Nicotine Dependence Treatment Among Alaska Native People. We re not quitting yet!
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1 Nicotine Dependence Treatment Among Alaska Native People We re not quitting yet! MCH and Immunizations Conference September 27, 2010
2 Objectives Current state of tobacco prevalence Tribal considerations and differences A brief history and examination of events Policy enactments Cessation systems development State of cessation TX in tribal clinical setting Future directions
3 Acknowledgements for Slides and Data Erin Peterson, Charles Utermerole, & Patty Owens, State of Alaska Julia Dilly, State of OR Evaluation Contractor for AK Karen Doster, ANTHC Tobacco Program Richard Hurt, Christi Patten & Lowell Dale Mayo Clinic Nicotine Dependence Treatment and Research Centers
4 Number of Deaths Due to Selected Causes, Alaska, 2006 Sources: Alaska Bureau of Vital Statistics (2006 deaths); Alaska Behavioral Risk Factor Surveillance System (smoking prevalence); CDC, Smoking Attributable Morbidity, Mortality, and Economic Costs.
5 Economic Costs of Tobacco-Related Deaths in Alaska Source: CDC, Smoking Attributable Morbidity, Mortality, and Economic Costs
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8 Considerations: Mixed use combining ST and smoking Nicotine metabolism differences
9 Considerations: Mixed use combining ST and smoking Nicotine metabolism differences
10 Impact of Lower Smoking Rate
11 Alaska Native Health Corporation Regions Arctic Slope Northwest Arctic Norton Sound Interior Yukon-Kuskokwim Southcentral Copper River/ Prince William Sound Bristol Bay Anchorage/Mat-su Southeast Kodiak Aleutians/Pribilofs
12 Anchorage & Mat-Su Source: Alaska Behavioral Risk Factor Surveillance System (BRFSS), Alaska Department of Health & Social Services
13 Source: Alaska Behavioral Risk Factor Surveillance System (BRFSS), Alaska Department of Health & Social Services BRFSS is a telephone survey given in English to adults who agree to participate. 3,374 total Alaska Native adults are represented in these data. Cigarette Smoking Among Alaska Native Adults by Health Corporation Region Aleutians and Pribilofs Anchorage/Mat-Su Arctic Slope Bristol Bay Copper River/Prince William Sound Interior Kodiak Northwest Arctic Norton Sound Southcentral Southeast Yukon-Kuskokwim % Current Use
14 Anchorage & Mat-Su Source: Alaska Behavioral Risk Factor Surveillance System (BRFSS), Alaska Department of Health & Social Services
15 Source: Alaska Behavioral Risk Factor Surveillance System (BRFSS), Alaska Department of Health & Social Services BRFSS is a telephone survey given in English to adults who agree to participate. 3,374 total Alaska Native adults are represented in these data. Smokeless Tobacco Use Among Alaska Native Adults by Health Corporation Region Aleutians and Pribilofs Anchorage/Mat-Su Arctic Slope Bristol Bay Copper River/Prince William Sound Interior Kodiak Northwest Arctic Norton Sound Southcentral Southeast Yukon-Kuskokwim % Current Use
16 Anchorage & Mat-Su Source: Alaska Behavioral Risk Factor Surveillance System (BRFSS), Alaska Department of Health & Social Services
17 Source: Alaska Behavioral Risk Factor Surveillance System (BRFSS), Alaska Department of Health & Social Services BRFSS is a telephone survey given in English to adults who agree to participate. 3,374 total Alaska Native adults are represented in these data. Iqmik Use Among Alaska Native Adults by Health Corporation Region Aleutians and Pribilofs Anchorage/Mat-Su Arctic Slope Bristol Bay Copper River/Prince William Sound Interior Kodiak Northwest Arctic Norton Sound Southcentral Southeast Yukon-Kuskokwim % Current Use
18 Anchorage & Mat-Su Source: Alaska Behavioral Risk Factor Surveillance System (BRFSS), Alaska Department of Health & Social Services
