Assessing the Scientific Accuracy, Readability, and Cultural Appropriateness of a Culturally Targeted Smoking Cessation Program for American Indians Christine Makosky Daley, PhD, MA, SM Paul Cowan, BS Nicole L. Nollen, PhD, MA K. Allen Greiner, MD, MPH Won S. Choi, PhD, MPH Alaska Natives (AI/AN) currently smoke more than any other ethnic group (41% versus 24% for African Americans and Whites; Okuyemi, Cox, Choi, & Ahluwalia, 2004). In addition, AI/AN women are the only group in the United States in whom smoking prevalence has increased during the past two decades, from 34% to 41% (Okuyemi et al., 2004). Because of these disproportion- ately high smoking rates, mortality among AI/AN because of tobacco use is double that of others in the United States (U.S. Department of Health and Human Services [USD- HHS], 1998). AI/AN smokers also have more difficulty trying to quit smoking compared to other ethnic groups (USDHHS, 1998), evidenced by their significantly lower quit ratios (41% of AI/AN who ever smoked have suc- cessfully quit versus 51% of Whites) (Gohdes et al., 2002; Hodge, Fredericks, & Kipnis, 1999) and low rates of long-term cessation success (5% of AI/AN smokers who have made quit attempts have succeeded for 3 months or more) (Centers for Disease Control and Prevention, 2002). The reason for these low quit rates is currently unknown. However, based on our preliminary research, we believe that they may be partially because of a lack of culturally appropriate smoking cessation programs and educational materials that acknowledge traditional use of tobacco, while discouraging secular use. The All Nations Breath of Life (ANBL) program is a smoking cessation program developed for use in a This study assesses educational materials developed for the All Nations Breath of Life smoking cessation program (targeted for American Indians and Alaska Natives) for scientific accuracy, readability and other literacy fac- tors, and cultural appropriateness. The authors used a scientific review panel of experts in smoking cessation representing epidemiology, medicine, and psychology; the suitability assessment of materials (SAM) and the simplified measure of gobbledygook (SMOG) reading grade level formulas; and review by Native program facil- itators and pilot participants. Materials were scientifi- cally accurate and culturally appropriate. The mean SAM score was 80% (superior rating), and the average reading grade level was 7.1 using the Fry formula (part of the SAM) and 8.4 using the SMOG formula (difference was not statistically significant). Based on this project, the SAM can be used in combination with scientific review and input from community members during for- mative research to assess and modify educational mate- rials for a targeted population. Keywords: assessing educational materials; targeted population; American Indian; Alaska Native; smoking cessation I n the United States, tobacco use, especially cigarette smoking, is the leading cause of preventable diseases (McGinnis & Foege, 1993), and American Indians or Health Promotion Practice July 2009 Vol. 10, No. 3, 386-393 DOI: 10.1177/1524839907301407 ©2009 Society for Public Health Education Authors’ Note: The authors wish to thank our program facilitators, Marcia Segraves and Charlotte McCloskey, and our pilot program participants for their input on the All Nations Breath of Life educa- tional materials and Amy Weaver, MPH, for her help in scoring the materials. In addition, we thank the American Lung Association and the University of Kansas Research Institute for funding for our pilot program and development of educational materials. 386 by guest on April 23, 2016 hpp.sagepub.com Downloaded from