# Optimizing Smoking Cessation within Diabetes Care at the Cherokee Nation

> **NIH NIH S06** · CHEROKEE NATION · 2021 · $84,909

## Abstract

Smoking remains the leading cause of preventable morbidity and mortality in the US, and American 
Indians/Alaska Natives (AI/ANs) suffer a disproportionate burden of tobacco-related disease. AI/ANs also have 
the highest type 2 diabetes (T2D) prevalence of any racial group, with an age-adjusted prevalence of 15.9% 
among AI/AN adults aged 20 or older compared to 7.6% among Non-Hispanic whites in the US. The harms of 
commercial cigarette smoking are particularly profound among individuals with T2D who continue to smoke, 
with an accelerated progression of microvascular and macrovascular complications and an increased risk of 
death. Although AI/ANs in Oklahoma are known to have a higher smoking prevalence than the general 
population, the impact of smoking on T2D and complications is unclear. Furthermore, it is unknown whether 
AI/AN smokers with T2D are aware of their increased risks or if they receive evidence-based tobacco 
cessation interventions in the context of their T2D care. To address this critical gap in research, we propose an 
epidemiological pilot study of AI/AN T2D patients to examine tobacco use patterns and health outcomes. The 
Cherokee Nation is one of the largest tribes in the nation and is the only tribal nation that currently maintains a 
tribally-operated Surveillance, Epidemiology, and End Results cancer registry. By linking the cancer registry 
with Cherokee Nation Electronic Medical Records (CNEMR) and the diabetes registry, Cherokee Nation is 
well-suited to examine diabetes- and tobacco-related health outcomes by smoking status. Through a mixed- 
methods study, we will measure perceived risks of smoking and identify facilitators and barriers to cessation to 
then design and pilot test a tailored smoking cessation intervention in this unique population. The specific aims 
of this study are to: 1) Compare diabetes- and smoking-related health outcomes, which include glycemic 
control, blood pressure control, cholesterol, neuropathy, retinopathy, amputation, and tobacco-related cancers 
among patients with T2D by smoking status; 2) Identify the perceived risks of smoking and the facilitators and 
barriers to smoking cessation among Cherokee Nation patients with T2D as perceived by both patients and 
providers; and 3) Determine the feasibility, acceptability, and potential effectiveness of a tailored and 
coordinated smoking cessation intervention within T2D care. During the pilot intervention, we will use mobile- 
based real-time ecological momentary assessments (EMA) to capture brief daily assessments on urges to 
smoke, stress, motivation, and exposure to secondhand smoke and will biochemically validate abstinence 
using remote carbon monoxide monitors. With the results from the pilot study, we expect to better understand 
the feasibility and acceptability of the designed intervention in this study population as well as the benefits or 
challenges with using the mobile technology in this setting. We expect to gather evid...

## Key facts

- **NIH application ID:** 10246870
- **Project number:** 5S06GM127983-04
- **Recipient organization:** CHEROKEE NATION
- **Principal Investigator:** Sydney Ann Martinez
- **Activity code:** S06 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $84,909
- **Award type:** 5
- **Project period:** 2018-09-12 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10246870

## Citation

> US National Institutes of Health, RePORTER application 10246870, Optimizing Smoking Cessation within Diabetes Care at the Cherokee Nation (5S06GM127983-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10246870. Licensed CC0.

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