19 Source: Alaska Behavioral Risk Factor Surveillance System (BRFSS), Alaska Department of Health & Social Services BRFSS is a telephone survey given in English to adults who agree to participate. 3,374 total Alaska Native adults are represented in these data. Any Tobacco Use Among Alaska Native Adults by Health Corporation Region Aleutians and Pribilofs Anchorage/Mat-Su Arctic Slope Bristol Bay Copper River/Prince William Sound Interior Kodiak Northwest Arctic Norton Sound Southcentral Southeast Yukon-Kuskokwim % Current Use
20 Tobacco Prevention and Control History in Alaska Present Statewide Tax Increases 1997: $.29 to $ : $1 increase, phased implementation Local Taxes (Anchorage, Barrow, Fairbanks, Juneau, Klawock, Matanuska-Susitna Borough, Sitka) Local Clean Indoor Air Policies Began in 1998 Cover over 50% of population Regional AN Evidence Based Tobacco Cessation Began in 2000 Currently 9 in AN regions & 2 private/non-profit statewide providing clinical systemic cessation access Quit line
21 Active Evidence Based Tobacco Cessation Programs Tribal 2 Private/non-profit Arctic Slope Northwest Arctic Norton Sound Interior Yukon-Kuskokwim Southcentral Copper River/ Prince William Sound Bristol Bay Anchorage/Mat-su Southeast Kodiak Aleutians/Pribilofs
22 Statewide Tribal System Tobacco Cessation Rates 30 Day Point Prevalence (self report) % 57% 50 49% % Weeks 12 Weeks 26 Weeks 52 Weeks
23 Smoking Prevalence and Tobacco Control Events in Alaska st evidence based TX in AK begins in tribal facility Bethel Tribal health Corps. Begin establishing TX and CIA 1998: 1 st AN driven CIA Ordinance Bethel AN Nicotine Rsch begins (neonatal) Hurt et. al.
24 Percent of Smokers who Agree with the Following Statements: Every Cigarette Does a Smoker Damage Alaska Native, 93% agree Non-Native, 89% agree Tobacco is the Number One Cause of Preventable Deaths in the U.S. Alaska Native, 79% agree Non-Native, 62% agree
25 70% Percent of High School Students Who Smoke Cigarettes, Alaska Total and Alaska Native, Alaska YRBS 1995, 2003, 2007 and % 60% 50% % youth smokers 40% 30% 36.5% 25.2% 20% 15.7% 10% 0% All Youth AK Native Youth
26 Alaska YRBS 1995 (1st year completed), 2003, 2007, 2009 Was not conducted in Anchorage did not participate 1999 AK State went from passive to active consent for youth to participate in YRBS 2001 & 2005 were not successful surveys 2007 & 2009 close but successful
27
28 Tobacco Use Prevalence Among Alaska Native Youth (regional study ) 665 youth ages 6-18 (324 male, 341 female) seen for a Well Child Assessment within the region during a 1-year time period from Village based effort Children ages 6-10 seen every year, and every two years until age 20 Health aides conduct an interview with the child NCI Angstman et al., Am J of Health Behavior
29 Tobacco Use Prevalence Among Alaska Native Youth (regional study ) Determined regional proportion of youth who had ever tried and were currently using tobacco. Prevalence estimates were adjusted using the age and sex-specific population counts obtained from the 2000 Census for Alaska Natives residing in the region s villages and are thus generalized to the region.
30 Tobacco Use Prevalence Among Alaska Native Youth (regional study)
31 Tobacco Use Prevalence Among Alaska Native Youth (regional study)
32 Tobacco Use Prevalence Among Alaska Native Youth (regional study)
33 Tobacco Use Prevalence Among Alaska Native Youth (regional study)
34 We Can t Afford to Quit Yet! All types tobacco use rates remain high Disparity in use rates continues Youth rates and ST use in general of concern Industry on the move to declare ST an easy-touse/start (wild berry flavor?) safer and good solution-to-when-you-can t-use product Prenatal ST exposure unknown factor in predisposition to future addiction Some regional rural populations still remain unchanged
35 We Aren t Quitting Yet! Create effective culturally specific treatment. Conduct more research specific to ST and mixed use among Alaska Native people (NEAM And MAW studies. Reduce prenatal exposure to nicotine (FY09 42% at ANMC self report). Continue technical assistance and support. Continue training (2004-present TTS/Accredited 2009). Sustain community based paradigm shift in attitudes and behaviors with policy and TX.
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