Engaging Indigenous peoples in research on commercial tobacco control: a scoping review

Abstract

Commercial tobacco products are a leading contributor to health disparities for many Indigenous peoples. Mainstream interventions developed for non-Indigenous peoples have been found less effective at addressing these disparities. Meaningful engagement is needed to develop effective measures but there are limited understandings of what engagement means in practice. We conduct a scoping review of studies self-reporting engagement with Indigenous peoples; assess their engagement against ethics guidelines concerning research involving Indigenous peoples and writings of Indigenous scholars; and draw lessons for advancing practice. We found engagement of Indigenous peoples in tobacco control research is practiced in varied ways—who conducts the research, who is engaged with, for what purpose, at what research steps, and what approaches are applied. Engagement ranges from limited to deeper commitment to research as decolonizing practice. Critical reflection along five questions can advance research practice for this purpose.

Keywords

tobacco control Indigenous peoples Indigenous health community engagement research design

Introduction

Commercial tobacco is a leading contributor to health disparities among Indigenous peoples¹ in many settler countries (Glover et al., 2013; Maddox et al., 2019). Commercial tobacco is defined as

manufactured by companies for recreational and habitual use in cigarettes, smokeless tobacco, pipe tobacco, cigars, hookahs, and other products. Commercial tobacco is mass-produced and sold for profit. It contains thousands of chemicals and produces over 7,000 chemical compounds when burned, many of which are carcinogenic, cause heart and other diseases, and premature death. (US Department of Health and Human Services, 2014)

For example, commercial tobacco (hereafter tobacco) is responsible for 23% of the gap in health burden (the total impact of disease, injury, and death) between Indigenous and non-Indigenous Australians (Australian Department of Health, 2020). In Canada, tobacco has led to about 1.5 times greater rate of population-adjusted mortality attributable to smoking among Indigenous peoples in Canada (Reading, 2015).

Tobacco control interventions for general populations have been found to be less effective in addressing health inequities from commercial tobacco use among Indigenous peoples. Evidence attributes this to their design by, and for, non-Indigenous populations (Bond et al., 2012). Interventions can thus be perceived by Indigenous peoples as culturally inappropriate, lacking in local orientation and facilitation, and insufficiently drawing on traditional knowledge, strengths and practices. As Baillie et al. (2008) write, “borrowed tobacco control initiatives are failing” in Indigenous communities in Canada. Researchers in the USA (Boudreau et al., 2016; S. Smith et al., 2014), Australia (Cosh et al., 2013) and New Zealand (Grigg et al., 2008) note a similar history of ineffective tobacco control initiatives and need for Indigenous-led solutions. For example, systematic reviews by Minichiello et al. (2016) and Palmer et al. (2017) conclude that Indigenous ownership and community engagement, and culturally appropriate measures, leads to more effective tobacco control. Health Canada’s Federal Tobacco Control Strategy (2018–2023) acknowledges the need to “recognize the unique circumstances of Indigenous populations in Canada,” and commits to “work[ing] with national and regional Indigenous organizations to co-develop distinct approaches” (Health Canada, 2018). At the global level, Article 4 of the World Health Organization (WHO) Framework Convention of Tobacco Control (FCTC) acknowledges, “the need for Indigenous individuals and communities to participate in the development, implementation and evaluation of tobacco control programs that are socially and culturally appropriate to their needs and perspectives” (WHO, 2003).

While there is recognized need for meaningful engagement with Indigenous peoples, to achieve more effective commercial tobacco control, what this means in practice varies widely. Oberly and Macedo (2004) describe a long history of public health researchers and practitioners claiming to consult with Indigenous peoples while prioritizing their own agendas and interests. As a result, “data concerning tobacco-use knowledge, attitudes, and behaviors are woefully lacking . . . due to a shortage of funds, lack of health promotion infrastructure, and the legacy, and continuing practice, of culturally inappropriate research.” More recently, Boudreau et al. (2016) write that the tobacco control community in the USA has not always dealt respectfully with Indigenous communities in the past. To continue to move beyond this legacy of colonization, tobacco control scholars and advocates need a shared understanding and practice around meaningful engagement with Indigenous peoples.

As one step towards this goal, this article presents a scoping review of peer-reviewed studies and theses which self-report engagement with Indigenous peoples. A scoping review is an “examination of a broader area to identify gaps in the research knowledge base, clarify key concepts, and report on the types of evidence that address and inform practice in the field” (Peters et al., 2015). Drawing on core values and principles set out in ethical guidelines for conducting research concerning Indigenous peoples, and writings of Indigenous scholars, we assess this research along five questions concerning different aspects of engagement. We acknowledge that existing guidelines are still emerging, alongside agreement on how to translate them into practice. As such, this review aims to scope, rather than formally evaluate, research practice to date. The article concludes by drawing lessons for supporting meaningful engagement with Indigenous peoples in commercial tobacco control research, as a precursor, to reducing tobacco-related health disparities.

Methods

To identify tobacco control research that self-reports engagement with Indigenous peoples, we searched Google Scholar and the Medline (EBSCO) academic research database (>9,000 journals across all disciplines) from inception to January 2020 without language limits. We used the search string “tobacco” AND “Indigenous” (OR “Aboriginal,” “First Nation*,” “Metis,” “Inuit,” “American Indian,” “Native,” “Maori”) AND “invol*” (OR “engag*,” “consult*,” “participat*,” “collaborat*,” “cooperat*,” “dialogue”) but NOT “India” to search title, abstract or keywords. Google Scholar yielded 231 articles and Medline provided an additional 86 articles (n=317). An additional four articles were brought to our attention during the peer review process. We then searched the ProQuest Dissertations and Theses database and Medline (EBSCO) Host Open Dissertations from inception to January 2020 (n = 97). We screened titles and abstracts for original studies against three inclusion criteria: (a) reporting primary research findings, (b) focusing on Indigenous people(s) and tobacco use and (c) involving engagement with Indigenous people(s) in some aspect of the research process. Consequently, literature reviews and commentaries were excluded, along with those that did not mention methods that included participation of Indigenous peoples in the title or abstract. We acknowledge that studies which may apply these approaches, but do not describe them in the title or abstract, may be overlooked. This resulted in 56 articles and seven dissertations (n = 63) for detailed review (Appendix 1).

The engagement by these studies with Indigenous peoples was then assessed against ethics guidelines concerning research involving Indigenous peoples in settler countries. These include the OCAP^® (Ownership, Control, Access and Possession) principles (First Nations Information Governance Centre, 2019; Inter-Tribal Health Authority, 2005), TriCouncil Policy Statement Research Involving the First Nations, Inuit and Métis Peoples of Canada (Government of Canada, 2018), Guidelines for Ethical Research in Australian Indigenous Studies (AIATSIS, 2012) and Ethical Conduct in research with Aboriginal and Torres Strait Islander Peoples and communities (National Health and Medical Research Council [NHMRC], 2018a). Recognizing that existing guidelines reflect settler perspectives, vary in scope and focus, and thus are emergent as Indigenous people(s) reclaim “control over research activities and the knowledge that research produces” (L. T. Smith, 1999, p. 4), we also draw upon Indigenous scholars writing about health research practice (Boudreau et al., 2016; Castellano, 2020; Drawson et al., 2017; Oberly & Macedo, 2004; Rix et al., 2019; L. T. Smith, 1999).

We organize our scoping review, of how engagement with Indigenous peoples has been practiced to date in commercial tobacco control research, around the following five questions concerning different aspects of engagement: who conducts the research, who does the study engage with, what is the purpose of the research, what research step(s) does engagement take place and what approach is used for engagement.

We consider existing practices against core values (e.g., equity, reciprocity, respect, relevance) and principles (e.g., consent, cultural competency, cultural and intellectual property) put forth in guidelines and scholarly writings (Table 1). Given the emergent nature of these values and principles, we do not consider it appropriate to conduct a formal evaluation of these studies retrospectively. Ethical principles and standards of practice change over time. Moreover, we acknowledge that studies as reported may omit information needed to fully assess them and may thus be more aligned with core values and principles than described. For example, few studies provide details of ethics approvals or research agreements with Indigenous communities. This is not necessarily because these practices were not followed, but that they simply may not have been reported. Instead, based on the self-reported information provided, we draw lessons for meaningful engagement with Indigenous peoples in commercial tobacco control research practice.

Table 1.

