Claradina Soto, PhD, MPH, tackles youth vaping in Native American communities through community partnership

American Indian and Alaska Native (AIAN) high school youth are twice more likely than the general population to use electronic vapor products. They also have the highest current cigarette smoking rate of any other race or ethnicity in this age group. In order to address growing concerns around youth vaping in underserved and hard-to-reach AIAN populations, researchers from University of Southern California and the Resources for Indian Student Education (RISE), an American Indian education center, conducted a community-based participatory research initiative. “Our aim was to foster a partnership to elevate community-based research to ensure that the populations we are working with are included in the entire process,” says Claradina Soto, PhD, associate professor of clinical population and public health sciences and director of the Initiative for California American Indian Health Research and Evaluation.

“Initially, we engaged with a Native community in Modoc County, the farthest northeast county in California, to learn about their needs and perspectives of living in rural areas in relation to commercial tobacco control,” explains Soto. “We learned that more youth had started vaping and the adults had tried to dissuade them. However, when young people raised questions about common misconceptions around vaping, the adults did not know how to advise them. Essentially, they said ‘we need to understand vaping!’ This highlighted the need for comprehensive vaping education for AIAN parents, families, and community members.”

Community advisory board

Community members were engaged through an advisory board comprising of educators, parents, young adults, elders and Tribal leaders. This group provided guidance on prevention and intervention development and outcomes.

Next, RISE recruited 15 American Indian youth to form a Youth Advocacy Team (YAT) who underwent leadership and tobacco control research skills training. They learned how to recruit vaping peers to the intervention. The initiative supported YAT members with resources to ensure training success, including transportation support, food, and stipends.

A culturally-relevant intervention

To reduce vaping among the youth, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends approaches that are responsive to diverse cultural health beliefs and practices. As a result, the intervention piloted in rural Tribal communities incorporated cultural adaptations to meet the needs of the American Indian community. Through a grant from the Tobacco-Related Disease Research Program (TRDRP), USC and RISE created a culturally specific youth vaping intervention curriculum and a community vaping education program.

This intervention set out to understand individual-level knowledge, attitudes, and behavioral intentions to using commercial tobacco and/or vaping. The pilot program had five lessons focused on education and self-empowerment. It used medicine wheel teachings and traditional storytelling to build self-advocacy and encourage healthy choices. Students explored the health risks of vaping, learned positive coping strategies for stress and peer pressure, and reflected on their identity and decisions.

Beyond the classroom, YAT members were trained on strategy, current data, research with data collection, evaluation, lesson development and dissemination. They facilitated town hall meetings, attended school-community meetings, and presented the youth intervention to school administrators and staff. They provided input towards the ‘alternative to suspension’ program developed by the American Lung Association: Intervention for Nicotine Dependence: Education, Prevention, Tobacco and Health (INDEPTH). This engagement highlighted the importance of youth inclusion in the creation of effective prevention tools.

Partnering with high schools
One goal of the program was to reach students in schools to address the teen vaping epidemic in a supportive manner. “Through a collaboration with the Modoc Joint Unified School District, we reached about 32 youth across five sessions at Burney and Fall Rover Jr/Sr High Schools. These sessions were conducted for an hour during school lunchtime which the school systems appreciated,” says Soto. The sessions provided participants with information about nicotine dependence and alternative activities, and then measured changes in knowledge, awareness, attitudes, and intentions to quit.

At completion, 32 American Indian students in grades 7-12 took part in the pilot and survey results showed that students demonstrated increased knowledge of the addictive nature and health risks of vaping, and their personal control over decisions about nicotine and commercial tobacco use. They also demonstrated increased knowledge about traditional/ceremonial tobacco.

Supporting AIAN parents and adults
During community presentations, participants received a fact sheet with key information and tips for discussing vaping with youth. Over the course of three events, 60 AIAN adults participated in educational sessions to learn about the history of vaping, health risks, and trends of vaping.

A national outlook
“This was a great mutual partnership because it brought together academia and the community,” shares Soto. “Some of these communities are difficult to access, so for them to be part of a successfully developed program, for their community and by their community— where they are the guiding force, was the success. I cannot express how appreciative they were that we engaged with them and created a program that was implemented in the school system. We are hoping to take this statewide and keep it going. We recognize, there are many inequities and disparities that exist in our Native communities including high suicide rates and fentanyl overdose deaths. Even though, tobacco use may not always be the priority across communities, we would like Native communities to know that this intervention exists. If they want to better understand how substances impact their youth, this is something they can implement,” Soto concludes.