OBJECTIVES:American Indian (AI) people are disproportionately impacted by opioid use disorder (OUD) and its associated consequences. However, there is a dearth of published research about substance-use treatment and its efficacy for AI people with OUD. People with OUD, especially those with a longer substance-use history, often have widely variable experiences in their access to and engagement in substance-use treatment. Furthermore, there is a paucity of literature on AI people's perceptions of their substance-use treatment experiences. This study seeks to fill this research gap. METHOD:Conventional content analysis was used to document perceptions of substance-use treatment among AI people who have used opioids (N = 45) as well as their suggestions for the improvement of treatment moving forward. RESULTS:Participants highlighted the importance of connection to nonjudgmental counselors and peers with lived experience, challenges of logistical barriers to treatment (e.g., cost, distances to facilities), the importance of intrinsic versus extrinsic motivation for recovery, and a preference for treatment as respite versus punishment. Participants felt substance-use treatment could be enhanced through the incorporation of Native-centric cultural programming, the integration of social services into substance-use treatment (e.g., housing and vocational training), provision of robust individual and group counseling options, and healing settings that include nature and flexible structures. CONCLUSIONS:Findings should be taken into consideration when establishing and designing substance-use treatment for AI people who have used opioids to ensure appropriate accessibility, feasibility, and implementation concerns are addressed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

This systematic review evaluated the psychometric performance of the National Institutes of Health's Toolbox Cognition Battery (NIHTB-CB) composite scores in older adults with and without Alzheimer's disease and related dementias (ADRD). A systematic literature search was conducted using MEDLINE, Embase, PsycINFO, and CINHAL databases. The evidence quality of NIHTB-CB measurement properties was assessed using integrated Consensus-based Standards for the Selection of Health Measurement Instrument (COSMIN) methodology and the Interpretation/Use Argument framework. Fourteen studies met inclusion criteria for this review of the NIHTB-CB. Evidence supporting the scoring, generalization, and extrapolation inferences of the Total, Crystallized, and Fluid composite scores in older adults ranged from developing through exemplary ratings. Findings indicate additional research is warranted on the NIHTB-CB in older adult and ADRD populations. The present study highlights the importance of continued use and research of the NIHTB-CB in diverse, older populations who are at risk for ADRD. HIGHLIGHTS: Limited research focuses on the National Institutes of Health's Toolbox Cognition Battery (NIHTB-CB) composites in older adults. The general psychometric robustness of the NIHTB-CB has been es. The Crystallized composite shows proficient psychometric evidence. The psychometric evidence of Fluid composite is developing due to limited data.

Background and Purpose: Supported Conversation for Adults with Aphasia (SCA™ ), an evidence-based framework to improve communicative access, is a unique concept to nursing with theoretical and technical components. Effective communication is essential in all patient interactions, and SCA™ could aid health care professionals in meeting the needs of people with aphasia. Methods: A principle-based concept analysis was conducted using a systematic and conceptually driven literature search. A review of literature from 1998 to 2024 contained in CINAHL, PubMed, and PsycINFO databases was performed on the concept of SCA™ The concept was explored for (a) definitional clarity (epistemological principle), (b) relevance to nursing (pragmatic principle), (c) consistency in meaning (linguistic principle), and (d) differentiation from related concepts (logical principle). Results: The final dataset consisted of 49 articles. Findings revealed that (a) SCA™ is composed of theoretical and technical components used to acknowledge and reveal the competence of a person with aphasia, but there is a vague use and a lack of definitional clarity; (b) the philosophical framework and techniques outlined by the concept are relevant and useful for nursing; (c) there is variability in the use, nomenclature, and conceptualization of SCA™; and (d) the concept is poorly differentiated from other similar concepts. Implications for Practice: Nurses working with people diagnosed with aphasia and other communication disorders should consider SCA™ and its application in nursing practice. Findings from this concept analysis stress the importance of an interdisciplinary approach to future SCA™ studies, as nursing can lend its distinct viewpoint to integrate SCA™ techniques into practice.