Summary of engagement with Indigenous peoples in literature reviewed

Authors	Title	Date	Indigenous (co) author	Indigenous researcher(s) or advisors	Study Population	Study Purpose	Tobacco control measure	Early Stage	Middle Stage	Later Stage	Total number of stages	Research approach and methods
Anderson et al.	Adaptation of a brief smoke-free homes intervention for American Indian and Alaska Native families.	2019	Yes (Nez-Henderson, Halfacre)	Yes	Self-identifying American Indian or Alaska Native ⩾ 18 years of age in California, Oklahoma, Michigan and Alaska, USA	"to adapt the evidence-based intervention“Smoke-Free Homes: Some Things are Better Outside”for use in AI/AN households, to ultimately increase the prevalence of smokefree homes and reduce SHS exposure among AI/AN children and adult nonsmokers"	smokefree environments	1,2,3	4,5	7	6	"community-engaged approach" involving multi-step process for adapting evidence-based interventions; focus groups, participant surveys
Báezconde-Garbanati et al.	Building capacity to address tobacco-related disparities among American Indian and Hispanic/Latino communities: conceptual and systemic considerations	2007	No	No	American Indian community in Oklahoma, USA	“to create a conceptual framework for constructs of community capacity most relevant to American Indian tobacco control efforts, and make recommendations for effective tobacco control and prevention efforts in American Indian communities that are based on our understanding of community capacity”		3	4, 5		3	"community-based participatory process" using key informant interviews, cross-sectional surveys, case study methods
Bar-Zeev Y. et al.	Assessing and Validating an Educational Resource Package for Health Professionals to Improve Smoking Cessation Care in Aboriginal and Torres Strait Islander Pregnant Women	2017	Yes (Bovill)	Yes	health professionals and Aboriginal health workers of Aboriginal Medical Services in three states, AUSTRALIA	to assess and validate an educational resource package for health workers to support smoking cessation care for Aboriginal pregnant women	cessation		4, 5	6	3	"multi-centred community-based participatory 4-step process" including panel review and focus groups
Blanchard J. et al.	Stakeholder Engagement A Model for Tobacco Policy Planning in Oklahoma Tribal Communities	2015	Yes (Petherick)	No	38 Tribal Nations in Oklahoma, USA	"to provide recommendations for employing university-Tribal partnerships as an effective strategy for tobacco policy planning in tribal communities"	smokefree environments	3	4	6	3	"community-based participatory research" using meetings with key Tribal stakeholders (visits, tours, interviews, attendance at tribal events)
Bortoff J. et al.	Bingo halls and smoking: Perspectives of First Nations women	2009	Yes (Mowatt, Sullivan and Williams)	Yes	Gitxsan women living in rural communities, British Columbia, CANADA	to examine bingo halls as a frequent site for exposure to secondhand cigarette smoke for First Nations women in rural communities	smokefree environments	2	4,5	6	4	"qualitative participatory design, informed by an epistemology of constructivism" using interviews, group discussions and observation
Bortoff J. et al.	Strategies for Supporting Smoking Cessation Among Indigenous Fathers: A Qualitative Participatory Study	2018	Yes (Wilson)	No	Self-identifying Indigenous (First Nation or Metis) men and key informants in one urban and one rural (off reserve) community in BC, CANADA	"to engage Indigenous men and key informants in guiding cultural adaptations to the Dads in Gear (DIG) cessation program"	cessation		4,5	6,7	4	qualitative participatory study using group sessions, semi-structured interviews
Bosma L. et al.	The Widookowishin Program : Results From a Qualitative Process Evaluation of Culturally Tailored Commercial Tobacco Cessation Program	2014	Yes (Sandman)	No	Fond du Lac Reservation in Minnesota, USA	to identify the factors contributing to successful recruitment and enrolment of participants from American Indian population in cessation program	cessation	3	4,5		3	"qualitative process evaluation" based on key informant interviews
Bovill M. et al.	Giri-nya-la-nha (talk together) to explore acceptability of targeted smoking cessation resources with Australian Aboriginal women	2018	Yes (Bovill, Gruppetta) Lead Author	Yes	Aboriginal women of varied age in three states, AUSTRALIA	To engage with health providers and Aboriginal women to understand what educational resources they want and need to support quit smoking attempts during pregnancy in order to develop a comprehensive evidence-based intervention	cessation	3	4,5	6,7,8	6	"participatory action research approach" to develop and pilot intervention using yarning circles (focus groups)
Bowen D. et al.	Short-Term Effects of smoking Prevention Website in American Indian Youth	2012	Yes (Henderson)	No	American Indian youth attending Native summer camp in Northern Plains, USA	to test feasibility of web-based intervention, adapted from intervention for Canadian youth, to influence attitudes towards and intentions to smoke among American Indian youth	prevention		4	6	2	RCT involving pre and post test of intervention
Burgess D. et al.	Beliefs and Experiences Regarding Smoking Cessation Among American Indians	2007	No	Yes	American Indian communities in Minneapolis/St Paul’s metropolitan area of Minnesota, USA	to understand American Indian views about smoking and cessation	cessation		4		1	no approach described in use of focus groups
Campbell M. et al.	Kick the Habit: a Social Marketing Campaign by Aboriginal Communities in NSW	2014	No	No	Aboriginal communities in New South Wales, AUSTRALIA	to evaluate the Kick the Habit Phase 2 social marketing campaign which was locally tailored and culturally relevant	cessation	3	4,5	6	4	mixed methods approach using surveys and interviews
Chan Osilla K et al.	Regular Tobacco Use among American Indian and Alaska Native Adolescents: An examination of protective mechanisms	2008	No	No	112 American Indian and Alaskan Native adolescents (13-19 years), Seattle, WA, USA	"to fill the void in knowledge about prosocial behaviors and characteristics, essential for promoting and fostering positive youth outcomes, by discussing prosocial peer networks, future aspirations, and extracurricular activities as protective factors against regular tobacco use"	cessation, prevention		4		4	no approach stated “to identify the prosocial behaviors and characteristics” using interviews
Charlier N. et al.	Keeping Kids Smokefree: lessons learned on community participation	2009	Yes (Glover)		4000 pre-adolescents students in a community with a high percentage of Māori and Pacific Island people, NEW ZEALAND	to draw lessons about community participation in program decision-making and implementation based on a quasi-experimental trial	prevention		4	6, 7	3	Process evaluation using document review, focus groups and interviews
Choi W. et al.	Culturally Tailored Smoking Cessation for American Indians: Study protocol for a randomized controlled trial	2011	Yes (Daley)	Yes	448 American Indian smokers, USA	to present the study protocol for a RCT to determine the efficacy of a culturally-tailored smoking cessation program for American Indians	cessation	3	4	6	3	RCT to pre and post test intervention using interviews, focus groups and testing (saliva)
Cosh S. et al.	Aboriginal and Torres Strait Islander utilisation of the Quitline service for smoking cessation in South Australia	2013	Yes (Copley)	No	Indigenous Australians in South Australia, AUSTRALIA	to explore utilisation of cessation program by Indigenous Australians	cessation		4	6	2	quantitative study of demographic data using survey
Cuthbert K. et al.	Engaging with Aboriginal Shire Councils in remote Cape York communities to address smoke-free environments.	2019	Yes (Tayley, Deemal-Hall)	Yes	16 communities in Cape York, Far North Queensland, AUSTRALIA	to discuss how Apunipima Cape York Health Council worked with three Aboriginal Shire Councils to create more smokefree places	smokefree environments	1,3	4	7,8	5	community-led action approach using working groups, workshop and information sessions
Dawson A. et al.	Aboriginal health workers experience multilevel barriers to quitting smoking: a qualitative study	2012	Yes (Chong and Stewart)	No	23 Aboriginal Health Workers and 11 other health staff, key informants in South Australia, AUSTRALIA	"to identify the direct and indirect barriers to quitting smoking experienced by AHWs"	cessation	3	4,5	6	4	mixed-method participatory approach using interviews, focus groups and content analysis
Dawson A. et al.	Identifying Multi-Level Culturally Appropriate Smoking Cessation Strategies for Aboriginal Health Staff: A Concept Mapping Approach	2013	Yes (Chong)	No	Aboriginal health workers, other health workers, tobacco control personnel, AUSTRALIA	to identify and prioritize culturally relevant strategies to promote smoking cessation among Aboriginal health workers	cessation		4,5	6,7	4	"partnership approach" applying a structured group conceptualization process integrating stakeholder inputs using interviews, focus groups and workshop
D’Silva J. et al.	Evaluation of a Tailored Approach for Tobacco Dependence Treatment for American Indians	2011	Yes (Sandman)	No	Fond du Lac Reservation in Minnesota, USA	"To evaluate a tailored approach for tobacco dependence for American Indians"	cessation		4	6	2	"culturally tailored approach" to adapt science-based models and tailoring content and service delibery using baseline and exit interviews
Esdonk T. et al.	Reducing Smoking in Pregnancy Among Māori Women: “Aunties” Perceptions and Willingness to Help	2014	Yes (Glover)		Maori community health workers, NEW ZEALAND	to determine the willingness and perceived ability of Maori “Aunties” to find pregnant Māori smokers early in pregnancy and to provide cessation support	cessation		4	6	2	community-based participatory research using focus groups,
Gendron F.	Aboriginal youth’s perceptions of traditional and commercial tobacco in Canada	2017	No	No	25 Aboriginal youth ( 9-14 years) attending FN University of Canada summer camp in Saskatchewan, CANADA	"to examine Aboriginal youth’s perceptions of traditional and commercial tobacco and to evaluate perception changes following workshops on traditional uses of tobacco by Elders and other community members, native plants used in ceremony and health impacts of cigarette smoking"	prevention		4		1	no approach stated in testing intervention using surveys and workshop
Glover M. et al.	Keeping Kids Smokefree: rationale, design, and implementation of a community, school, and family-based intervention to modify behaviors related to smoking among Māori and Pacific Island children in New Zealand	2009	Yes (Glover) Lead author		11-12 year olds in 4 schools in an urban area of high social deprivation with large numbers of Māori and Pacific Islands families, NEW ZEALAND	to investigate whether changing parental smoking behavior and attitudes via a community-partnership approach with parents, schools, and local health providers can reduce smoking initiation	prevention	1, 3	4	6	4	quasi-experimental trial using surveys
Glover M. et al.	Enlisting “Aunties” to Support IndigenousPregnant Women to Stop Smoking: FeasibilityStudy Results	2015	Yes (Glover) Lead author	No	Maori voluntary health workers, NEW ZEALAND	to test a “proactive approach, utilizing Māori voluntary community health workers to identify and reach Māori pregnant women who smoke and provide cessation support”	cessation	3	4	6	3	"exploratory participatory study" using surveys and interviews
Glover M. et al.	Could ‘Aunties’ Recruit Pregnant Indigenous Women Who Smoke Into a Trial and Deliver a Cessation Intervention? A Feasibility Study	2016	Yes (Glover) Lead author	Yes	pregnant Maori women and role of “Aunties”, NEW ZEALAND	to test an intervention for pregnant Maori women who smoke, recruit them into a study and deliver an acceptable cessation intervention	cessation	1	4	6, 8	4	participatory approach using survey, interviews
Gould G. et al	Exploring anti-tobacco messages from an experiential arts activity with Aboriginal youth in an Australian high-school setting	2017	Yes (Gruppetta)	No	20 Aboriginal high school students at regional New South Wales school, AUSTRALIA	"To engage youth in exploring the meaning of smoking for the Aboriginal community through an interactive classroom session"	prevention	2	4,5	8	4	no approach stated to test intervention using interactive classroom session, poster making and framework analysis
Gould G. et al	“Building strength in coming together”: A mixed methods study using the arts to explore smoking with staff working in Indigenous tobacco control	2018	Yes (Bovill, Gruppetta)	No	Indigenous and non indigenous staff working in Indigenous tobacco control who registered for pre-conference workshop at Oceania Tobacco Control Conference (2015)	"to introduce health professionals, who work with Indigenous communities, to the idea of using arts within their tobacco control work"			4,5	6,7,8	5	mixed methods study to pre and post test use intervention involving workshop and surveys
Grigg M. et al.	Response to an Indigenous Smoking Cessation Media Campaign- It’s about whānau	2008	Yes (Brandbrock)	Yes	Maori smokers and family unit, NEW ZEALAND	"to assess any effects among Māori smokers and their whānau of a campaign designed to support Māori smokers to quit smoking"	cessation		4	6	2	no approach stated to pre and post campaign using cross sectional population surveys
Harvey D. et al.	An evaluation of tobacco brief intervention training in three Indigenous health care settings in north Queensland	2002	Yes (Cadet-James)	Yes	health staff and patients of three health care settings in rural and remote north Queensland, AUSTRALIA	"To evaluate the pilot phase of a tobacco brief intervention program"	cessation	2	4	6	3	no approach stated to “develop and evaluate evidence-based strategies” using interviews and focus groups
Hayward L. et al.	Aboriginal Users of Canadian Quitlines: an exploratory analysis	2007	No	No	first time quitline callers (Aboriginal and non-Aboriginal) ⩾18 years, CANADA	"To conduct an exploratory, comparative study of the utilisation and effectiveness of tobacco cessation quitlines among aboriginal and non-aboriginal Canadian smokers"	cessation		4		1	exploratory comparative analysis of survey data
Hefler M. et al.	Using Facebook to reduce smoking amongAustralian Aboriginal and Torres StraitIslander people: a participatory groundedaction study	2019	No	No	13 self-identifying Aboriginal or Torres Strait Islander participants varying by gender, age, residential location, socioeconomic and employment/study status, and smoking status, Northern Territory, AUSTRALIA	"to investigate how social media can be effectively used to enhance Indigenous tobacco control in Australia by understanding the decision making processes of community members for sharing tobacco control content with family and friends on Facebook"	prevention	3	4		2	grounded action (grounded theory and participatory action research) approach using social media data
Hodge C.	“Starting Stories” among Older Northern Plains American Indian Smokers	2009	Yes (Hodge) Lead Author	Yes	Community members of 7 Plains Indian tribes in Minnesota, Nebraska and South Dakota, USA	To understand factors influencing starting smoking behaviour among American Indian smokers	prevention		4,5	6	3	no approach stated to understand high smoking rates using focus groups
