Reducing Disparities in Tobacco Use among American Indians in the Cherokee Nation: A Partnership Cherokee Nation Oklahom

1. Reducing Disparities in Tobacco Use among American Indians in the Cherokee Nation: A Partnership Cherokee Nation Oklahoma State Health Department

2. CHEROKEE NATION Tribal Jurisdictional Service Area (TJSA) * Tribal Jurisdictional Service Area (TJSA) - 9,200 square miles – Population: 399,385 * Oklahoma - 2nd largest number of Native Americans residing in a state - 200,000 plus members; -90,000 reside in Cherokee Nation Service Area * 27.5% American Indian * 51% of TJSA is rural vs. 32% for State

3. 286, 279 Members 100,000 patients 6 Tribal outpatient health centers 2 Tribal satellite clinics 2 IHS Hospitals

4. Cherokee Nation Health Centers A-Mo Salina Community Center Nowata Primary Health Care Center Sam Hider Jay Community Center Muskogee Health Center Wilma P. Mankiller Health Center Redbird Smith Health Center

5. Muskogee Clinic Opening Fall 2007

6. Active Patients

7. Indian Health Service Managed Hospitals with Outpatient Services Claremore Indian Hospital Hastings Indian Medical Center

8. Problem • American Indians in Cherokee Nation are • more likely to smoke cigarettes. • more likely to be diagnosed with lung cancer. • more likely to die from lung cancer.

9. Goals • Increase number of American Indian registrants calling the Oklahoma Tobacco Helpline. • Increase number of American Indians quitting smoking cigarettes. • Decrease the percentage of American Indians smoking cigarettes.

10. Partners • Cherokee Nation • Oklahoma Tobacco Settlement Endowment Trust • Cherokee County Tobacco Coalition • Muskogee County Tobacco Coalition • Oklahoma State Department of Health-Tobacco Use Prevention • Oklahoma State Department of Health-Chronic Disease Service

11. Oklahoma Tobacco Settlement Endowment Trust (TSET) • Constitutional amendment approved by Oklahoma voters. • Assures tobacco settlement funds are used for tobacco prevention and other programs to improve health. • Assures that the funds will be available for these purposes for generations to come. http://www.tset.ok.gov/

12. TSET Funds • Oklahoma Tobacco Helpline • Communities of Excellence in Tobacco Control • Addressing Tobacco in Specific Populations • Counter-marketing campaigns

13. Oklahoma Tobacco Helpline (OTH) • One-on-one “quit coaching” • Specialized materials • Referrals to community resources • Telephone-based coaching sessions with the same “Quit Coach” throughout their quitting process. • No cost patches and/or gum for uninsured.

14. Oklahoma State Department of Health, Tobacco Use Prevention Service (OSDH-TUPS) • No cost material • Training for Cherokee Nation Clinicians

16. Materials are free of charge. Materials are focus group tested. All materials are drop shipped. Materials are being created in Cherokee. http://www.health.state.ok.us/program/tobac/

17. Tobacco Prevention Coalitions The Oklahoma Communities of Excellence Program • 17 local coalitions serving 24 Oklahoma counties and three tribal nations. • Primarily funded through competitive grants awarded by the Oklahoma Tobacco Settlement Endowment Trust. • Provide coordination of comprehensive tobacco use prevention and cessation activities.

18. Tobacco Prevention Coalitions • Bill Willis Community Mental Health Center • Community Health Coalition of Cherokee County • Muskogee County Health Department • Muskogee Turning Point

19. Oklahoma State Department of Health, Chronic Disease Service • Data • Linked mortality data • Linked cancer data • OTH registration data • BRFSS Data • Knowledge Attitude Practices Survey

20. Cherokee Nation Resources • HPDP • Wings • Steps • Tobacco • Cherokee Nation Cancer Programs • Comprehensive Cancer Plan • Cancer Registry

21. What Has Been Done • Advertising • Monthly Cherokee Phoenix Ads since July 2004 • Monthly Newsletters since January 2002 • Posters placed in all health facilities and Cherokee Nation Headquarters • Clinical Training • Effectiveness of helpline; how to use the OTH • Resourcesavailable to clinicians and clients • Community Interventions • Freedom From Smoking® (American Lung Association) training available for Community members 4 times from 2004-2006

22. What Has Been Done • Cancer Plan • For 3 years (2005-2007) • Targets Cherokee Nation community • Focuses on the primary prevention of cancer, affecting lifestyle behaviors such as physical activity, diet, and tobacco use • Billboards • 4 placed in Muskogee (Muskogee County) April 2006. • 2 placed in Tahlequah (Cherokee County) in January 2007 (1 American Indian specific).

23. Tobacco is a killer! It is a known fact that tobacco use is the major cause of lung and bronchial cancer in the US. The five-year survival rate for those diagnosed with this disease is 15%, all stages included. Tobacco use is also associated with other cancers, such as esophageal, cervical, urinary bladder, kidney, and renal pelvis cancer, to name a few. It is also associated with other health problems like cardiovascular disease and respiratory problems. “Smoking harms nearly every major organ of the body, often in profound ways, causing many diseases and significantly diminishing the health of smokers in general.”

25. Results

26. Likelihood of Calling the Quitline to Get Help: Cherokee Nation BRFS 2005 Very likely/Likely 100 Not sure 90 Unlikely/Very Unlikely 80 Don't Know 70 60 Percent 50 40 30 20 10 0 Oklahoma Cherokee Nation Cherokee Steps Steps American American Indian Indian

27. Percentage “Yes” Quitting Smoking and Oklahoma Tobacco Helpline: Cherokee BRFSS 2005 Cherokee Steps Cherokee American American Oklahoma Nation Indian Steps Indian Are you seriously considering stopping smoking within the next 6 months? 55.3 55.2 55.1 53.0 48.0 Are you planning to stop within the next 30 days? 25.3 28.1 24.8 25.7 24.0 Are you aware of any 1-800, or toll free, smoking quitlines in Oklahoma that a smoker can call to receive help quitting smoking? 26.1 26.6 30.4 29.7 32.7 Knows the tag-line or slogan used by the Oklahoma quitline. 12.0 18.7 15.4 6.8 n/a

28. Number of Oklahoma Tobacco Helpline Phone Registrants in Cherokee Nation by Race: 4th Quarter 2003- 1st Quarter 2007 Tobacco Tax Billboard in Muskogee County Billboard in Cherokee County

29. Percentage of Oklahoma Tobacco Helpline Phone Registrants by Race: 4th Quarter 2003- 1st Quarter 2007

30. Percentage of Oklahoma Tobacco Helpline Phone Registrants by Race: 4th Quarter 2003- 1st Quarter 2007

31. Percentage of American Indians Calling the Oklahoma Tobacco Helpline Phone Registrants by County and Year * Only 1st Quarter data included

32. Three Year Running Average of Smoking Cigarettes Everyday in Cherokee Nation Area by Race: BRFSS 2001-2003, 2002-2004, 2003-2005

33. Results • American Indians in the Cherokee Nation area know about the OTH and report they will use it. • American Indians in the Cherokee Nation area are using the OTH at an increasing number and proportion. • Fewer American Indians in the Cherokee Nation Area are smoking cigarettes. • The disparity between White and American Indian rates of cigarette smoking are no longer significant.

34. Conclusions • American Indians in the Cherokee Nation will use the Oklahoma Tobacco Helpline. • The Oklahoma Tobacco Helpline is a valuable tool in the reduction of disparities in cigarette smoking among American Indians in the Cherokee Nation. • Partners can provide valuable resources in the the prevention of lung cancer.

35. Thank You!JanisC@health.ok.gov