Due to the colonization of tobacco plants by European settlers and the subsequent intensive marketing of commercial tobacco products to American Indian and Alaska Native (AI/AN) communities in the U.S., commercial cigarette smoking accounts for half of all deaths among AI/AN people. Lack of awareness, access to treatment, and the absence of culturally relevant, effective smoking cessation interventions contribute to these high death rates. To culturally adapt iCanQuit, a smartphone smoking cessation application (“app”) proven efficacious for the general population, for AI/AN people. A user-centered and community-based participatory research (CBPR) mixed-methods approach was applied to culturally adapt iCanQuit for AI/AN people in collaboration with a community advisory board (CAB) of AI/AN individuals using a three-step process between June/2024 and August/2025. Step 1 identified ways to culturally adapt the iCanQuit for AI/AN people through one-on-one qualitative interviews with eight prior iCanQuit AI/AN participants. Step 2 involved developing prototypes of cultural refinements identified in Step 1 through regular bi-weekly meetings of the CAB, research and app development teams. The prototypes were then evaluated with a separate group of four prior iCanQuit AI/AN participants through one-on-one qualitative interviews. Step 3 involved beta testing the app through a six-day diary study followed by one-on-one qualitative interviews with a nationally recruited group of seven AI/AN adults who smoke commercial cigarettes. The development work associated with Step 3 was further informed by the CAB and the research and app development teams. Step 1 yielded five suggested cultural refinements to iCanQuit that were subsequently developed and tested in Steps 2 and 3: (1) modify the app’s stories to feature AI/AN adults and elders who quit smoking, emphasizing the values of culture, spirituality, family, and community as motivators; (2) add the value of honoring the Earth as a motivator to quit smoking; (3) make the appearance of the app’s “guide” character more representative of AI/AN people; (4) add information distinguishing ceremonial vs. commercial tobacco use; and (5) use earth tones in the app’s colors. In Step 3, 100% of diary study participants rated the beta version of the app as excellent or good/meets expectations (69% and 31%, respectively) and that it felt made for them. They suggested six modifications which were incorporated into the final version of the app: (1) include a vaping FAQ, (2) feature motivation icons more prominently, (3) increase notification frequency, (4) track today’s cigarettes rather than yesterday’s, (5) allow users to update how much they spend per pack of cigarettes; and (6) rename the medications tool to reflect the inclusion of AI/AN traditional healing modalities. A user-centered and CBPR development process yielded IndigeQuit—one of the first known apps developed specifically to help AI/AN adults quit commercial cigarette smoking. ClinicalTrials.gov Identifier, NCT06145763

Communication difficulties experienced by people with aphasia (PWA) cause disconnects between meaningful conversations and care received. The purpose of this study was to identify concepts PWA define as (1) the most critical facilitators to transitional care and communicative access success, and (2) transitional care and communicative barriers. A qualitative descriptive study design was utilized. Semi-structured interviews were conducted with six PWA and two communication partners and analyzed using directed content analysis, guided by the theory of Human Scale Development. Findings revealed that barriers and facilitators centered on three Needs: (1) Participation: Participation in life events was directly related to public understanding of aphasia; (2) Protection: Healthcare services failed to provide necessary care, and participants relied on themselves to gain access to healthcare; and (3) Understanding: Healthcare conversations were described as one-sided, with successful healthcare interactions being mediated by empathic responses. Results identified how successful navigation of stroke care for PWA are complex and multifaceted processes. Findings affirm the importance of effective communication in healthcare. Participants call to action the need for healthcare professionals to be better educated on accessible communicative strategies.

Few studies have examined associations of social support with blood glucose control in American Indians (AIs), a population with a high burden of type 2 diabetes and related complications. This study examined the association of perceived social support with A1C among AIs in the Strong Heart Study. This cross-sectional study included 431 AI participants. Social support was measured using questions adapted from the National Comorbidity Survey and validated for use in AIs. A1C was measured using high-performance liquid chromatography. Generalized estimating equations were used to examine the association of social support with A1C. Participants who reported greater levels of social support had lower A1C levels. After adjustment for potential confounders, for every 1-SD increase in social support (6.8 points), A1C was 0.21% lower (β = -0.21%, 95% CI -0.40 to -0.01, P = 0.04). These data suggest that higher levels of social support are associated with better control of blood glucose. Further studies are needed to determine the mechanism by which perceived social support affects A1C.

