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

Native American Cancer
  Research (NACR)
Ute Mountain Ute Tribe
       NACR Staff
Dr. Burhansstipanov - Project
           Director
     Lisa Harjo - Project
         Coordinator
 Terri Rattler - Native Sister
  Rose Lee - Native Sister
        (Navigators)
  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.
 Two Advisory Coalitions
one in the Denver Metropolitan Area

one within Ute Mountain Ute
Reservation.
             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.
       Expected Outcomes

(1)two functional Native Tobacco
   Coalitions (one in each site)
(2)baseline data from local focus and
   working groups to help the Coalitions
   prioritize issues; and
    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.
     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.
           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.)
            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).
            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.
         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;
      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).
          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.
       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
         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
       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
 Overview of Training cont.

Overview of AIAN Tobacco Surveys
Social Norm Strategies
ARS – Audience Response System
        Second Phase

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

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


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



Lack of participation in the
advisory council by tribal program
representatives and leaders.
     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.
       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.
     Responses


NATE staff raised the issue of
changing and limited office
space to the Tribe on many
occasions.
         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.
         Results
The NATE staff in Ute Mountain Ute
now has a permanent office and is
housed in the Substance Abuse
Program.
      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
  Preliminary NATE “Survey” findings
 Survey Items Evolved from:
   o CO TAB instrument
   o Native American Tobacco Prevention
     Network (survey tools)
   o National Health Interview Survey (2 items)
   o California Health Interview Survey
   o 4 National Cancer Institute Native tobacco
     surveys
   o NATE Coalition Guidance
  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
    Examples of Preliminary NATE
         “Survey” findings

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

             Denver         Ute Mt. Ute

                         Gender

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

         Denver      Ute Mt. Ute

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

        Denver     Ute Mt. Ute

    Primarily raised on reservation
9 (n=29; 31%)          17 (n= ; 62.4%)
   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%)
   Examples of Preliminary NATE
    “Survey” Tobacco Behaviors

         Denver      Ute Mt. Ute

             Not smoke at all

27 (n=44; 61.4%)         13 (n=23; 55%)
   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%)
    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%)
     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%)
   Examples of Preliminary NATE
    “Survey” Tobacco Behaviors

         Denver     Ute Mt. Ute

 No habitual smoking in home at any age

21 (n=45; 46.7%)       12 (n=27; 43.5%)
   Examples of Preliminary NATE
    “Survey” Tobacco Behaviors

         Denver     Ute Mt. Ute

No smoking or chewing in home <18 years

22 (n=45; 48.9%)       11 (n=27; 40.6%)
        Examples of Preliminary NATE
              “Survey” NHIS

                  Denver          Ute Mt. Ute

          Yes, always wear seat belt
   29 (n=45; 64.4%)        16 (n=25; 63.3%)

Strong correlation between consistent seat belt use and likelihood
                 of adhering to tobacco cessation
     Examples of Preliminary NATE
      “Survey” Tobacco Cessation

            Denver        Ute Mt. Ute

Culturally Appropriate Tobacco Quit Programs
   (“none”, “none that I know of”, “don’t know”)

 30 (n=37; 81.1%)              22 (n=22; 100%)
  Examples of Preliminary NATE
   “Survey” Tobacco Cessation

         Denver     Ute Mt. Ute

 Yes, I’ve heard of CO Quitline / Quitnet
27 (n=45; 60%)          18 (n=30; 57.5%)
     What is NATE?
NATE is the Native
American Tobacco
                                       NATE Staff
Education Project. It is a
community-based initiative
                                                                     Respect
                                   Lisa Harjo, MA [Choctaw]
to raise awareness in the
Denver American Indian
                                  Terri Rattler [Oglala Lakota]
                                       Rose Lee [Navajo]
                                                                     Tobacco
community about tobacco.       Linda Burhansstipanov [Cherokee]