Horn K. et al.	Quit and Reduction Rates for a Pilot Study of the American Indian Not On Tobacco (NOT) Program	2005	Yes (Shorty)	No	74 American Indian youths (14-19 years) in North Carolina, USA	"to determine the preliminary quit and reduction outcomes of the American Lung Association’s newly adapted American Indian Not On Tobacco (NOT) program"	cessation	3	4	6	3	community-based participatory research using focus groups, interviews, surveys, informal discussions (testimonials, storytelling) to develop intervention; quasi-experimental pre and post intervention testing of participant and control group using self reported quit and reduction behaviours
Ivers R. et al.	The role of remote community stores in reducing the harm resulting from tobacco to Aboriginal people	2005	No	No	29 tobacco vendors (85% Aboriginal) and 5 tobacco control workers (2 Aboriginal) in remote Aboriginal communities, Northern Territory, AUSTRALIA	"to assess the potential for reducing the harm resulting from tobacco use through health promotion programmes run in community stores in remote Aboriginal communities"	prevention, cessation, smokefree environments		4		1	no approach stated to conduct pre and post test evaluation of evidence-based interventions using stakeholder interviews, observation and community surveys
Ivers R. et al.	Evaluation of a multi-component community tobacco intervention in three remote Australian Aboriginal communities	2006	No	No	6 Aboriginal communities in the Northern Territory, AUSTRALIA	"to assess the effect of community tobacco interventions in Aboriginal communities"	prevention, cessation, smokefree environments, tobacco sponsorship	3	4		2	RCT to pre and post interventions using surveys
Johnston V, Thomas D.	What works in Indigenous tobacco control? The perceptions of remote Indigenous community members and health staff	2010	No	Yes	Members of 3 remote communities in the Northern Territory, AUSTRALIA	"to explore the perceptions of remove Indigenous community members and health staff regarding the acceptability and effectiveness of different tobacco control health promotion interventions"	cessation, prevention, smokefree environments	2	4,5		3	qualitative study to explore perceptions of different interventions using interviews and observation
Lichtenstein E. et al.	Promoting tobacco control policies in northwest Indian tribes.	1995	Yes (Lopez)	No	Members of 39 Indian tribes in Washington, Oregon and Idaho, USA	"to develop and evaluate a culturally appropriate tobacco policy consultation process"	cessation, prevention, smokefree environments		4		1	RCT to pre and post test early and late intervention using telephone surveys
Lichtenstein E. et al.	Effectiveness of a consultation intervention to promote tobacco control policies in Northwest Indian tribes: Integrating experimental evaluation and service delivery	1996	Yes (Lopez)	No	Members of 20 autonomous Indian tribes in Washington, Oregon and Idaho, and 19 Indian tribes previously studied, USA	to conduct and evaluate a “quasi-experimental replication of an intervention for promoting tobacco control policies in Northwest India Tribes”	cessation, prevention, smokefree environments		4		1	quasi-experimental pre and post test design using kick off orientation, visits, workbooks and telephone consultation
Makosky Daley C. et al.	Tobacco Has a Purpose, Not Just a Past: Feasibility of Developing a Culturally Appropriate Smoking Cessation Program for a Pan-Tribal Native Population	2006	Yes (Makosky Daley) Lead Author	Yes	Pan-tribal population representing >200 American Indian groups in Kansas, MI, USA	to evaluate a currently untested program designed by the Muscogee Nation as basis for feasibility of smoking cessation intervention in a pan-tribal population	cessation		4	6	2	"critical interpretive framework" using surveys and focus groups
Makosky Daley C. et al.	All Nations Breath of Life: Using Community-Based Participatory Research to Address Health Disparities in Cigarette Smoking among American Indians	2010	Yes (Makosky Daley) Lead Author	No	Pan-tribal population representing >200 American Indian groups in Kansas, MI, USA	to develop and pilot test pan-tribal smoking cessation program for American Indian communities	cessation		4	6,7	3	"community-based participatory research approach" to develop intervention using focus groups and peer evaluation
Margalit R. et al.	Lakota Elders’ Views on Traditional Versus Commercial Addictive Tobacco Use; Oral History Depicting a Fundamental Distinction	2013	Yes (Red Shirt and Kills Small)	Yes	Lakota elders of Northern Plains Indians, USA	"to elucidate Lakota elders’ views on traditional tobacco and commercial/addictive tobacco use" as oral history	prevention	2,3	4,5	6,7	6	"community-based participatory research approach" using interviews and qualitative analysis
Marley J. et al.	Clinical trials in a remote Aboriginal setting: lessons from the BOABS smoking cessation study	2014	Yes (Kitaura)	Yes	project staff and chief investigators of BOABS Study, AUSTRALIA	to describe the lessons learned from the Be Our Ally Beat Smoking (BOABS) Study for development and implementation of an integrated smoking cessation program	cessation		4	6,8	3	qualitative study using diaries, reflection, meetings, interviews and workshops
McKennitt D, Currie C.	Does A Culturally Sensitive Smoking Prevention Program Reduce Smoking Intentions Among Aboriginal Children? A Pilot Study	2012	Yes (McKennitt) Lead Author	No	Students in Grade 4 class in 2 schools with high Aboriginal student populations, Alberta, CANADA	"to determine if a culturally sensitive smoking prevention program would have short-term impacts on smoking intentions among Aboriginal children"	prevention		4	6	2	RCT to pre and post test intervention using surveys
Moncher M, Schinke S.	Group Intervention to Prevent Tobacco Use Among Native American Youth	1994	No	No	1386 Native American youth living in Pacific Northwest, USA	to report findings from a “culturally sensitive intervention to reduce tobacco use among Native Americans in the Pacific Northwest”	prevention		4		1	no approach stated to conduct “intervention outcome study” to pre and post test prevention strategy using surveys and biochemical marker samples
Montgomery M. et al.	The Native Comic Book Project: Native Youth Making Comics and Healthy Decisions	2012	Yes (Chock)	Yes	30 Native youth leaders and 6 youth (12-15 years) from 1 tribal community in Pacific Northwest, USA	"to describe the development of a curriculum that trains Native youth leaders to plan, write, and design original comic books to enhance healthy decision making"	prevention	2,3	4	6,7,8	6	no approach stated to pilot and evaluate intervention using surveys, participant observations and meetings
Patten C. et al.	Focus Groups of Alaska Native Adolescent Tobacco Users: Preferences for Tobacco Cessation Interventions and Barriers to Participation	2009	Yes	Yes	49 Alaskan Native female adolescents, Western Alaska, USA	"to explore preferences for tobacco cessation interventions and barriers to participation"	cessation		4	6	2	content analysis of data from focus groups
Patten C. et al.	Feasibility of a tobacco cessation intervention for pregnant Alaska Native women	2010	Yes	No	Alaska native pregnant tobacco users, USA	"to assess the feasibility and acceptability of a targeted cessation intervention for Alaska Native pregnant women"	cessation		4	6	2	RCT using pre and post intervention interviews, data on recruitment and retention rates
Patten C. et al.	Tobacco Cessation Treatment for Alaska NativeAdolescents: Group Randomized Pilot Trial	2014	Yes	Yes	adolescents in 8 villages in Western Alaska, USA	to evaluate feasibility and potential efficacy of targeted cessation intervention for Alaska Native youth	cessation		4,5	6	3	RCT comparing participant and control groups using talking circles, surveys, saliva testing
Ratsch AM. et al.	The Pituri Learning Circle: central Australian Aboriginal women’s knowledge and practices around the use of Nicotiana spp. as a chewing tobacco	2017	Yes (Mason)	Yes	13 senior Aboriginal women representatives of Ngaanyatjarra, Pitjantjatjara and Yankunytjatjara, AUSTRALIA	To understand knowledge and practices around the use of Nicotiana spp (chewing tobacco) among central Australian Aboriginal women	cessation	1,2,3	4,5	6,7	7	narrative approach using Learning Circle methodology based on semi-structured interviews with trigger resources and thematic validation
Sabesan S. et al.	My Family’s Anti-Tobacco Education (MY-FATE) model for Aboriginal and Torres Strait Islander Peoples	2015	Yes (Geia)	Yes	28 extended family members of Aboriginal cancer patient, North Queensland, AUSTRALIA	to describe the lessons learned and feasibility of My-FATE program to Australian and Torres Strait Islander peoples	cessation, prevention	3	4	6	3	participant action research approach using focus groups (yarning circles)
Schinke S. et al.	Reducing Cancer Risk among Native American Adolescents	1996	No	No	Youth of 8 Native American communities, Connecticut, Maine, Massachusetts, New Jersey, New York and Rhode Island, USA	to discuss the development, implementation and preliminary testing of an intervention to reduce cancer risks through tobacco use prevention and dietary modification among Native American youth	prevention	3	4		2	"culturally specific approach" to advance skills interventions for risk reduction using focus groups, interviews, surveys
Tane M. et al.	An evaluation of the ‘Yaka Ŋarali’’ Tackling Indigenous Smoking program in East Arnhem Land: Yolŋu people and their connection to ŋarali	2017	Yes (Tane) Lead Author	Yes	30 elders and leaders in 7 communities of Yolŋu peoples, East Arnheim Land, Northern Territory, AUSTRALIA	to report on evaluation of Indigenous smoking program	cessation	3	4,5	6,7	5	symbolic interactionism approach using interviews based on story telling ultural mentors
Tane M. et al.	Do the Yolŋu people of East Arnhem Land experience smoking related stigma associated with local and regional tobacco control strategies?: An Indigenous qualitative study from Australia.	2019	Yes (Tane) Lead Author	Yes	13 members of Yolŋu peoples including elders, family members and health workers, East Arnheim Land, Northern Territory, AUSTRALIA	to explore the lived experiences of Yolŋu informants to determine whether tobacco control denormalisation efforts in the region had produced smoking-relatedstigma	cessation	1,3	4,5	7	5	qualitative study with intentional positioning using interviews
Taualii M. et al.	Adaptation of a Smoking Cessation and Prevention Website for Urban American Indian/Alaska Native Youth	2010	Yes (Taualii) Lead Author	Yes	12 American Indian and Alaska Natives youth (12-18 years) including Ponca, Assinaboin, Cree, Shoshone, Yakama,Shoshone, Gros Vente, Sioux, Caddo, Blackfeet, Makah,Lakota Sioux, and Aztecvaried, urban areas of Pacific Northwest, USA	to report on efficacy of adapted and modified web-based and youth focused tobacco control program	cessation, prevention	3	4	6	3	no approach stated to conduct formative pilot study using focus groups
Unger J. et al.	Perceptions of ceremonial and nonceremonial uses of tobacco by American-Indian adolescents in California	2006	Yes (Soto)	Yes	40 American Indian adolescents in urban and rural southern California, USA	to understand “modern day perceptions of tobacco among American-Indian adolescents”	prevention		4	6	2	focus groups
Varcoe C. et al.	Wisdom and influence of elders: Possibilities for health promotion and decreasing tobacco exposure in First Nations communities	2010	Yes (Williams)	Yes	Elders of 6 rural reserves in Gitxsan territory, northern BC, CANADA	to gather information on interpersonal and systemic influences on smoking practices and exposures to inform development of meaningful strategies with community	cessation, smokefree environments	2,3	4,5	6,7	6	decolonising approaches informed ethnographic methods using individual and group interviews, and participant observation
Weaver H, Jackson K.	Healthy Living in Two Worlds: Testing a Wellness Curriculum for Urban Native Youth	2010	Yes (Weaver)	No	16 urban Native American youth (9-13 years) in Northeastern states, USA	to pilot test a wellness curriculum which covers physical activity, tobacco use and diet	cessation, prevention	2,3	4	6,8	5	no stated approach for pilot study to pre and post test culturally grounded curriculum using surveys and process evaluation
DISSERTATIONS
Angstman S.	Tobacco use among Alaska Native and American Indian college students	2009	No		105 American Indian and 68 Alaskan Native college students in Montana and Alaska, USA	to describe tobacco use and related characteristics within each population and to determine whether differences existed between the populations with respect to proportion of students using spit tobacco and using tobacco in a ceremonial context in order to to inform targeted interventions	cessation	3	4,5	7	4	some principles of community-based participatory approach using surveys and focus groups
Doucette M.	A study of the Social Factors Contributing to Youth Smoking in an Inuit Community	2007	No		Inuit youth, CANADA	to understand what social influences may encourage youth to begin smoking or abstain from tobacco use	prevention	3	4		2	mixed methods approach using survey and focus groups
Haring R.	Describing the process of meaningful change: Seneca stories of becoming smoke free	2007	Yes		16 members from the Seneca Nation, Allegany and Cattaraugus Indian Reservations, New York, USA	to discover the method, strategies, and process members used when they quit smoking	cessation		4	6	2	grounded theory approach guided by social work principles using key informant interviews
Lukasewich M.	“It was a once in a lifetime opportunity”: The Power of Participating in a Video Research Project for Aboriginal Youth	2015	No		adult collaborators and 28 Indigenous youth from of K’alemi Dene School, Ndilo, Northwest Territories, and Queen Elizabeth High School, Edmonton, Alberta, CANADA	to understand the extent participation in a school-based health promotion CBPR video project conducted with Aboriginal youth led to positive youth perspectives of their health and wellbeing; how the process of participation in research can contribute to building the necessary foundation for youth to embark on an empowering journey	cessation, prevention		4,5		2	community based participatory action approach, from strengths-based perspective, using interviews, focus groups and participatory video method
Mutch B.	Bringing it Back: The Meaning of Tobacco to Manitoba’s Metis Peoples	2011	Yes		7 Metis adults living in Winnipeg, Manitoba, CANADA	to provide insight into the meaning of tobacco and tobacco control from the perspective of Metis people living in Manitoba			4	6	2	Aboriginal-guided decolonizing approach using oral tradition, interviews and grounded theory
Rollins K	A Culturally Tailored Tobacco Cessation Program for American Indians: Program Development	2016	No		community members of Prairie Band Potawatomi Nation and Kickapoo Tribe in Kansas, USA	to collect information through formative research to beused inthedevelopment of a culturally tailored SLT cessation program for AI. A secondary purpose was to assess program curriculum for scientific accuracy, readability and cultural appropriateness	cessation	3	4		2	community-based participatory approach using focus groups and interviews
Stevenson, S	Traditional and Non-Traditional Tobacco Use Among First Nations Persons Living on Reservein Canada: Distinctions, Emotions, and Visions of Best-Case Future Realities	2013	No		Indigenous people in Fort William First Nation, Ontario, CANADA	to determine whether a concept of traditional and non-traditional tobacco use exists among members Fort William First Nation; how members distinguish between traditional and non-traditional uses of tobacco; tobacco’s roles in the community; emotions that members experience in relation to tobacco; and members’ visions of best-case, future realities of tobacco use in their community	prevention, cessation	3	4,5	7	4	qualitative study using focus groups
											3.33898305

