A new Mayo Clinic review has found that access to free or low-cost medication smoking cessation aids and individualized counseling are most helpful for Indigenous North Americans looking to quit smoking.

An estimated 41.2% of Indigenous North Americans smoke, which is the highest rate of any race or ethnicity in the U.S., according to the Centers for Disease Control. The high prevalence of smoking among these diverse tribal communities has been linked to disparities in cancer, cardiovascular disease and cancer rates.

"These findings have important implications for public health efforts to lower smoking prevalence among Indigenous populations, help bridge the gap in health disparities and promote health equity," says Annie Rusk, M.D., a pulmonary disease specialist at Mayo Clinic.

Dr. Rusk, a member of a tribal nation herself, notes that many Native people have not been offered standard-of-care, evidence-based interventions.

In their review, the researchers analyzed 608 studies of smoking cessation interventions completed between 2010 and 2021. They found only 10 that examined standard-of-care interventions in Indigenous North Americans.

Among those studies, they identified five categories of smoking cessation therapies that may help improve smoking cessation outcomes: phone or web-based tools, culturally tailored interventions, the inclusion of Indigenous study personnel, behavioral intervention aids and medications.

Their review found that the two most effective approaches were providing individualized counseling sessions or offering access to validated smoking cessation tools, including medications. Involving tribal or community input in planning the studies also was found to be helpful.

They noted an overall favorable smoking cessation rate of 21.8% among Indigenous North Americans, with 67% of participants using medications. Within that group, 52% of participants received varenicline, 42% accessed nicotine replacement therapy and 6% were given bupropion.

In addition to finding that medications were the most beneficial smoking cessation aid, researchers found that the most effective single intervention included individualized counseling sessions tailored to the tribe or community.

"Many people have tried to make interventions culturally tailored or to acknowledge the role of tobacco because there is a spiritual element to tobacco use for many tribes, particularly in the Northwest," says Dr. Rusk. "Each tribal nation is so different and has different practices and beliefs that you can't have a blanket intervention for every tribe because it's going to be different in terms of beliefs and practices you're walking into."

There are over five million Indigenous North Americans in the U.S., represented by 574 federally recognized tribal communities, with roughly 54% of the population residing in rural areas. Among the various communities, examples of culturally tailored cessation interventions include acknowledging the traditional role of tobacco, hiring Indigenous study staff and collaborating with Indigenous communities.

The researchers further underscored that culturally tailored collaborative efforts with tribal communities in planning and implementing interventions aided in improving smoking cessation outcomes. Identifying the economic and social conditions that influence a person, differences in health status and tobacco's role in specific communities provided additional background and understanding within the study.

Dr. Rusk emphasizes the importance of approaching every patient with evidence-based treatments.

"When it comes to health care disparities, there is this preconceived notion that a certain population isn't interested in receiving the same treatments," says Dr. Rusk. "If you don't know something, just ask. If you're asking from a place that's sincere, that's the first way to start a dialogue with patients who are not like yourself," says Dr. Rusk.

The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery supported the research. Review the study for a complete list of authors, disclosures and funding.

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