While American Indian (AI) persons have historically used wild or homegrown tobacco for spiritual purposes, the use of commercially produced tobacco has risen dramatically. Today, smoking-related cancers are as much as three fold higher among AI persons than White persons. Our preliminary data show that the odds of quitting smoking among AI persons are 40% lower than White persons. Low engagement with smoking cessation interventions is considered a major contributor to the disparity in cessation. NCI’s Smokefree program provides a suite of evidence-based digital resources for smoking cessation, including a website (Smokefree.gov), text program (Smokefree TXT), smartphone app (QuitGuide), and social media (Smokefree Facebook). These resources facilitate interaction with one another, have wide reach, and have been shown to increase cessation in the general population. However, we posit that Smokefree does not meet the needs and cultures of AI persons and is unlikely to engage and maximize cessation in AI persons. For this reason, through engagement with tribes and AI-serving clinics and nationally drawn community advisory boards, our team has conducted preliminary studies to develop Smokefree TXT for Natives and QuitGuide for Natives. Our team also maintains a social media page, Quit Connections, to provide a community for AI persons during their quit journey. These culturally aligned resources incorporate Indigenous worldviews and strengths, respect tobacco for spiritual purposes, integrate smoking triggers such as grief that are common to AI persons, and promote healing through culture and community connectedness as part of the quit journey. Our next step is to determine to what extent these culturally aligned resources, when packaged as Smokefree for Natives and supplemented with a culturally aligned Smokefree.gov, increase smoking cessation among AI persons. Our central hypothesis is that in AI persons who smoke (PWS) Smokefree for Natives will yield greater smoking abstinence versus the non-tailored Smokefree. This proposal builds on longstanding collaborations and employs mixed methodologies including Indigenous practices in engagement, a rigorous clinical trial, and qualitative interviews. The aims are: Aim 1: To co-create a website, Smokefree.gov for Natives, which will serve as the landing page for AI-aligned online cessation treatment content and facilitate access to a suite of culturally aligned digital cessation resources for AI persons; Aim 2: To test the efficacy of Smokefree for Natives via a remotely conducted randomized controlled trial among American Indian PWS (n=416); Aim 3: To qualitatively assess perceptions of Smokefree for Natives among AI PWS (n=40) and thematic differences in response based on demographics and geography. This proposal represents the braiding together of Indigenous and Western research approaches and represents a logical progression of our engagement efforts to date. Given that AI persons experience one of the most extreme smoking disparities, a scalable and culturally aligned smoking cessation intervention for AI persons could have considerable public health impact.

PROJECT NARRATIVE Given that American Indian (AI) persons experience one of the most extreme smoking inequities, a scalable and culturally-aligned smoking cessation intervention could have a meaningful public health impact in this population. Through engagement with tribes and AI serving clinics and nationally drawn community advisory boards (CABs), our team has conducted multiple preliminary studies to culturally tailor NCI’s Smokefree TXT and QuitGuide smartphone app for AI persons. The present study will culturally-align the final Smokefree resource (Smokefree.gov) and then utilize mixed-methods to evaluate the efficacy of Smokefree for Natives, a suite of culturally-aligned digital cessation resources, among AI persons who smoke.