                               Native American Cancer Research
                                                                    Youth / Children
                                      1835 Franklin Street
                                      Denver, CO 80218
                                     phone: 303-837-8137
                                       fax: 303-837-7115

                               Native Cancer Survivors' Support
                                  Network: 1-800-537-8295

The NATE project is                       web page:
coordinated through Native       http://www.NatAmCancer.org
American Cancer Research         email: NatAmLisaH@aol.com
(NACR). It is funded through
a grant from Colorado’s
State Tobacco Education
and Prevention Partnership
(STEPP)
                                                                  Denver, Colorado
                                                                  September 2006
   Focus Groups and                      What we Learned from our Community
       Surveys
                                Based on the responses of        12% of youth use
NATE conducted a series of      the American Indians who         tobacco with alcohol two
Focus Groups and surveys        participated in the Focus        times a week or less
in the Denver Metro Area
                                Groups and surveys:              25% of youth were
with American Indian people
                                                                 exposed to second hand
of all ages during the Spring     41% first tried tobacco        smoke in their home
and Summer of 2006 to             between 14 and 16 years
learn more about attitudes,       of age
beliefs, and behaviors
related to tobacco.                68% were introduced to
                                  tobacco by their friends
                                                                   What they said
                                  or peers                       “I thought it was cool …
                                                                 every movie you went to,
                                   33% began using
                                                                 someone was blowing
                                  tobacco habitually before
                                                                 smoke … it looked
                                  20 years of age
                                                                 sophisticated.”
                                  57% believe that
                                                                 “My boyfriend got me to
                                  enforcement for minors is
                                                                 smoke. He was always
                                  not adequate
                                                                 smoking cigarettes and
                                   87% believe that store        he said come on, smoke
   Who Participated?              owners should have a           a cigarette… So, I
                                  license to sell tobacco        smoked a cigarette. Now
 59 American Indians who                                         I’m hooked.”
                                  62% of youth believe that
   reside in Denver, CO           enforcement for minors is      “Our coach used to
         40% males                not adequate                   smoke … Wow, a coach
                                                                 is smoking and this guy is
        60% females               13% of youth currently
                                                                 athletic and everything.”
                                  smoke tobacco daily
     What is NATE?
NATE is the Native
American Tobacco
                                       NATE Staff
Education Project. It is a
community-based initiative
                                                                     Respect
                                   Lisa Harjo, MA [Choctaw]
to raise awareness in the
Denver American Indian
                                  Terri Rattler [Oglala Lakota]
                                       Rose Lee [Navajo]
                                                                     Tobacco
community about tobacco.       Linda Burhansstipanov [Cherokee]

                               Native American Cancer Research      Ceremonial Use
                                      1835 Franklin Street
                                      Denver, CO 80218
                                     phone: 303-837-8137
                                       fax: 303-837-7115

                               Native Cancer Survivors' Support
                                  Network: 1-800-537-8295

The NATE project is                       web page:
coordinated through Native       http://www.NatAmCancer.org
American Cancer Research         email: NatAmLisaH@aol.com
(NACR). It is funded through
a grant from Colorado’s
State Tobacco Education
and Prevention Partnership
(STEPP)
                                                                  Denver, Colorado
                                                                  September 2006
   Focus Groups and                      What we Learned from our Community
       Surveys
                                Based on the responses of         How is Traditional
NATE conducted a series of      the American Indians who
Focus Groups and surveys                                            Tobacco Used?
                                participated in the Focus
in the Denver Metro Area
                                Groups and surveys:              For healing with
with American Indian people
of all ages during the Spring                                    headaches, fevers, chills,
                                   60% use tobacco for
and Summer of 2006 to                                            earaches and other
                                  ceremonial purposes
learn more about attitudes,                                      illnesses
beliefs, and behaviors             45% use traditional, non-
                                                                 For pain relief from
related to tobacco.               commercial tobacco for
                                                                 childbirth pains,
                                  ceremonial purposes
                                                                 headaches, and
                                  Over 50% of American           toothaches
                                  Indians use both
                                                                 For relief from symptoms
                                  traditional tobacco and
                                                                 of asthma, stomach
                                  commercially prepared
                                                                 aches, and rheumatism
                                  tobacco for ceremonial
                                  purposes                       As a remedy for wounds
                                  47% use tobacco for non-       As a bug repellant
                                  ceremonial purposes
                                                                 To honor and welcome
   Who Participated?                                             guests
                                                                 To communicate with the
 59 American Indians who
                                                                 Creator
   reside in Denver, CO
                                                                 To bind agreements
         40% males
                                                                 To bless events, buildings,
        60% females
                                                                 homes, and people
     What is NATE?
NATE is the Native                                                    Respect
American Tobacco
Education Project. It is a
                                       NATE Staff                     Tobacco
community-based initiative         Lisa Harjo, MA [Choctaw]
to raise awareness in the         Terri Rattler [Oglala Lakota]
Denver American Indian                 Rose Lee [Navajo]           General Information
community about tobacco.       Linda Burhansstipanov [Cherokee]

