for high emotional level with strong emotional valence e.g., fear/disgust, joy/pride

•Some said that advertisements do not affect their decision to smoke

What did we find?

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________



21

Research Question Similar to literature (or no literature to compare*)

Different from literature

RQ6: Ideas for program elements

• Enthusiasm for smartphone app*

•Aversion to smartphone video game*

•Mixed reaction to texting

RQ7: eCommunicationhabits

•Almost ubiquitous cell phoneownership

•Heavy use of texting and mobile Facebook

•Little use of email or general Internet

•[none]

What did we find?

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 22 Three goals accomplished

22

Overarching goal:Reduce smoking rates

for young adult SEARHC beneficiaries

GOALS:

1. Determine if/how to modify current program

2. Determine what quit-support methods and what marketing messages appeal to young adults

3. Develop baseline research protocol for potential reuse

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________


Slide 23 Social marketing program

• Target audience: Young Southeast Alaska Native adults who have decided to quit smoking

• Positioning:We want young Alaska Native adults who decide to quit smoking to view seeking support from the tobacco health educator as normal, simple, and more effective than quitting on their own.

• Behavior change: Enroll in the tribal program rather than quitting cold turkey

23

Practical implications?

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 24 Marketing Mix: 4Ps

24

Price:

•Maximize:

•Short-term benefits

•Benefits to extended family

•Minimize:

•Smoking as stress relief

Product:

•Rename counseling to “coaching”

•Optional pharmacotherapy

Place:

•Optional texting component

•Telephone contact with counselor

Promotion:

•Flyers and quitcards

•Social norms

•Family values and/or social impact

•Facebook incentives for favorable postings


___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________


Slide 25 Further Research

• SEARHC

• Alaska

• Young adult

– Special need for qualitative research

“...to learn why young adults choose to smoke and choose to quit rather than just whether

they are successful”1

251Bader et al., 2007


___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 26 Conclusions

• Notable similarities and notable differences

• Practical use of findings

• Contribution made to young adult, Alaska Native, and Indigenous literature

– Especially non-university based young adult

– Extends via social marketing framework

26

Conclusions

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________


Slide 27 ReferencesBader, P., Travis, H. E., & Skinner, H. A. (2007). Knowledge synthesis of smoking cessation among employed and

unemployed young adults. American Journal of Public Health, 97(8), 1434-1443.

Boeije, H. (2002). A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality and Quantity, 36(4), 391-409.

Centers for Disease Control and Prevention. (2011). Quitting Smoking Among Adults — United States, 2001–2010 Morbidity and Mortality Weekly Report (Vol. 60, pp. 1513-1519). Atlanta: Centers for Disease Control and Prevention.

Fiore, M., Jaén, C., & Baker, T. (2008). Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services, Public Health Service.

Kasza, K. A., Hyland, A. J., Borland, R., McNeill, A. D., Bansal‐Travers, M., Fix, B. V., . . . Cummings, K. M. (2013). Effectiveness of stop smoking medications: Findings from the International Tobacco Control (ITC) Four Country Survey. Addiction, 108(1), 193-202.

Krueger, R., & Casey, M. (2009). Focus Groups: A Practical Guide for Applied Research (4th ed.). Thousand Oaks, CA: SAGE.

Lancaster, T., & Stead, L. (2008). Individual behavioural counselling for smoking cessation. Cochrane Database of Systematic Reviews (Issue 2).

Lee, N. R., & Kotler, P. (2011). Social marketing: Influencing behaviors for good (4th ed.). Thousand Oaks, CA: SAGE

Mills, E. J., Wu, P., Spurden, D., Ebbert, J. O., & Wilson, K. (2009). Efficacy of pharmacotherapies for short-term smoking abstinance: A systematic review and meta-analysis. Harm Reduction Journal, 6(25), 1-16.

Pleis, J., Lucas, J., & Ward, B. (2009). Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008 Vital and Health Statistics 10(242): National Center for Health Statistics.

Shiffman, S., Brockwell, S. E., Pillitteri, J. L., & Gitchell, J. G. (2008). Use of smoking-cessation treatments in the United States. American Journal of Preventive Medicine, 34(2), 102-111.

Weinstein, N. D., Slovic, P., & Gibson, G. (2004). Accuracy and optimism in smokers' beliefs about quitting. Nicotine & Tobacco Research, 6(Suppl 3), S375-S380.

27

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 28 Questions?

28

Conclusions

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

southeast alaska regional health consortium, sitka, … · slide 2 presenter ... the following...

Documents