Findings

Who conducts the study?

One long-standing criticism of much health research concerning Indigenous people(s) has been its conduct by non-Indigenous researchers. As Abimbola (2019) writes, the legacy of colonization continues to impact how research is conducted. For Indigenous peoples, the phrase “nothing about us without us” has been used to express concern about the “unidirectional gaze by non-Indigenous researchers” (Ball, 2005). For example, under the OCAP^® principles, Indigenous control extends to “all aspects of research and information management processes . . . all steps of a particular research project—from start to finish” (First Nations Information Governance Centre, 2019). This includes Indigenous peoples with lived experience as researchers. As Ball (2014) describes,

[w]hile the number of Indigenous researchers is growing, most research about Indigenous people continues to be done by non-Indigenous investigators and students. Supporting the development of Indigenous research capacity and the inclusion of Indigenous students and community members on research teams, must be a priority in research involving Indigenous people.

Based on online searches of author names, 46 (73%) studies have at least one self-identified Indigenous (co)author, with 13 studies (21%) having Indigenous lead authors. Beyond authorship, at least 24 studies (38%) involve Indigenous peoples as research assistants or advisors. For example, Ivers, Castro, Parfitt, Baili, D’Abbs and Richmond (2006) and Ivers, Castro, Parfitt, Bailie, Richmond & D’Abbs (2006) employ an Indigenous research assistant to recruit participants, explain the study in the local language when needed, and facilitate informed consent. Many studies acknowledge the importance of hiring Indigenous research assistants to collect data in culturally appropriate ways. Tane et al. (2019) recruit “Cultural Mentors” who provide “oversight and guidance throughout the research, through language interpretation during qualitative interviews, cultural advice pertaining to the observance of ŋarali’ [tobacco] traditional practices and insight during analysis.” It is not possible, with the information provided by the studies, to determine the extent Indigenous (co)authors, research assistants and advisors are from the Indigenous study population. Where the study concerns a broadly defined Indigenous population, such as Aboriginal health workers in Australia (Bar-Zeev et al., 2017), the specific cultural affiliation of the Indigenous researcher may not be as important. Where the research concerns a specific community, involving community members as researchers could be important for achieving more meaningful engagement.

Who does the study engage with?

While all the studies in this review self-report engagement with Indigenous peoples, who each study actually engages with specifically varies. Indigenist and decolonizing research methodology calls for research that “fully captures and honors the voices and perspectives of Indigenous peoples but, more importantly, emanates from an Indigenous ontological and epistemological basis” (Rix et al., 2019, p. 259). Principles of ethical research involving Indigenous peoples require for example “consultation,” “negotiation,” “participation” and “informed consent” (AIATSIS, 2012). However, what these terms mean in practice lacks clarity and consensus. To move towards improved research practice to meet recognized principles, greater clarity is needed about who should be consulted and negotiated with, or invited to participate and give informed consent. The extent to which there is meaningful engagement, which enables research that genuinely reflects the perspectives of Indigenous peoples, depends on who is actually engaged with by the research.

By settler country, the distribution of studies reviewed engaged with Indigenous peoples in the USA (45%), Australia (29%), Canada (16%) and New Zealand (10%). This is perhaps reflective of the balance of tobacco control research in general being conducted in these countries. However, this may also be suggestive of the extent to which tobacco control research, being conducted in these countries, seek to engage with Indigenous peoples.

By unit of analysis, studies range from individuals selected by demographic variable (i.e., sex and gender, age, social status, expectant women) or specific behaviour (e.g., smokers, health workers) related to tobacco use, to social groups spanning single or multiple nations/tribal affiliations or other defined domain (e.g., urban, rural, online website user). We found the term “community” used in the studies reviewed to variably refer to membership by shared ethnicity, tribal affiliation or geographical location (e.g., living on reserve). Study population size ranges from a small number of key informants to nation-level population surveys.

On the approach used by each study to identify the Indigenous peoples with whom to engage with, most apply the methods of settler scholars to select subjects for focus groups, surveys or interviews. These research methods seek to enhance validity and reliability through appropriate sampling (e.g., random, purposive, convenience) to ensure an appropriate study population. Indigenist and decolonizing approaches and methods may also seek to enhance validity through the building of meaningful relationships by the researcher. As Rix et al. (2019) describe,

we do not engage in relationships, nor are we in relationships, but we are relationships. Our very being, and the nature of reality itself, is relational. We are relationships with people and communities, with the Land, with ideas, with everything. (p. 259)

As such, the researcher “is not outside of reality looking in but has entered into a different set of relationships with the people and issues that they are researching.”

The challenges faced, in applying mainstream sampling methods to a randomized control trial (RCT), in some of the studies reviewed, illustrate the difference between settler² and Indigenist approaches to identifying who should be engaged with (Glover et al., 2015). Lichtenstein et al.,(1995, 1996), partnering with an Indian Health Board in the northwestern USA, describe opposition to their initial RCT plans on the grounds that a “control community” contradicted the Board’s mandate to serve all tribes equally. The agreed compromise was for communities to be randomly allocated to begin the consultation immediately or be “waitlisted” until an evaluation of the first communities was completed. In seeking to conduct an RCT among Alaskan Native adolescents, Patten et al. (2014) also describe challenges in recruiting a control group. They conclude that the study design was ineffective and there is a need for innovative sampling methods to capture multiple domains (e.g., familial, social and community). The studies reviewed suggest that, when seeking to define study populations for meaningful engagement, mainstream sampling methods may be inappropriate. Rather than criteria such as representativeness, generalizability or efficiency, the significance of social relationships and cultural values held by Indigenous peoples to be engaged with may be more important considerations. A form of purposeful sampling might be conducted, for instance, in partnership with an Indigenous community in ways that align with relationships and values. For example, Margalit et al. (2013) consult community members to identify who is recognized as an elder before purposive sampling of key informants. Overall, researchers seeking to meaningfully engage with Indigenous peoples should critically reflect on how Indigenous people come to be defined as study populations in their research and, in turn, who is then chosen to engage with.

What is the purpose of the research?