                               Native American Cancer Research
                                      1835 Franklin Street
                                      Denver, CO 80218
                                     phone: 303-837-8137
                                       fax: 303-837-7115

                               Native Cancer Survivors' Support
                                  Network: 1-800-537-8295

The NATE project is                       web page:
coordinated through Native       http://www.NatAmCancer.org
American Cancer Research         email: NatAmLisaH@aol.com
(NACR). It is funded through
a grant from Colorado’s
State Tobacco Education
and Prevention Partnership
(STEPP)
                                                                  Denver, Colorado
                                                                  September 2006
   Focus Groups and                      What we Learned from our Community
       Surveys
NATE conducted a series of      Based on the responses of        60% use tobacco for
Focus Groups and surveys        the American Indians who         ceremonial purposes
in the Denver Metro Area        participated in the Focus
                                                                 45% use traditional, non-
with American Indian people     Groups and surveys:              commercial tobacco for
of all ages during the Spring
                                                                 ceremonies
and Summer of 2006 to              41% currently smoke
learn more about attitudes,       cigarettes                     18% allow smoking in
beliefs, and behaviors                                           their home
related to tobacco.               6% currently chew
                                  tobacco                        26% stated a desire to quit
                                                                 smoking
                                  38% smoke tobacco
                                  when they drink alcohol        57% believe that
                                                                 enforcement for minors is
                                  58% have smoked more
                                                                 not adequate
                                  than 100 cigarettes in
                                  their life                     87% believe that store
                                                                 owners should have a
                                  41% first tried tobacco
                                                                 license to sell tobacco
                                  between 14 and 16 years
                                  of age
                                                                   What people said
   Who Participated?              68% were introduced to
                                  tobacco by their friends
 59 American Indians who          or peers                        “I don’t think Indians want to
   reside in Denver, CO                                           quit smoking”
                                  % began using tobacco           “I think tobacco isn’t a risk
         40% males                habitually before 20            for us (American Indians)
        60% females               years of age                    because it was a gift to us
                                                                  from the Creator
     What is NATE?
NATE is the Native
American Tobacco
                                       NATE Staff
Education Project. It is a
community-based initiative         Lisa Harjo, MA [Choctaw]
                                                                     Respect
to raise awareness in the
Denver American Indian
                                  Terri Rattler [Oglala Lakota]
                                       Rose Lee [Navajo]             Tobacco
community about tobacco.       Linda Burhansstipanov [Cherokee]

                               Native American Cancer Research        Quitting
                                      1835 Franklin Street
                                      Denver, CO 80218
                                     phone: 303-837-8137
                                       fax: 303-837-7115

                               Native Cancer Survivors' Support
                                  Network: 1-800-537-8295