Objective: Both opioid misuse and overdose mortality have disproportionately impacted the American Indian population. Although medications for opioid use disorder, such as buprenorphine (BUP-NX), are highly effective in reducing overdose mortality, questions have been raised about the cultural acceptability of Western medical approaches in this population. Understanding patients' desired recovery pathways can lead to more culturally appropriate, patient-centered, and effective approaches to opioid use disorder (OUD) treatment. In this qualitative study, we document experiences with combined pharmacobehavioral treatment for OUD and suggestions for enhancing it. Method: Participants (N = 45) were American Indian patients and community members impacted by OUD. They participated in one-time, 45- to 60-min, semistructured interviews. Results: Findings from conventional content analysis indicated participants were grateful for a Tribally run combined pharmacobehavioral OUD treatment program, which made treatment more financially and geographically accessible over a large, rural area. Participants expressed satisfaction with BUP-NX and the accompanying behavioral health programming but were interested in making it more accessible through telemedicine appointments and mailed prescriptions. Participants noted the importance of clear communication about this kind of programming, which tends to be less structured than other substance-use treatment programs, but also appreciated its tailored, compassionate, and holistic approach. Participants were interested in robust counseling options; a low-barrier, acceptance-based, and harm-reduction orientation; as well as more culturally aligned programming that honored their Native heritage and traditional medicine. Conclusions: Treatment providers, researchers, and policymakers should consider integration of more patient-driven, compassionate, and culturally aligned means of intervention for American Indian patients with OUD.

INTRODUCTION:Accurate epidemiologic estimates for dementia are lacking for American Indians, despite substantive social and health disparities. METHODS:The Strong Heart Study, a population-based cohort of 11 American Indian tribes, conducted detailed cognitive testing and examinations over two visits approximately 7 years apart. An expert panel reviewed case materials for consensus adjudication of cognitive status (intact; mild cognitive impairment [MCI]; dementia; other impaired/not MCI) and probable etiology (Alzheimer's disease [AD], vascular bain injury [VBI], traumatic brain injury [TBI], other). RESULTS:American Indians aged 70-95 years had 54% cognitive impairment including 10% dementia. VBI and AD were primary etiology approximately equal proportions (>40%). Apolipoprotein (APO) Eε4 carriers were more common among those with dementia (p = 0.040). Plasma pTau, glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL) were higher among those with cognitive impairment, but not amyloid beta (Aβ). Cognitive intact had mean 3MSE 92.2 (SD 6.4) and mean Montreal Cognitive Assessment (MoCA) score of 21.3 (SD 3.2). DISCUSSION:This is the first population-based study to estimate the prevalence of vascular and Alzheimer's dementias in a population-based study of American Indians. HIGHLIGHTS:The Strong Heart Study is a population-based cohort of American Indian tribes, conducted over 30+ years and three US geographic regions (Northern Plains, Southern Plains, Southwest). Our teams conducted detailed cognitive testing, neurological examination, and brain imaging over two visits approximately 7 years apart. An expert panel reviewed collected materials for consensus-based adjudication of cognitive status (intact; MCI; dementia; other impaired/not MCI) and probable underlying etiology (AD; VBI; TBI; other). In this cohort of American Indians aged 70-95, 54% were adjudicated with cognitive impairment, including approximately 35% MCI and 10% dementia. These data expand on prior reports from studies using electronic health records, which had suggested prevalence, and incidence of dementia in American Indians to be more comparable to the majority population or non-Hispanic White individuals, perhaps due to latent case undercounts in clinical settings. Vascular and neurodegenerative injuries were approximately equally responsible for cognitive impairment, suggesting that reduction of cardiovascular disease is needed for primary prevention. Traumatic injury was more prevalent than in other populations, and common among those in the "other/not MCI" cognitive impairment category. Mean scores for common dementia screening instruments-even among those adjudicated as unimpaired-were relatively low compared to other populations (mean unimpaired 3MSE 92.2, SD 6.4; mean unimpaired MoCA 21.3, SD 3.2), suggesting the need for cultural and environmental adaptation of common screening and evaluation instruments.

