All Nations Breath of Life: A Successful Smoking Cessation Program for Heterogeneous American Indian Communities

American Indians have some of the highest smoking rates of any racial/ethnic group in the United States and some of the lowest quit rates.  The All Nations Breath of Life smoking cessation program was developed using community-based participatory research in collaboration with American Indian communities in Kansas and Missouri.  It is a 12-week program that provides both typical cessation information and information about the diversity of traditional use of tobacco.  It teaches about respecting the plant, regardless of whether or not an individual uses traditional tobacco, rather than abusing it recreationally.  The primary endpoint is 7-day point prevalence abstinence at 6-months post-baseline, biochemically verified through salivary cotinine.  In the urban implementation trial described here, the program was tested in five states with heterogenous multi-tribal populations (N=317).  Smokers in ANBL were able to quit at rates higher than those reported in the literature for AI using other cessation programs (31% using an intent-to-treat analysis versus 8-10% reported in the literature at study inception; p<0.01).  The retention rate for participants at the study endpoint was 74%.  Participants who successfully quit attributed their success to a strong personal desire to quit, respect for tobacco, and the help of pharmacotherapy and group support.  This culturally-tailored cessation program allows AI smokers to quit at rates similar to those reported for best practices interventions in other communities.