The NATE project is                       web page:
coordinated through Native       http://www.NatAmCancer.org
American Cancer Research         email: NatAmLisaH@aol.com
(NACR). It is funded through
a grant from Colorado’s
State Tobacco Education
and Prevention Partnership
(STEPP)
                                                                  Denver, Colorado
                                                                  September 2006
   Focus Groups and                      What we Learned from our Community
       Surveys
NATE conducted a series of      Based on the responses of        64% were not aware of
Focus Groups and surveys        the American Indians who         tobacco quitting programs
in the Denver Metro Area        participated in the Focus        in the Denver American
with American Indian people     Groups and surveys:              Indian community
of all ages during the Spring
and Summer of 2006 to              41% currently smoke           60% had heard of the
learn more about attitudes,       cigarettes                     Quitline or Quitnet (1-800-
beliefs, and behaviors                                           639-QUIT) or
related to tobacco.               6% currently chew              http://co.quitnet.com
                                  tobacco
                                                                 91% have never contact
                                  38% smoke tobacco              the Quitline or Quitnet
                                  when they drink alcohol
                                                                 26% stated that they
                                  58% have smoked more           would like to quit using
                                  than 100 cigarettes in         tobacco in the next six
                                  their life                     months
                                  26% stated a desire to         97% were aware of the
                                  quit smoking                   harm second hand smoke
                                  18% would use the Cold         can cause to children and
   Who Participated?              Turkey method of quitting      youth, homes, and people
                                  without help or
 59 American Indians who          counseling
   reside in Denver, CO
                                  33% began using
         40% males                tobacco habitually before
        60% females               20 years of age
Smoking during pregnancy “Facts”


 Pregnant females who smoke increase
 their chances of having a low birth
 weight baby by up to 39%
         CO Quitline “Tobacco Use in Colorado” fact sheet, October 2001




 Low birth weight may cause stillbirths
 and newborn deaths.
         CO Quitline “Tobacco Use in Colorado” fact sheet, October 2001
  Benefits of Quitting “Facts”

Within 20 minutes of quitting, blood
pressure and pulse rate decrease.
 Most Smokers regret the day they started smoking. CO Quitline 1-800-639-QUIT or http://co.quitnet.com



Within 8 hours of quitting, carbon
monoxide and oxygen levels in the
blood return to normal.
 Most Smokers regret the day they started smoking. CO Quitline 1-800-639-QUIT or http://co.quitnet.com



Within 1 day of quitting, the likelhood
of heart attack decreases.
 Most Smokers regret the day they started smoking. CO Quitline 1-800-639-QUIT or http://co.quitnet.com
  Benefits of Quitting “Facts”
Within 2 days of quitting, nerve
endings regenerate; sense of smell and
taste improve.
 Most Smokers regret the day they started smoking. CO Quitline 1-800-639-QUIT or http://co.quitnet.com



Within 2 weeks, circulation improves
and lug function increases.
 Most Smokers regret the day they started smoking. CO Quitline 1-800-639-QUIT or http://co.quitnet.com



After quitting for 1-9 months,
coughing, sinus congestion, fatigue and
shortness of breath decrease.
 Most Smokers regret the day they started smoking. CO Quitline 1-800-639-QUIT or http://co.quitnet.com
  Benefits of Quitting “Facts”

Within 1 year of quitting, the likelihood
of heart attack is cut in half.
 Most Smokers regret the day they started smoking. CO Quitline 1-800-639-QUIT or http://co.quitnet.com




Within 5 years of quitting stroke risk
is reduced to the same levels as a non-
smoker..
 Most Smokers regret the day they started smoking. CO Quitline 1-800-639-QUIT or http://co.quitnet.com
  Benefits of Quitting “Facts”

Within 10 years of quitting, risk of
dying from lung cancer is about half
that of a current smoker.
 Most Smokers regret the day they started smoking. CO Quitline 1-800-639-QUIT or http://co.quitnet.com




Within 15 years of quitting, risk of
coronary heart disease and death
become roughly equivalent to those
who have never smoked.
 Most Smokers regret the day they started smoking. CO Quitline 1-800-639-QUIT or http://co.quitnet.com

				
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