# Urban and Reservation Implementation of All Nations Breath of Life to Improve Smoking Cessation Rates among American Indians

> **NIH NIH R01** · LEHIGH UNIVERSITY · 2020 · $541,068

## Abstract

PROJECT SUMMARY
Lung cancer is the leading cause of cancer death and cardiovascular disease is the overall leading cause of
death among American Indians (AI). A major risk factor contributing to this premature mortality is the fact that
AI have the highest smoking rates of all major ethnic groups in the US, at 31.8%, nearly double that of both
African Americans and Whites. Despite these high rates of smoking and tobacco-related illness, few
researchers have addressed this issue, in part because tobacco is a sacred plant to many AI and cannot be
treated completely negatively, as most smoking cessation programs do. Researchers at the University of
Kansas Medical Center (KUMC) and Johnson County Community College (JCCC) have been working with AI
communities using community-based participatory research (CBPR) to address recreational tobacco since
2003. Together we have developed a successful culturally tailored cessation program, All Nations Breath of
Life (ANBL), that respects tobacco as a sacred plant and promotes honoring it rather than abusing it
recreationally. Our in-person, group-based program had an intent-to-treat quit rate of 27.9% versus 17.4% in a
current best practices comparison arm at end of treatment (12 weeks) in a reservation-based efficacy trial
(N=463). Cessation rate was 20% vs. 12% at 6 months (p=0.02). In a large urban implementation feasibility
pilot (N=312 across sites in five states), our quit rate was 22% at 6-months (p<0.002 compared to the highest
previously reported quit rates for an urban AI population); our retention rate was 71%. Because ANBL has
been proven efficacious in reservation populations and shows promise in urban populations and because of
the significance of the tobacco abuse problem in both reservation and urban AI communities, we believe it
prudent to move towards expeditious implementation and dissemination of ANBL. Therefore, we propose
continued efficacy testing through an effectiveness-implementation type 2 hybrid design. This design allows
for efficacy testing with simultaneous implementation testing to move the program towards large-scale
dissemination at the conclusion of the study. We will address the following specific aims: (1) To assess 7-day
point prevalence expired CO validated quit rates at 6 months (24 weeks) at each community site among
participating individuals following randomization and implementation of ANBL in two urban and two reservation
communities (N=576), using a waitlist control design. We hypothesize that quit rates will be 21% in the ANBL
arm and 9% in the waitlist control arm of individuals at each site; (2) To identify programmatic and
organizational factors that enhance implementation of ANBL and contribute to program success or failure
guided by RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and Consolidated
Framework for Implementation Research (CFIR) approaches; and (3) To compare different resources and
costs used in each grantee site for delivery ...

## Key facts

- **NIH application ID:** 10205774
- **Project number:** 7R01DA047863-03
- **Recipient organization:** LEHIGH UNIVERSITY
- **Principal Investigator:** CHRISTINE Makosky DALEY
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $541,068
- **Award type:** 7
- **Project period:** 2019-04-01 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10205774

## Citation

> US National Institutes of Health, RePORTER application 10205774, Urban and Reservation Implementation of All Nations Breath of Life to Improve Smoking Cessation Rates among American Indians (7R01DA047863-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10205774. Licensed CC0.

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