Smoking Cessation Interventions in Native Americans, a Systematic Review
Bibliographic record
Abstract
Introduction:According to the Centers for Disease Control, tobacco use is highest among adult Native Americans (NA) at 33.9% and contributes to numerous health disparities. The cultural significance of tobacco for NA creates dissonance with conventional smoking cessation interventions. Development of culturally adapted smoking cessation interventions has sought to address these issues. Our objective was to systematically review the available literature to identify effective components of conventional and/or culturally-adapted smoking cessation interventions in adult NA.Methods:With an expert research librarian, we designed a comprehensive search strategy from 2010 to 2020. We included observational or clinical trials in French or English using pharmaceutical, behavioral, or complex interventions to achieve smoking cessation in NA. Retrieved studies were first reviewed independently and in duplicate for eligibility by title and abstract and then subsequently by full text. Disagreements were resolved by a third reviewer. Quality and study characteristics were abstracted. Quality assessment of randomized control trials (RCT) was conducted using the Cochrane Risk of Bias Tool; cohort studies were assessed with the Newcastle Ottawa Scale. Outcomes included tobacco cessation, NA study personnel, community engagement, use of pharmaceutical agents, and cultural tailoring. Meta-analysis was planned as possible when two or more studies used comparable interventions.Results:Our search returned 429 articles, with 70 potential articles following abstract review. Ultimately, nine studies including four cohort studies and five RCT were included in final analysis. Cohen's kappa coefficient was 0.892, indicating excellent agreement. Interventions utilized included nicotine replacement therapy, counseling, phone follow-up, text messaging, webbased interventions, use of NA study personnel, and cultural component. Quality limitations included small sample sizes and significant loss to follow-up in most studies. Study interventions were heterogeneous and therefore meta-analysis was not performed. Biochemically verified, statistically significant smoking cessation was not achieved in any study. Conducting interventions in collaboration with community members was associated with cessation. A study utilizing case managers resulted in significant tobacco cessation as a secondary outcome.Conclusions:There is limited evidence describing smoking cessation interventions targeted for NA. Although most studies did not reach significance for primary outcome, self-reported tobacco cessation was achieved as a secondary outcome with several common themes. Providing a smoking cessation aid such as nicotine replacement therapy (NRT) in conjunction with another type of intervention was associated with cessation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.048 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.008 |
| Bibliometrics | 0.013 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".