AIM(S):This discursive article aims to examine how systemic factors (both) reproduce the structure of settler colonialism and influence health outcomes among Indigenous peoples in the United States through settler colonial determinants of Indigenous health (SCDoIH). DESIGN:Discursive paper. METHODS:This discursive paper demonstrates how settler colonialism and health relate to each other within a nursing context. The concept of settler colonialism that was consolidated into a scholarly field beginning in the late 1990s is used to identify and contextualize SCDoIH for individuals residing in the United States as an entry point to advance scholarship on settler colonialism and nursing. RESULTS:A research framework that identifies factors of settler colonialism and SCDoIH within the United States is presented. CONCLUSION:The structure of settler colonialism in the United States includes settler colonial determinants of health for Indigenous populations that have detrimental effects on health outcomes. IMPLICATIONS FOR NURSING:To provide holistic nursing care, nurses must be aware of settler colonialism as a determinant of health. Nurses providing care to Indigenous peoples need to be attuned to the pathways and processes through which settler colonialism leads to exposures that may affect their patients' health.

OBJECTIVE:Modified Mini-Mental State Examination (3MSE) is often used to screen for dementia, but little is known about psychometric validity in American Indians.METHODS:We recruited 818 American Indians aged 65-95 for 3MSE examinations in 2010-2013; 403 returned for a repeat examination in 2017-2019. Analyses included standard psychometrics inferences for interpretation, generalizability, and extrapolation: factor analysis; internal consistency-reliability; test-retest score stability; multiple indicator multiple cause structural equation models.RESULTS:This cohort was mean age 73, majority female, mean 12 years education, and majority bilingual. The 4-factor and 2nd-order models fit best, with subfactors for orientation and visuo-construction (OVC), language and executive functioning (LEF), psychomotor and working memory (PMWM), verbal and episodic memory (VEM). Factor structure was supported for both research and clinical interpretation, and factor loadings were moderate to high. Scores were generally consistent over mean 7 years. Younger participants performed better in overall scores, but not in individual factors. Males performed better on OVC and LEF, females better on PMWM. Those with more education performed better on LEF and worse on OVC; the converse was true for bilinguals. All differences were significant, but small.CONCLUSION:These findings support use of 3MSE for individual interpretation in clinic and research among American Indians, with moderate consistency, stability, reliability over time. Observed extrapolations across age, sex, education, and bilingual groups suggest some important contextual differences may exist.

Enhancing social support and connectedness can reduce suicide risk, yet few studies have examined this effect in American Indian and Alaska Native (AI/AN) adults. We assessed suicidal ideation and behavior, thwarted belongingness, social support, enculturation, historical trauma, and traumatic life events in 709 AI/AN adults at high risk of suicide from five AI/AN communities. Suicidal ideation was associated with thwarted belongingness and protected against by social support and engaging in AI/AN ceremonies. Among those who made lifetime suicide attempts, traumatic life events, symptoms of depression/anxiety due to historical trauma, and thwarted belongingness were linked to more attempts. More engagement in cultural practices was associated with fewer suicide attempts. Higher levels of social support were associated with more suicide attempts, an observation potentially attributable to the cross-sectional nature of the study. Interventions should focus on protective factors and context-specific interventions emphasizing community history, values, and strengths.