A common criticism of health research involving Indigenous peoples is a lack of relevance to their lived experience, and hence priority health needs, of Indigenous peoples. This can arise for a number of reasons including inadequate representation of Indigenous perspectives among the researchers and insufficient engagement with the study population as described earlier. In addition, there can be a prioritization of benefits accruing to researchers, rather than Indigenous peoples, in the funding and design of research. More fundamentally, the epistemological and ontological starting points of settler methodologies tend to “pathologize” Indigenous people and communities, focusing on compartmentalizing and then addressing perceived deficits in the physical and mental health of individuals, Indigenous peoples’ behaviours, or the shortcomings of Indigenous societies. While seeking to improve health, mainstream research is described as too often framed and conducted in ways that are inherently biased towards maintaining systems of dispossession and oppression (Carlson, 2016; Rix et al., 2019; L. T. Smith, 1999). In contrast, Indigenous methodologies emphasize strengths-based approaches, and a holistic view of health and wellness, locating individuals within social and historical contexts, as well as “links which bind the generations together” (NHMRC, 2018a, p. 4). To address the need for research to be more relevant to Indigenous peoples, many guidelines support the value of reciprocity (First Nations Information Governance Centre, 2019; Government of Canada, 2018), and call for research outcomes that produce “specific results that respond to the needs and interests of Indigenous peoples” (AIATSIS, 2012). As Ball (2005) writes, “[p]artnerships can help to ensure that topics under investigation are priorities for Indigenous peoples, that they reinforce Indigenous values, are understood using Indigenous frames of reference, and are beneficial to Indigenous peoples.”

On study purpose, we found 43 (68%) of the studies reviewed seek to achieve individual behaviour change through measures focused on cessation and/or prevention. Twenty-eight of these studies assess the effectiveness of culturally adapted cessation and/or prevention interventions for reducing, or increasing knowledge of the health harms arising from, tobacco use as a behavioural risk factor. For example, Schinke et al. (1996) attribute the “high prevalence of cancers” among Indigenous peoples to “behavioural and lifestyle patterns,” and the fact that “[c]learly, the wisdom of cancer prevention has not found its way into the lives of most Native Americans.” Similarly, Weaver and Jackson (2010) seek to develop a culturally appropriate wellness curriculum based on the starting point that “risk factors such as poor diet, recreational tobacco use, and a sedentary lifestyle can be modified through health conscious choices.” This strong emphasis on modifying the behaviour of Indigenous peoples is consistent with commercial tobacco control research as a whole, as well as, public health efforts to address rising rates of non-communicable diseases more generally. As Lee and Crosbie (2020) argue, “mainstream approaches to tackling NCDs have so far overwhelmingly focused on so-called demand-side measures which seek to change the modifiable behaviours of consumers.” These approaches assume that “NCDs are primarily self-inflicted, and that people must simply be convinced of the error of their unhealthy ways.” This emphasis on individual behaviour is also a reflection of reductionist western approaches versus holistic Indigenous perspectives, as described earlier, which prioritize relationships and communities. For example, the Māori model of health emphasises four cornerstones of health—physical, spiritual, family and mental health (Durie, 2017).

A small number of studies seek to understand broader factors that contribute to tobacco use. Ten studies (16%) concern secondhand smoke exposure and the promotion of smokefree environments in homes, private venues (e.g., casinos) and public places. One study (1%) considers the role of sports sponsorship and is, indeed, the only study to examine the role of marketing of commercial tobacco products to Indigenous peoples. The purpose of six studies (10%) is to better understand the meanings of tobacco (commercial and traditional) from Indigenous perspectives as a precursor to developing culturally appropriate measures (Unger et al., 2006; Varcoe et al., 2010). Mutch (2011), for example, uses “a framework for Aboriginal-guided decolonizing research” to understand “the meaning of tobacco and tobacco control from the perspective of Metis people.” As a Metis woman, the author locates tobacco misuse within “a long-standing history within Aboriginal culture,” which includes ceremonial, spiritual and cultural aspects. A study by Stevensen (2013) seeks,

to determine whether a concept of traditional and non-traditional tobacco use exists among members of Fort William First Nation; how members distinguish between traditional and non-traditional uses of tobacco; tobacco’s roles in the community; emotions that members experience in relation to tobacco; and members’ visions of best-case, future realities of tobacco use in their community.

Similarly, Margalit et al. (2013) aim “to elucidate Lakota elders’ views on traditional tobacco and commercial/addictive tobacco use,” and Ratsch et al. (2017) sets out to “understand knowledge and practices around the use of Nicotiana spp (chewing tobacco) among central Australian Aboriginal women.”

Three studies (5%) take a strengths-based approach. Lukasewich (2015) seeks to understand the extent participation in a school-based health promotion video project with Aboriginal youth led to positive perspectives on health and wellbeing; and how research participation can contribute to embarking on an empowering journey. Chan Osilla et al. (2007) aim “to fill the void in knowledge about prosocial behaviors and characteristics, essential for promoting and fostering positive youth outcomes, by discussing prosocial peer networks, future aspirations, and extracurricular activities as protective factors against regular tobacco use.” Weaver and Jackson (2010) pilot a wellness curriculum which covers physical activity, tobacco use and diet.

Overall, the majority of the studies reviewed seek to evaluate the effectiveness of standard (albeit adapted) tobacco control interventions at changing Indigenous peoples’ behaviours, rather than the structural conditions which shape those behaviours. Needs are defined largely in deficit terms as reducing commercial tobacco use, as a health harming behaviour associated with negative outcomes, largely through prevention and cessation interventions. While most studies recognize the need to adapt interventions to Indigenous cultures, only a few studies align this purpose with strengths-based approaches, and fewer yet being designed by Indigenous peoples based on their priorities.

What research step(s) does engagement take place?

When seeking to engage meaningfully with Indigenous peoples, in conducting research that supports commercial tobacco control programmes, we argue that the research step(s) when engagement takes place is meaningful. The WHO FCTC states that there is a “need for Indigenous individuals and communities to participate in the development, implementation and evaluation of tobacco control programs” (WHO, 2003). Guidelines by the Australian National Health and Medical Research Council set out “community/organisational involvement” in each of “eight steps of the research journey” (NHMRC, 2018a). To what extent has tobacco control research to date engaged Indigenous peoples across these steps?

Applying the NHMRC (2018a) guidelines to the methodologies described in each study, Table 1 shows that no studies engage Indigenous peoples across all eight research steps. Ratsch et al. (2017) engage across seven steps and, in doing so, might be described as engaging more meaningfully. Five studies (8%) engage across six steps (Anderson et al., 2019; Bovill et al., 2018; Margalit et al., 2013; Montogomery et al. 2012; Varcoe et al., 2010). In contrast, seven studies (11%) engage in one step (with Indigenous peoples involved in data collection as subjects or researchers) and, in doing so, might be described as engaging least meaningfully.

Table 2 shows the total number of studies engaging Indigenous peoples by early, middle and later steps of research. This review finds most engagement with Indigenous peoples during the middle steps of data collection (63) and data analysis (23). By virtue of the inclusion criteria for this review, all the studies engage Indigenous peoples in data collection (n = 63) as study participants or subjects. In addition, at least 46 studies (73%) involve Indigenous peoples in data collection as (co)authors and 11 studies (17%) as researchers or advisors. It is notable that 23 studies (37%) involve Indigenous peoples in data analysis to enhance the validity of findings. For example, Johnston and Thomas (2010) involve Indigenous health care workers, elders and leaders in the thematic analysis of qualitative data. After a non-Indigenous researcher codes the interview data gathered, preliminary findings are reviewed by Indigenous researchers and stakeholders who then refine the emergent themes.

Table 2.

Total number of tobacco control studies engaging Indigenous peoples by research step.

	Steps of research^a	Number of studies	Total
Early	1. Building relationships	6	41
	2. Developing the research idea	10
	3. Developing the project and seeking agreement	28
Middle	4. Collecting the data	63	82
Middle	5. Analysing the data and making sense of findings (including validation)	23	82
Later	6. Report writing (authorship)	40	58
	7. Sharing and translating the results into action (knowledge translation)	16
	8. Learning from experience (evaluation)	8

Steps of research taken from NHMRC (2018b, Table 1, pp. 18–19).

Beyond report writing (36), during the later steps of research, fewer studies engage Indigenous peoples in knowledge translation (16) and evaluation (8). One exception is Bar-Zeev et al. (2017) who carry out a “structured 4-step evaluation process” to inform “the development of a resource package to be used as part of a multi-component intervention, aimed at improving how health professionals manage smoking in Aboriginal and Torres Strait Islander pregnant women who smoke.” This is described as a

novel formative evaluation protocol [which] has never been done previously in Australia. If these resources prove effective, the methodology could be adapted for other Indigenous interventions, and culturally diverse programs. The added value of this time-consuming and costly process is yet to be justified in research, and might impact the potential adaption by other projects.

While many studies conduct evaluations, almost all involve impact (to measure short-term effect of a programme), outcome (to measure short-term effect of a programme) or evaluations (Campbell et al., 2014; D’Silva et al., 2011; Harvey et al., 2002; Hayward et al., 2007; Ivers, Castro, Parfitt, Baili, D’Abbs and Richmond, 2006). Marley et al. (2014) is notable in conducting a process evaluation of the Be Our Ally Beat Smoking (BOABS) Study to draw lessons about “how to develop and implement an integrated smoking cessation program.” As the authors write, the results of the study

demonstrated the importance of local Aboriginal ownership, commitment, participation and control. This included knowledge of local communities, the flexibility to adapt interventions to local communities and circumstances, and taking sufficient time to allow this to occur. Short-term project funding undermines community control and ownership, and program development and delivery [29,30]. Researchers, including ourselves, can also be optimistic and/or naïve in anticipating unrealistic timeframes for completing research projects in settings characterised by significant structural barriers and competing community priorities.

Similarly, relatively few studies engage Indigenous peoples from the study community or engage in the study as participants at the earliest steps of research, notably building relationships (4) and developing the research ideas (10). This is consistent with the observation by Boudreau et al. (2016) that “public health groups have not made efforts to build relationships with our [Indigenous] leaders and have even supported efforts to restrict tribal decision-making.” The exceptions in this review include Margalit et al. (2013) who describe engagement with Lakota community leaders to define the goals of the project which consequently focused on collection and preservation of oral history, and data for cessation efforts. More common is engagement with Indigenous people to provide input on research design. Lichtenstein et al. (1995, 1996) describe a “consultative intervention” with tribes in Washington, Idaho and Oregon as the basis of developing and then evaluating culturally appropriate tobacco control policies. Bar-Zeev et al. (2017) work with Indigenous leaders and community members to develop and evaluate educational materials related to tobacco use. Campbell et al. (2014) report on a social marketing campaign designed by Aboriginal communities. Bowen et al. (2012) conduct a feasibility study of a web-based intervention designed through consultation with Indigenous youth. Báezconde-Garbanati et al. (2007) mobilize the capacity of American Indian communities to develop locally relevant tobacco control policies.

