Commercial Tobacco Cessation Interventions for American Indian and Alaska Native Persons Living in the United States: A Narrative Systematic Review of Effectiveness Using a Health Equity Lens

Abstract

Objective

Identify commercial tobacco cessation interventions for American Indian and Alaska Native (AI/AN) communities, focusing on strategies used to advance health equity, including strategies to address social determinants of health (SDOH), community engagement, and cultural tailoring.

Data Source

We searched Medline, Embase, PsycINFO, Cochrane Library, CINAHL, Scopus, ProQuest Central, Academic Search Complete, JSTOR, and Indigenous/Tribal health-related journals and databases.

Study Inclusion and Exclusion Criteria

We included peer-reviewed studies on commercial tobacco cessation for AI/AN persons published January 1998–April 2023 that reported quit rates/attempts. We excluded studies that only used pharmaceutical interventions.

Data Extraction

Two reviewers independently assessed each study against our inclusion/exclusion criteria. A reviewer extracted data, and another checked for completeness.

Data Synthesis

Synthesis focused on reported intervention effectiveness and strategies used for addressing SDOH, community engagement, and cultural tailoring. We used a synthesis matrix which allowed for comparison across studies.

Results

We screened 1116 articles and included 12 for synthesis. Of the 12, five engaged community health workers; four included SDOH elements; and six were reported effective. Of these six, five included early-stage community engagement and four were culturally tailored.

Conclusions

There are few commercial tobacco cessation interventions for AI/AN populations. Building capacity, including tribal capacity, to develop and test multi-level, culturally grounded cessation interventions that address relevant SDOH may advance commercial tobacco cessation efforts in these populations.