Tobacco use and cessation: What matters to Southeast Alaska Native young adults?

Thesis (Ph.D.) University of Alaska Fairbanks, 2013Background: The smoking rate among young Alaska Native adults (ages 19-29) in Southeast Alaska is 70% as compared to the statewide adult smoking rate of 21%, the Alaska Native adult rate of 41%, and the overall young adult rate of 32%. Southeast Alaska Regional Health Consortium (SEARHC), the non-profit tribal health consortium serving Southeast Alaska, commissioned this research to inform development of a young adult-specific, social marketing-based smoking cessation intervention. Methods: Using purposive sampling, 23 individuals were recruited for five focus groups and four individual interviews in Juneau, Alaska. Following a social marketing framework, the research assessed participant beliefs about the benefits and negative impacts of smoking, barriers to quitting, and preferred quit support methods, as well as participant reactions to particular anti-smoking advertisements and quit support methods. Results: Almost all participants reported an interest in quitting smoking. Stress relief, boredom relief, relaxation, and oral satisfaction were the main benefits of smoking. Downsides to smoking included negative short-term health impacts, negative impacts on children in the extended family, and negative cosmetic impacts. Barriers to quitting included loss of listed benefits, addiction and habit, fatalism, and the high prevalence of smoking among family and friends. The preferred method of quitting was cold turkey (unassisted quitting), with very few participants reporting use of counseling or pharmacotherapy. Participants preferred high emotional level anti-smoking advertisements with either strongly negative emotional valence (e.g., fear and disgust) or strongly positive emotional valence (e.g., joy, happiness). Reaction to quit support methods was most favorable to texting support and a smart phone app, and most negative toward a smart phone video game. Reaction to counseling was strongly supportive among those who had tried it and largely but not totally negative among those who had not. Conclusion: Young Alaska Native adults in Juneau who smoke are interested in quitting but prefer cold turkey to counseling and pharmacotherapy. They are more concerned about short-term than long-term health impacts, and they are sensitive to the impact of smoking on their appearance and on children in their extended family. Findings formed a foundation for a proposed social-marketing based intervention