Overall, engagement by step of research reveals substantial variation across the studies reviewed, from limited engagement of Indigenous peoples as the subject of study, to efforts to engage Indigenous peoples across selected steps. The average number of research steps that Indigenous peoples were engaged is 2.87 steps which suggest much scope for improvement. Our findings also suggest that perceptions of what meaningful engagement means may be changing over time, with studies conducted prior to 2005 having a lower breadth of engagement. Schinke et al. (1996), for example, write that “[t]he collaborative nature of the[ir] study . . . embodies a cultural sensitivity not often seen in preventive intervention and health programs,” and that “the study and the approaches to cancer risk reduction that it is testing are pioneer steps in health education for an important, yet underserved and underresearched, population.” While the study was perhaps pioneering in the mid 1990s, when few tobacco control studies collaborated with Indigenous peoples, core principles and values set out by research guidelines and Indigenous scholars since have raised expectations of what meaningful engagement means in practice. The five studies which engage with Indigenous peoples across six steps of research have been conducted since 2010, suggesting a possible shift towards increasing engagement earlier and later in the research process. Weaver and Jackson (2010) describe their study as having “Native American involvement at every step and level with culture as an important backdrop rather than an ‘add on’ feature.” However, such studies remain relatively few in number. The concentration of engagement during the middle steps indicate that there remains scope to achieve more meaningful engagement by involving Indigenous peoples across the full breadth of research practice.

What approach and methods are used for engagement?

What approaches and associated methods might be advanced to make engagement with Indigenous peoples in commercial tobacco control research more meaningful? Guidelines set out core values, such as respect, and principles such as consent, but do not set out specific approaches to inform practice. In the studies reviewed, we found 19 studies (30%) pre and post test pre-selected interventions (many culturally adapted) for their efficacy at achieving behavioural change or increasing knowledge of commercial tobacco use. These include seven RCTs and 11 studies (17%) which do not identify a specific approach. The latter describe the methods for developing and implementing an intervention, and assessing the degree of their effectiveness, but do not set out broader assumptions which inform the selection of methods.

In contrast, community-based participatory research (CBPR) and participatory action research (PAR) approaches are adopted in 20 studies (32%) as starting points. These approaches are described as particularly apt for enhancing control and ownership by Indigenous peoples, acknowledging power inequities between researchers and participants, and fostering local capacities. For example, Blanchard et al. (2015) describe CBPR as an “approach that reinforces the importance of power sharing and promotes the idea that collaborative partnerships give prominent roles to community partners in the ownership and control of project outcomes.” Similarly, Choi et al. (2011) describe the principles of CBPR as: “1) tailoring to meet the needs of individuals and communities; and 2) providing the opportunity for the people for whom the program is developed to participate in the development, implementation, and evaluation.” Sabesan et al. (2015) write that the PAR approach “seeks to bring about positive change and is based on equal and collaborative involvement with the affected community.”

Four studies (6%) explicitly adopt reflexive approaches which recognizes research as a relational process requiring, not only the creation of opportunities for Indigenous participation, but also a willingness by settler researchers to locate their privileged position within a context of colonization. As a result, these studies seek to challenge, not only what is researched and who carries it out, but how the research is conceived, designed and conducted. Bottorff et al. (2009) and Varcoe et al. (2010), for example, adopt a decolonizing approach by reframing commercial tobacco use through Indigenous epistemologies and methodologies. Daley et al. (2006) apply a critical anthropology framework to understand the meaning of tobacco use and related illnesses within the context of colonization. The approach and methods adopted by Bosma et al. (2014) begin with recognition of the need for researchers to honour Indigenous sovereignty. All four studies reflect on how historical and ongoing colonization impacts Indigenous health, including structuring relationships between researchers and Indigenous peoples. Four further studies (8%) incorporate Indigenous ways of knowing into their research. By honouring Indigenous knowledge positions, and Indigenous peoples as experts, these studies facilitate understanding of research in Indigenous terms. For example, Glover, Kira and Smith (2016) ground their approach—to develop programmes for reducing smoking by pregnant women—in Te Whare Tapa Wha, a model for understanding Māori health based on the four interdependent cornerstones of tinana (physical realm), hinengaro (emotional and mental aspects), whānau (family and social environments) and wairua (the spiritual realm). By applying an Indigenous knowledge framework, they are able to recognize that previous interventions relied on individual action without considering the importance of smokers’ relationships with others and their environment. Together with the community, they then develop an intervention based on the whānau component by engaging “aunties” as community health workers connected with pregnant women.

Overall, this review suggests that more meaningful engagement of Indigenous peoples in commercial tobacco control research should begin with careful reflection about philosophical assumptions and the positionality of the researchers in the context of colonization. Research approach, in turn, shapes decisions about research design and methods. Where researchers critically acknowledge the role of mainstream health research, as a construct of ongoing colonization, the studies engage Indigenous peoples across more steps of research (see above). This suggests choices about approaches and methods are integral to achieving more meaningful engagement, involving Indigenous peoples in designing how the research is conducted from start to finish.

Discussion: lessons for advancing meaningful engagement with Indigenous peoples in commercial tobacco control research

This article conducts a scoping review of 63 studies of commercial tobacco control which self-describe research engagement with Indigenous peoples. While there is now broad commitment, within the health research community in settler countries, to comply with recognized guidelines and Indigenous scholarship setting out core principles and values on the ethical conduct of research involving Indigenous peoples, there remains limited guidance of how to put these into practice. Our review suggests that there is wide-ranging and evolving practices based on differing interpretations of what constitutes meaningful engagement. As a contribution towards informing better practice, this scoping review assesses the identified studies around five questions concerning different aspects of engagement.

There are a number of lessons arising from the findings of this review. First, the studies suggest that meaningful engagement begins with the involvement of Indigenous peoples in conducting research, ideally as principal investigators and lead authors, but also as co-authors, researchers and advisors. At least 46 studies (73%) involve an Indigenous (co)author, 13 (21%) as lead authors, all but four published since 2009. This suggests a positive trend perhaps towards increasing Indigenous research capacity, a trend that could be supported by increasing recruitment and training of Indigenous peoples, including community members from study settings. Moreover, capacity building of non-Indigenous researchers, to conduct research with Indigenous peoples in ways that uphold core principles and values, is needed. An important lesson, for deepening commitment to meaningful engagement, is thus the need to integrate mutual learning and capacity building, in ways that enable knowledge production and dissemination to be genuinely collaborative and shared.

Second, meaningfulness of engagement can be reflected in how a study population is defined and selected. Who is deemed appropriate for researchers to engage with varies substantially between settler and Indigenous ways of knowing. Mainstream sampling methods, to optimize efficiency, scientific validity or generalizability, should recognize Indigenous world views which value social relationships, respect towards key knowledge holders, and benefits sharing. This requires acknowledgement of a major difference between reductionist western methods focused on the individual, and Indigenous approaches which prioritize relationships and communities. An understanding of these latter approaches, and integration into research design, requires genuine consultation with Indigenous peoples.

Third, this review suggests that the purpose of commercial tobacco control research has been largely defined by settler researchers rather than Indigenous peoples. While many studies seek to adapt interventions (most often prevention and cessation) to be culturally appropriate, and then test their effectiveness among Indigenous peoples, the purpose of such studies are generally framed in deficit or problem-based terms. This, in part, reflects a strong emphasis in commercial tobacco control research on modifying lifestyles behaviours as risk factors. An important lesson from this review is the need to critically reflect on how the purpose of commercial tobacco control research is framed in these ways and by whom. The need to understand the societal factors that shape individual decisions, supported by the development of strengths based approaches, are important alternatives to the mainstream interventions that have been less effective at improving health and wellness among Indigenous peoples.

Fourth, engagement of Indigenous peoples in commercial tobacco control research tends to take place during the middle steps of research. Self-reported engagement is most often in the form of Indigenous peoples as study subjects during data gathering and, to a lesser extent, as contributors to the actual research process during specific steps. There is limited engagement during early steps, when critical decisions are made about the research purpose and design, and the later steps when the resulting knowledge is articulated, shared and evaluated. This includes essential processes for achieving ongoing consent from Indigenous peoples. An important lesson from this review is that researchers should consider how they might extend engagement, as far as possible, across all eight steps of research to make it more meaningful. The planning of research should span from relationship building to the need for reflective practice to evaluate the research process. On the latter, the development of an agreed framework to carry out process evaluations of research involving Indigenous peoples is recommended. As well as encouraging critical reflection on how a specific study has been conducted, cumulative process evaluations can lead to lessons to support better practice in Indigenous health research more broadly.

Finally, 16 (25%) of the studies reviewed adopt CBPR and PAR approaches, as a starting point for establishing collaborative relationships with Indigenous peoples, and potentially addressing inequities in power between researcher and subject. An additional eight studies (13%) adopt approaches which are reflexive or based on Indigenous ways of knowing. As Rix et al. (2019) write, “[r]eflexive practice is essential for any researcher in examining their motivations and intent in working with Indigenous people.” The majority of studies, however, either do not explicitly identify their philosophical assumptions and positionality, or adopt mainstream approaches that lead to limited engagement with Indigenous peoples. These approaches are based on public health research paradigms which favour positivist, hypothesis-driven epistemology which are then tested against settler-defined world views (Carlson, 2016). This contrasts with grounded approaches which iteratively engage with Indigenous peoples in the conceptualization and design of research. The research thus emerges from engagement, rather than set out a priori, with engagement ongoing and embedded in the research approach. An important lesson emerging from this review is that researchers, funders, peer reviewers and publishers must prioritizes meaningful engagement.

Conclusion

To improve the relevance and effectiveness of public health efforts, to reduce the health disparities arising from higher rates of commercial tobacco use among Indigenous peoples, tobacco control research needs to strengthen engagement with Indigenous peoples. This scoping review finds increasing commitment to engagement based on recognition of the ineffectiveness of mainstream interventions. This commitment is also aligned with evolving guidelines and Indigenous scholarship which set out core principles and values for conducting research involving Indigenous peoples. However, reviewing the nature of engagement to date in commercial tobacco control research, we find varying practices. Meaningful engagement of Indigenous peoples can be advanced by critical reflection on who conducts the research, whom is engaged with, for what purpose, at what steps of the research, and using what approaches. In this way, we argue that commercial tobacco control research is more likely to contribute to improved health and wellness.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research has been conducted as part of the Promoting Indigenous Led Approaches to Respecting (PILAR) Tobacco Project funded by CIHR Project Grant FRN# 379337 and the First Nations Health Authority Respecting Tobacco Program.

ORCID iD

Kelley Lee

Notes

References

Abimbola

(2019). The foreign gaze: Authorship in academic global health. BMJ Global Health, 4, Article e002068. https://doi.org/10.1136/bmjgh-2019-002068

AIATSIS. (2012). Guidelines for ethical research in Australian Indigenous Studies. https://aiatsis.gov.au/sites/default/files/2020-09/gerais.pdf

Australian Department of Health. (2020). Tackling indigenous smoking. Canberra, January. https://www.health.gov.au/initiatives-and-programs/tackling-indigenous-smoking

Baillie

Maas

Buchholz

Mutch

(2008). “These Girls Are Our Future”: Exploring aboriginal ownership of nontraditional tobacco control research. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 6(3), 83–93. https://journalindigenouswellbeing.com/media/2018/10/5_Baillie.pdf

Ball

(2005). “Nothing about us without us”: Restorative research partnerships involving Indigenous children and communities in Canada. In Farrell

(Ed.), Ethical research with children (pp. 81–96). Open University Press/McGraw Hill Education.