Prior research suggests that culturally aligned, accessible and lower-barrier interventions are well-placed to align with the needs of American Indian and Alaska Native (AI/AN) people with alcohol use disorder (AUD). Taking into account community members' suggestions and the need for physical distancing during the COVID-19 pandemic, our team developed a protocol for virtual Harm Reduction Talking Circles (HaRTC) to incorporate these points. The aims of this 8-week, single-arm pilot were to initially document feasibility, acceptability, and outcomes associated with attendance at virtual HaRTC, which integrates the accessibility of virtual connection, a lower-barrier harm-reduction approach, and a culturally aligned intervention. Participants ( N  = 51) were AI/AN people with AUD (current or in remission) across 41 Tribal affiliations and 25 US states. After a baseline interview, participants were invited to attend 8, weekly virtual HaRTC sessions. At the baseline, midpoint and post-test assessments, we collected data on virtual HaRTC acceptability, cultural connectedness, quality of life, and alcohol outcomes. Of the 123 people approached, 63% were interested in and consented to participation. Participants attended an average of 2.1 (SD = 2.02) virtual HaRTC sessions, with 64% of participants attending at least one. On a scale from 1 to 10, participants rated the virtual HaRTC as highly acceptable ( M  = 9.3, SD = 1.9), effective ( M  = 8.4, SD = 2.9), culturally aligned ( M  = 9.2, SD = 1.5), helpful ( M  = 8.8, SD = 1.9), and conducted in a good way ( M  = 9.8, SD = 0.5). Although the single-arm study design precludes causal inferences, participants evinced statistically significant decreases in days of alcohol use and alcohol-related harm over the three timepoints. Additionally, both sense of spirituality, which is a factor of cultural connectedness, and health-related quality of life increased over time as a function of the number of HaRTC sessions attended. Virtual HaRTC shows initial feasibility and acceptability as a culturally aligned intervention for AI/AN people with AUD. Future randomized controlled trials will provide a test of the efficacy of this approach.

Approximately three fourths of the American Indian and Alaska Native (AI/AN) population lives in urban areas, and urban AI/ANs are disproportionately affected by alcohol-related morbidity and mortality. Although no studies have documented alcohol use disorder (AUD) treatment outcomes specific to urban AI/ANs, studies in other Native communities highlight concerns about the cultural acceptability of directive, abstinence-based approaches, such as cognitive behavioral therapy and 12-step programs. Understanding this population's desired recovery pathways in their own words may help providers create more culturally appropriate, patient-centered, and effective approaches. Participants (N = 31) were urban AI/ANs who screened positive for AUD using the AUDIT-C. They participated in semi-structured interviews eliciting their experiences in AUD treatment to date and suggestions for redesigning AUD treatment in their own vision. Conventional content analysis was used to create a thematic description. Findings indicated that intrinsic motivation and not extrinsic pressure (e.g., mandated treatment) was associated with positive treatment engagement and outcomes. Participants appreciated feeling safe and supported in AUD treatment, but also felt AUD treatment could be institutional and oppressive. Participants preferred compassionate counselors with lived experience who could provide insights into recovery; they largely did not appreciate a "tough love" approach or power struggles with counselors. Native-led treatment centers providing access to cultural practices were preferred. Moving forward, participants suggested AUD treatment providers should help patients meet basic needs, prioritize patient-driven versus provider-driven goal-setting, support patients' reconnection with meaningful activities, facilitate access to a supportive community network, and recognize cultural activities as important recovery pathways.

Suicide disproportionately affects many American Indian/Alaska Native (AI/AN) communities. Caring Contacts is one of the few suicide prevention interventions with demonstrated success in diverse populations, but its acceptability and effectiveness have not been evaluated in AI/AN communities. Using community-based participatory research (Phase 1), we conducted focus groups and semi-structured interviews with AI/AN adults, healthcare providers, and leaders in four communities to improve study design and maximize intervention acceptability and effectiveness for implementation in a randomized controlled trial (Phase 2). This paper describes how adaptations made during Phase 1 affected the acceptability, fit, and responsiveness of the study features to the communities’ needs. Acceptability of the study procedures and materials in this community appears to be high, with 92% of participants indicating the initial assessment interview was a positive experience. Broadening eligibility criteria with regard to age and possession of a cellular device resulted in the recruitment of an additional 48% and 46% of participants, respectively. Inclusion of locally-informed methods of self-harm allowed us to capture a wider range of suicidal behavior than would have otherwise been identified. Clinical trials would benefit from community-engaged, cultural adaptation studies with populations in which the interventions would eventually be applied.

