Implementing a Metabolism-informed approach for smoking cessation in an Alaska Tribal health system: study protocol for a single-arm implementation pilot trial

Kelley J Jansen; Brianna N Tranby; Aliassa L Shane; Todd Takeno; Kelly Chadwick; Pamela Sinicrope; Jennifer L Shaw; Rachel F Tyndale; Jeffrey R Harris; Christi A Patten; Jaedon P Avey

doi:10.1186/s13690-024-01365-7

Implementing a Metabolism-informed approach for smoking cessation in an Alaska Tribal health system: study protocol for a single-arm implementation pilot trial

Arch Public Health. 2024 Aug 22;82(1):129. doi: 10.1186/s13690-024-01365-7.

Authors

Kelley J Jansen^{1

2}, Brianna N Tranby³, Aliassa L Shane⁴, Todd Takeno⁴, Kelly Chadwick⁵, Pamela Sinicrope^{3

6}, Jennifer L Shaw⁷, Rachel F Tyndale⁸, Jeffrey R Harris⁵, Christi A Patten³, Jaedon P Avey⁴

Affiliations

¹ Center for Alaska Native Health Research, University of Alaska Fairbanks, 2141 Koyukuk Dr, Fairbanks, AK, 99775, USA. [email protected].
² Southcentral Foundation Research Department, 4085 Tudor Centre Drive, Anchorage, Alaska, 99508, USA. [email protected].
³ Department of Psychiatry & Psychology, Mayo Clinic, Behavioral Health Research Program, 200 First Street SW, Rochester, MN, 55905, USA.
⁴ Southcentral Foundation Research Department, 4085 Tudor Centre Drive, Anchorage, Alaska, 99508, USA.
⁵ Department of Health Systems and Population Health, School of Public Health, Fourth Floor, University of Washington, 15 Ave NE, Box 351621, Seattle, WA, 98195, USA.
⁶ MedVal Scientific Information Services, LLC, 175 Wall St, Princeton, NJ, 08540, USA.
⁷ Center for Alaska Native Health Research, University of Alaska Fairbanks, 2141 Koyukuk Dr, Fairbanks, AK, 99775, USA.
⁸ Centre for Addiction and Mental Health and Departments of Pharmacology and Toxicology, and Psychiatry, University of Toronto, 1 King's College Circle, Room 4326, Toronto, ON, M5S 1A8, Canada.

Abstract

Background: Individualized treatment for commercial tobacco smoking cessation, such as through the utilization of the nicotine metabolite ratio (NMR), offers potential clinical benefit. NMR is a metabolism-informed biomarker that can be used to guide medication selection. NMR testing is particularly promising for tobacco cessation efforts in populations with high rates of smoking, such as some Alaska Native and American Indian (AN/AI) communities. To date, no prior study has evaluated the implementation of NMR-guided tobacco cessation with AN/AI populations.

Methods: The present "QUIT" protocol is a two-phase study that will occur at Southcentral Foundation (SCF), an Alaska Native-owned health system, serving 70,000 AN/AI people, based in Anchorage, Alaska. In Phase one, qualitative interviews with customer-owners (patients), providers and administrators (n = 36) and a 10-participant beta-test will be used to refine a strategy to implement NMR testing in the health system. Phase two will involve a single-arm pilot trial (n = 50) and qualitative interviews throughout data collection (n = 48) to evaluate the implementation strategy and explore the real-world acceptability and feasibility of NMR testing to guide tobacco cessation with AN/AI populations.

Discussion: This study utilizes a community-based participatory approach to refine and implement a nicotine metabolism-informed smoking cessation program in a Tribal healthcare setting. The process and findings from this study will reflect the importance of customer-owner choice and honor the lived experience involved in quitting commercial tobacco. Pilot study data will inform the effect and sample sizes required for a future pragmatic trial of NMR-guided smoking cessation.

Trial registration: This study will be registered with clinicaltrials.gov after the beta test is complete and the final IRB protocol is approved.

Keywords: Alaska Native and American Indian; Health Services; Implementation; Nicotine Metabolite Ratio; Tobacco Cessation.