Ball

(2014). Enacting Indigenous research ethics through community-university partnerships. Early Childhood Development Intercultural Partnerships, University of Victoria. http://www.ecdip.org/docs/pdf/rp/ethics.pdf

Bond

Brough

Spurling

Hayman

(2012). “It Had to Be My Choice”: Indigenous smoking cessation and negotiations of risk, resistance and resilience. Health, Risk & Society, 14(6), 565–581. http://doi.org/10.1080/13698575.2012.701274

Boudreau

Hernandez

Hoffer

Preuss

K. S.

Tibbetts-Barto

Villaluz

N. T.

Scott

(2016). Why the world will never be tobacco-free: Reframing “Tobacco Control” into a traditional tobacco movement. American Journal of Public Health, 106(7), 1188–1195. https://doi.org/10.2105/AJPH.2016.303125

Carlson

(2016). Anti-colonial methodologies and practices for settler colonial studies. Settler Colonial Studies, 7(4), 496–517. http://doi.org/10.1080/2201473X.2016.1241213

10.

Castellano

M. B

. (2020). Ethics of aboriginal research. In Teays

Gordon

Renteln

(Eds.), Global bioethics and human rights: Contemporary issues (pp. 155–168). Rowman and Littlefield International.

11.

Chan Osilla

Lonczak

Mail

Larimer

Marlatt

. (2007). Regular tobacco use among American Indian and Alaska native adolescents: An examination of protective mechanisms. Journal of Ethnicity in Substance Abuse, 6(3–4), 143–153. https://doi.org/10.1300/J233v06n03_06

12.

Daley

James

Barnoskie

Segraves

Schupbach

Choi

(2006). “Tobacco Has a Purpose, Not Just a Past”: Feasibility of developing a culturally appropriate smoking cessation program for a pan-tribal native population. Medical Anthropology Quarterly, 20(4), 421–440. http://doi.org/10.1525/maq.2006.20.4.421

13.

Drawson

Toombs

Mushquash

(2017). Indigenous research methods: A systematic review. International Indigenous Policy Journal, 8(2), Article 5.

14.

Durie

(2017). Māori health models, Te Whare Tapa Whā. New Zealand Ministry of Health. https://www.health.govt.nz/our-work/populations/maori-health/maori-health-models/maori-health-models-te-whare-tapa-wha

15.

First Nations Information Governance Centre. (2019). The first nations principles of OCAP. https://fnigc.ca/ocap

16.

Glover

Kira

Cowie

Wong

Stephen

Marriner

(2013). Health consequences of tobacco use for Māori—Cessation essential for reducing inequalities in health. New Zealand Medical Journal, 126(1379), 60–73.

17.

Glover

Kira

Johnston

Walker

Thomas

D. P.

Change

Bullen

Segan

Brown

(2015). A systematic review of barriers and facilitators to participation in randomized controlled trials by Indigenous people from New Zealand, Australia, Canada and the United States. Global Health Promotion, 22(1), 21–31.

18.

Government of Canada. (2018). Chapter 9: Research involving the first nations, Inuit and Métis Peoples of Canada. In Tri council policy statement 2 (TCPS2). Panel on Research Ethics. https://ethics.gc.ca/eng/tcps2-eptc2_2018_chapter9-chapitre9.html

19.

Inter-Tribal Health Authority. (2005). Inter-tribal health authority research protocol: Working together for healthy nations. http://www.turtleisland.org/healing/itharesearch.pdf

20.

Lee

Crosbie

(2020). Understanding structure and agency as commercial determinants of health. International Journal of Health Policy Management, 7, 315–318. https://doi.org/10.15171/ijhpm.2019.127

21.

Maddox

Waa

Lee

Nez-Henderson

Blais

Reading

Lovett

(2019). Commercial tobacco and Indigenous peoples: A stock take on Framework Convention on Tobacco Control progress. Tobacco Control, 28(5), 574–581. https://doi.org/10.1136/tobaccocontrol-2018-054508

22.

Minichiello

Lefkowitz

Firestone

Smylie

Schwartz

(2016). Effective strategies to reduce commercial tobacco use in Indigenous communities globally: A systematic review. BMC Public Health, 16(1), Article 21. https://doi.org/10.1186/s12889-015-2645-x

23.

National Health and Medical Research Council. (2018a). Ethical conduct in research with Aboriginal and Torres Strait Islander peoples and communities: Guidelines for researchers and stakeholders. https://www.arts.unsw.edu.au/sites/default/files/documents/indigenousethicalguidelines.pdf

24.

National Health and Medical Research Council (2018b). Keeping research on track II.

25.

Oberly

Macedo

(2004). The R Word in Indian country: Culturally appropriate commercial tobacco-use research strategies. Health Promotion Practice, 5(4), 355–361. https://doi.org/10.1177/1524839904267391

26.

Palmer

Chaiton

Schwartz

(2017). Commercial tobacco reduction in Indigenous communities, 2017 literature update. Ontario Tobacco Reduction Unit. https://otru.org/wp-content/uploads/2017/04/special_RETRAC2_lit_update.pdf

27.

Reading

(2015). Confronting the growing crisis of cardiovascular disease and heart health among aboriginal peoples in Canada. Canadian Journal of Cardiology, 31(9), 1077–1080.

28.

Rix

Wilson

Sheehan

Tujague

(2019). Indigenist and decolonizing research methodology. In Liamputtong

(Ed.), Handbook of research methods in health social sciences (pp. 253–267). Springer.

29.

Smith

L. T.

(1999). Decolonizing methodologies, research and Indigenous peoples. Zed Books.

30.

Smith

Rouse

Caskey

Fossum

Strickland

Culhane

Waukau

(2014). Culturally-tailored smoking cessation for adult American Indian smokers: A clinical trial. Counseling Psychologist, 42(6), 852–886.

31.

US Department of Health and Human Services. (2014). The health consequences of smoking – 50 years of progress, a report of the surgeon-general.

32.

World Health Organization. (2003). Framework convention on tobacco control. https://www.who.int/tobacco/framework/WHO_FCTC_english.pdf

33.

Anderson

K. M.

Kegler

M. C.

Bundy

L. T.

Henderson

Halfacre

Escoffery

(2019). Adaptation of a brief smoke-free homes intervention for American Indian and Alaska Native families. BMC Public Health, 19, Article 981. https://doi.org/10.1186/s12889-019-7301-4

34.

Báezconde-Garbanati

Beebe

L. A.

Pérez-Stable

E. J.

(2007). Building capacity to address tobacco-related disparities among American Indian and Hispanic/Latino communities: Conceptual and systemic considerations. Addiction, 102(Suppl. 2), 112–122. https://doi-wiley-com.web.bisu.edu.cn/10.1111/j.1360-0443.2007.01962.x

35.

Bar-Zeev

Bovill

Bonevski

Gruppetta

Reath

ICANQUIT in Pregnancy Pilot Group, & Gould

G. S.

(2017). Assessing and validating an educational resource package for health professionals to improve smoking cessation care in Aboriginal and Torres Strait Islander pregnant women. International Journal of Environmental Research and Public Health, 14(10), Article 1148. https://doi.org/10.3390/ijerph14101148

36.

Blanchard

J. W.

Petherick

J. T.

Basara

(2015). Stakeholder engagement: A model for tobacco policy planning in Oklahoma tribal communities. American Journal of Preventive Medicine, 48(Suppl. 1), S44–S46. https://doi.org/10.1016/j.amepre.2014.09.025

37.

Bosma

L. M.

D’Silva

Jansen

A. L.

Sandman

N. R.

Hink

R. L.

(2014). The Wiidookowishin program: Results from a qualitative process evaluation of a culturally tailored commercial tobacco cessation program. American Indian & Alaska Native Mental Health Research: The Journal of the National Center, 21(1), 18–34. https://doi.org/10.5820/aian.2101.2014.18

38.

Bottorff

Carey

Mowatt

Varcoe

Johnson

Hutchinson

Sullivan

Williams

Wardman

(2009). Bingo halls and smoking: Perspectives of First Nations women. Health Place, 15(4), 1014–1021. https://doi.org/10.1016/j.healthplace.2009.04.005

39.

Bottorff

Sarbit

Oliffe

Caperchione

Wilson

Huisken

(2018). Strategies for supporting smoking cessation among Indigenous fathers: A qualitative participatory Study. American Journal of Men’s Health, 13(1), 1–11. https://doi.org/10.1177/15579883188064

40.

Bovill

Bar-Zeev

Y. B.

Grupetta

Clarke

Nicholls

O’Mara

Bonevski

Reath

Gould

(2018). Giri-nya-la-nha (Talk Together) to explore acceptability of targeted smoking cessation resources with Australian Aboriginal women. Public Health, 176, 149–158. https://doi.org/10.1016/j.puhe.2018.08.010

41.

Bowen

D. J.

Henderson

P. N.

Harvill

Buchwald

(2012). Short-term effects of a smoking prevention website in American Indian youth. Journal of Medical Internet Research, 14(3), Article e81. https://doi.org/10.2196/jmir.1682

42.

Burgess

S. S.

Joseph

A. M.

Hatsukami

D. K.

Solomon

van Ryan

(2007). Beliefs and experiences regarding smoking cessation among American Indians. Nicotine & Tobacco Research, 9(1), S19–S28. https://doi.org/10.1080/14622200601083426

43.

Campbell

M. A.

Finlay

Lucas

Neal

Williams

(2014). Kick the habit: A social marketing campaign by Aboriginal communities in NSW. Australian Journal of Primary Health, 20, 327–333. https://dx-doi-org.web.bisu.edu.cn/10.1071/PY14037

44.

Charlier

Glover

Robertson

(2009). Keeping kids smokefree: Lessons learned on community participation. Health Education Research, 24(6), 949–956.

45.

Choi

W. S.

Faseru

Beebe

L. A.

Greiner

A. K.

Yeh

Shireman

T. I.

Talawyma

Cully

Kaur

Daley

C. M.

(2011). Culturally tailored smoking cessation for American Indians: Study protocol for a randomized controlled trial. Trials, 12(1), Article 126. https://doi.org/10.1186/1745-6215-12-126

46.

Cosh

Maksimovic

Ettridge

Copley

Bowden

(2013). Aboriginal and Torres Strait Islander utilisation of the quitline service for smoking cessation in south Australia. Australian Journal of Primary Health, 19(2), 113–118. https://doi.org/10.1071/PY11152

47.