Abstract Background/Objective: The goal of the Patient-Centered Outcomes Research Partnership was to prepare health care professionals and researchers to conduct patient-centered outcomes and comparative effectiveness research (CER). Substantial evidence gaps, heterogeneous health care systems, and decision-making challenges in the USA underscore the need for evidence-based strategies. Methods: We engaged five community-based health care organizations that serve diverse and underrepresented patient populations from Hawai’i to Minnesota. Each partner nominated two in-house scholars to participate in the 2-year program. The program focused on seven competencies pertinent to patient-centered outcomes and CER. It combined in-person and experiential learning with asynchronous, online education, and created adaptive, pragmatic learning opportunities and a Summer Institute. Metrics included the Clinical Research Appraisal Inventory (CRAI), a tool designed to assess research self-efficacy and clinical research skills across 10 domains. Results: We trained 31 scholars in 3 cohorts. Mean scores in nine domains of the CRAI improved; greater improvement was observed from the beginning to the midpoint than from the midpoint to conclusion of the program. Across all three cohorts, mean scores on 52 items (100%) increased (p ≤ 0.01), and 91% of scholars reported the program improved their skills moderately/significantly. Satisfaction with the program was high (91%). Conclusions: Investigators that conduct patient-centered outcomes and CER must know how to collaborate with regional health care systems to identify priorities; pose questions; design, conduct, and disseminate observational and experimental research; and transform knowledge into practical clinical applications. Training programs such as ours can facilitate such collaborations.

Aim Despite substantial tribal, state, and federal effort, American Indian and Alaska Native (AI/AN) suicide rates have changed little in the last 30 years, prompting attention to new and innovative approaches to this persistent health disparity. Suicide prevention interventions with demonstrated success in other populations may be useful in AI/AN communities. Caring Contacts is a suicide prevention intervention that has been adapted and shown to reduce suicide ideation, attempts, and deaths in other populations. Methods We used a community-based participatory research approach to gather qualitative data from community members, healthcare providers, and leaders in four AI/AN communities. These data were analyzed thematically and used to adapt Caring Contacts for use in a subsequent clinical trial with AI/AN people at high risk for suicide. Results A total of 189 community members and other health system stakeholders in four tribal communities participated in focus groups and interviews. Caring Contacts was perceived in all communities to be acceptable. Feedback for intervention adaptations focused on the themes of trial eligibility criteria; instruments; message frequency, timing, and content; and cultural considerations. Conclusion Overall, AI/AN study participants in four diverse AI/AN communities endorsed the use of Caring Contacts for suicide prevention in their communities. Intervention adaptations for use in these communities centered primarily on message frequency and timing as well as expanding access to Caring Contacts. The results of this study may be applicable to other populations that experience suicide-related health disparities.

Over 86% of American Indian and Alaska Native elders live in urban metropolitan areas, yet the extant epidemiological data on cognition and aging in this racial and ethnic population has been collected in reservation communities and may have limited generalizability to the larger population. Multi-faceted, high quality data are needed to assess risk and protective factors in this underserved and understudied population. We intend to collect medical history, lifestyle and behavioral history, neurocognitive battery, anthropometric measures, blood and urine samples, cranial 3T MRI, rsfMRI, and wrist actigraphy data from 1200 urban-dwelling Native elders (age 55 and older) across 5 major metropolitan areas: Anchorage, AK; Seattle, WA; San Bernardino, CA; Phoenix, AZ; and Oklahoma City, OK. This initial cohort will be the first in a NIA-funded longitudinal cohort study to evaluate the brain and cognitive health of this population as they advance in age. Originally funded in the summer of 2019, data collection was initially delayed due to the pandemic, but was initiated at one site (Phoenix) in the summer of 2021 and is now underway at all 5 field sites, with a total of 260 participants enrolled as of the time of this writing. This study represents the largest effort to characterize the cognition and brain health of a generalizable sample of urban-dwelling American Indian and Alaska Native elders to date.

OBJECTIVE:People experiencing homelessness are disproportionately impacted by alcohol-related harm. Racially minoritized groups are disproportionately represented in the homeless population and are likewise disproportionately impacted by alcohol-related harm. Most alcohol outcome measures have not been adequately psychometrically studied in this marginalized population and across racial groups. This study documents psychometric properties, including measurement invariance, reliability, and convergent validity, of a measure of alcohol-related harm, the Short Inventory of Problems (SIP-2R), across Black, North American Indigenous (NAI), and White adults experiencing homelessness and alcohol use disorder (AUD). METHOD:Adults experiencing homelessness and AUD who had participated in one of two randomized controlled trials of harm-reduction treatment (N = 493; NAI = 205, Black = 125, and White = 163) were included in this psychometric study of the 15-item SIP-2R. RESULTS:Multigroup confirmatory factor analysis (MGCFA) indicated that a model comprising one general alcohol-related harm factor overarching five factors, showed close fit and partial scalar invariance, χ²(329, N = 493) = 624.902, p < .001, comparative fit index (CFI) = .966, root-mean-square error of approximation (RMSEA) = .074, 90% CI [.066, .083], standardized root-mean-square residual (SRMR) = .063, confirming acceptable measurement equivalence across racial groups. The SIP-2R showed internal consistency (α = .94, ω = .95) and convergent validity, that is, positive correlation between the total SIP-2R score and the number of drinks consumed the heaviest drinking day, ρ(490) = .30, p < .001. CONCLUSION:This study provided support for the internal consistency, convergent validity, and cross-group measurement equivalence of the SIP-2R for NAI, Black, and White adults experiencing homelessness with AUD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

INTRODUCTION:There is tremendous need for efficacious and accessible interventions for smoking cessation among American Indians and Alaska Natives. We tested the efficacy of an Acceptance and Commitment Therapy (ACT)-based smartphone application (iCanQuit) versus US Clinical Practice Guidelines-based smartphone application (QuitGuide) for smoking cessation among American Indians and Alaska Natives.AIMS AND METHODS:We compared cessation, changes in ACT-based processes, engagement and satisfaction between American Indian and Alaska Native iCanQuit (n = 89) and QuitGuide (n = 80) participants enrolled in the iCanQuit trial. The primary outcome was self-reported, complete-case, 30-day point-prevalence abstinence. Follow-up timepoints were 12, 6, and 3 months.RESULTS:Randomized American Indians and Alaska Natives from 31 US states (70% urban, 30% rural, with 25% of participants residing on tribal land). The outcome data retention rates were 93%, 92%, and 90% at the 12-, 6-, and 3-month follow-ups, respectively, with no differential retention between arms. The 30-day point-prevalence abstinence for iCanQuit versus QuitGuide was 30% versus 18% at 12 months (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 0.90 to 4.26) 25% versus 11% at 6 months (OR = 2.62; 95% CI: 1.06 to 6.45), and 15% versus 6% at 3 months (OR = 2.93; 95% CI: 0.90 to 9.59). Increases in acceptance of internal cues to smoke mediated the effect of treatment on smoking cessation at 12 months. iCanQuit arm participants were also significantly more engaged and satisfied with their assigned application.CONCLUSIONS:In a nationwide sample with high data retention and participant engagement, this is the first study to show that a digital intervention may be efficacious for helping American Indians and Alaska Natives quit smoking.IMPLICATIONS:This is the first study to provide evidence of an efficacious, accessible, and engaging treatment for helping American Indians and Alaska Natives quit smoking. Compared to a US Clinical Practice Guidelines-based smartphone application (QuitGuide), an ACT-based smartphone application (iCanQuit) was more efficacious, engaging, and satisfactory among American Indians and Alaska Natives nationwide. Our results will inform the tailoring of the iCanQuit smartphone application for American Indian and Alaska Native tribal communities and organizations with potential for broad dissemination and high impact.