Cuthbert

K. E.

Brown

Hammond

Williams

T. A.

Tayley

Deemal-Hall

Thomas

D. P.

(2019). Engaging with Aboriginal shire councils in remote Cape York communities to address smoke-free environments. Australian Journal of Primary Health, 25, 419–423. https://doi.org/10.1071/PY19023

48.

Dawson

Cargo

Stewart

Chong

Daniel

(2012). Aboriginal health workers experience multilevel barriers to quitting smoking: A qualitative study. International Journal for Equity in Health, 11, Article 27. https://doi.org/10.1186/1475-9276-11-27

49.

Dawson

Cargo

Stewart

Chong

Daniel

(2013). Identifying multi-level culturally appropriate smoking cessation strategies for Aboriginal health staff: A concept mapping approach. Health Education Research, 28(1), 31–45. https://doi.org/10.1093/her/cys111

50.

D’Silva

Schillo

B. A.

Sandman

Leonard

Boyle

(2011). Evaluation of a tailored approach for tobacco dependence treatment for American Indians. American Journal of Health Promotion, 25(Suppl. 5), S66–S69. https://doi.org/10.4278/ajhp.100611-QUAN-180

51.

Esdonk

Van Glover

Kira

Wagemakers

(2014). Reducing smoking in pregnancy among Māori women: Could “Aunties” in the community help? Maternal and Child Health Journal, 18, 2316–2322.

52.

Gendron

(2017). Aboriginal youth’s perceptions of traditional and commercial tobacco in Canada. Health Promotion International, 33, 1033–1041. https://doi.org/10.1093/heapro/dax048

53.

Glover

Kira

Cornell

Smith

(2016). Could “Aunties” recruit pregnant Indigenous women who smoke into a trial and deliver a cessation intervention? A feasibility study. Maternal and Child Health Journal, 20(6), 1211–1221.

54.

Glover

Kira

Smith

(2016). Enlisting “aunties” to support Indigenous pregnant women to stop smoking: Feasibility study results. Nicotine and Tobacco Research, 18(5), 1110–1115. https://doi.org/10.1093/ntr/ntv146

55.

Glover

M. P.

Scragg

Nosa

Bullen

Mccool

Kira

(2009). Keeping kids smokefree: Rationale, design and implementation of a community, school, and family-based intervention to modify behaviors related to smoking among Māori and Pacific Island children in New Zealand. International Quarterly of Community Health Education, 30(3), 205–222.

56.

Gould

G. S.

Skeel

Gruppetta

(2017). Exploring anti-tobacco messages from an experiential arts activity with Aboriginal youth in an Australian high-school setting. Journal of Applied Arts and Health, 8(1), 25–37. https://doi.org/10.1386/jaah.8.1.25_1

57.

Gould

G. S.

Stevenson

Bovill

Oliva

Keen

Dip

P. G.

Dimer

Gruppetta

(2018). Building strength in coming together: A mixed methods study using the arts to explore smoking with staffworking in Indigenous tobacco control. Health Promotion Journal of Australia, 29, 293–303. https://doi.org/10.1002/hpja.178

58.

Grigg

Waa

Bradbrook

(2008). Response to an Indigenous smoking cessation media campaign—It’s about Whānau. Australian and New Zealand Journal of Public Health, 32(6), 559–564. https://doi.org/10.1111/j.1753-6405.2008.00310.x

59.

Harvey

Tsey

Cadet-James

Minniecon

Ivers

McCalman

Lloyd

Young

(2002). An evaluation of tobacco brief intervention training in three Indigenous health care settings in north Queensland. Australian and New Zealand Journal of Public Health, 26(5), 426–431. https://doi.org/10.1111/j.1467-842x.2002.tb00342.x

60.

Hayward

Campbell

Sutherland-Brown

(2007). Aboriginal users of Canadian quitlines: An exploratory analysis. Tobacco Control, 16(Suppl. 1), i60–i64. https://doi.org/10.1136/tc.2007.020115

61.

Health Canada. (2018). Canada’s tobacco strategy. Ottawa: Tobacco Control Directorate. https://www.canada.ca/content/dam/hc-sc/documents/services/publications/healthy-living/canada-tobaccostrategy/overview-canada-tobacco-strategy-eng.pdf

62.

Hefler

Kerrigan

Freeman

Boot

G. R.

Thomas

D. P.

(2019). Using Facebook to reduce smoking among Australian Aboriginal and Torres Strait Islander People: A participatory grounded action study. BMC Public Health, 19, Article 615. https://doi.org/10.1186/s12889-019-6918-7

63.

Hodge

C. E.

(2009). “Starting stories” among older northern plains American Indian smokers. American Indian Culture and Research Journal, 33(3), 53–60.

64.

Horn

McGloin

Dino

Manzo

Lowry-Chavis

Shorty

McCracken

Noerachmanto

(2005). Quit and reduction rates for a pilot study of the American Indian not on tobacco (N-O-T) program. Preventing Chronic Disease: Public Health Research, Practice and Policy, 2(4). www.cdc.gov/pcd/issues/2005/oct/05_0001.htm

65.

Ivers

Castro

Parfitt

Bailie

D’Abbs

Richmond

(2006). Evaluation of a multi-component community tobacco intervention in three remote Australian Aboriginal communities. Australian and New Zealand Journal of Public Health, 30(2), 132–136. https://doi.org/10.1111/j.1467-842x.2006.tb00105.x

66.

Ivers

Castro

Parfitt

Bailie

Richmond

D’Abbs

(2006). The role of remote community stores in reducing the harm resulting from tobacco to Aboriginal people. Drug and Alcohol Review, 25(3), 195–199. https://doi.org/10.1080/09595230600644624

67.

Johnston

Thomas

(2010). What works in Indigenous tobacco control? The perceptions of remote Indigenous community members and health staff. Health Promotion Journal of Australia, 21(1), 45–50. https://doi.org/10.1071/he10045

68.

Lichtenstein

Glasgow

Lopes

Hall

McRae

Meyers

(1995). Promoting tobacco control policies in northwest Indian tribes. American Journal of Public Health, 85(7), 991–994. https://doi.org/10.2105/AJPH.85.7.991

69.

Lichtenstein

Lopes

Glasgow

R. E.

Gilbert-McRae

Hall

(1996). Effectiveness of a consultation intervention to promote tobacco control policies in northwest Indian tribes: Integrating experimental evaluation and service delivery. American Journal of Community Psychology, 24(5), 639–655. https://doi.org/10.1007/bf02509718

70.

Makosky Daley

Greiner

Nazir

Daley

S. M.

Solomon

C. L.

Braiuca

S. L.

Smith

T. E.

Choi

W. S

. (2010). All nations breath of life: Using community-based participatory research to address health disparities in cigarette smoking among American Indians. National Institutes of Health, 20(4), 334–338.

71.

Makosky Daley

James

A. S.

Barnoskie

R. S.

Segraves

Schupbach

Choi

W. S

. (2006). Tobacco has a purpose, not just a past: Feasibility of developing a culturally appropriate smoking cessation program for a pan-tribal Native population. Medical Anthropology Quarterly, 20(4), 421–440. www.ucpress.edu/journals/rights.htm

72.

Margalit

Watanabe-Galloway

Kennedy

Lacy

Red Shirt

Vinson

Kills Small

(2013). Lakota Elders’ Views on traditional versus commercial/addictive tobacco use; Oral history depicting a fundamental distinction. Journal of Community Health, 38(3), 538–545. https://doi.org/10.1007/s10900-012-9648-7

73.

Marley

Kitaura

Atkinson

Metcalf

Maguire

Gray

(2014). Clinical trials in a remote Aboriginal setting: Lessons from the BOABS smoking cessation study. BMC Public Health, 14(1), Article 579. https://doi.org/10.1186/1471-2458-14-579

74.

McKennitt

D. W.

Currie

C. L.

(2012). Does a culturally sensitive smoking prevention program reduce smoking intentions among Aboriginal children? A pilot study. American Indian and Alaska Native Mental Health Research, 19(2), 55–63. https://doi.org/10.5820/aian.1902.2012.55

75.

Moncher

Schinke

(1994). Group intervention to prevent tobacco use among Native American youth. Research on Social Work Practice, 4(2), 160–171. https://doi.org/10.1177/104973159400400203

76.

Montogomery

Manuelito

Nass

Chock

Buchwald

(2012). The Native comic book project: Native youth making comics and healthy decisions. Journal of Cancer Education, 27(10), S41–S46. https://doi.org/10.1007/s13187-012-0311-x

77.

Patten

C. A.

Enoch

Renner

C. C.

Offord

K. P.

Nevak

Kelley

S. F.

Thomas

Decker

P. A.

Hurt

R. D.

Lanier

Kaur

J. S.

(2009). Focus groups of Alaska Native adolescent tobacco users: Preferences for tobacco cessation interventions and barriers to participation. Health Education & Behaviour, 36(4), 711–723. https://doi.org/10.1177/1090198107309456

78.

Patten

C. A.

Fadahunsi

Hanza

Smith

Decker

Boyer

Ellsworth

Brockman

Hughes

Bronars

Offord

(2014). Tobacco cessation treatment for Alaska Native adolescents: Group randomized pilot trial. Nicotine and Tobacco Research, 16(6), 836–845. https://doi.org/10.1093/ntr/ntu004

79.

Pattern

C. A.

Windsor

Renner

Enoch

Hochreiter

Nevak

Smith

Decker

Bonnema

Hughes

Brockman

(2010). Feasibility of a tobacco cessation intervention for pregnant Alaska Native women. Nicotine & Tobacco Research, 12(2), 79–87. https://doi.org/10.1093/ntr/ntp180

80.

Peters

M. D.

Godfrey

C. M.

Khalil

McInerney

Parker

Soares

C. B.

(2015). Guidance for conducting systematic scoping reviews. International Journal of Evidence-Based Healthcare, 13(3), 141–146. https://doi.org/10.1097/XEB.0000000000000050

81.

Ratsch

Mason

Rive

Bogossian

Steadman

(2017). The Pituri learning circle: Central Australian Aboriginal women’s knowledge and practices around the use of Nicotiana as a chewing tobacco. Rural Remote Health, 17(3), Article 40440. https://doi.org/10.22605/RRH4044

82.

Sabesan

Kelly

Budden

Geia

L. K.

(2015). My family’s anti-tobacco education (My-FATE) model for Aboriginal and Torres Strait Islander peoples. Australian Journal of Rural Health, 23(3), 189–190. https://doi-wiley-com.web.bisu.edu.cn/10.1111/ajr.12130

83.

Schinke

S. P.

Singer

Cole

Contento

I. R.

(1996). Reducing cancer risk among Native American adolescents. Preventive Medicine, 25(2), 146–155.

84.

Tane

Hefler

Thomas

(2017). An evaluation of the “Yaka Ŋarali” tackling Indigenous smoking program in East Arnhem Land: Yolŋu people and their connection to Ŋarali. Health Promotion Journal of Australia, 29(1), 10–17. https://doi.org/10.1002/hpja.1

85.

Tane

Hefler

Thomas

(2019). Do the Yolŋu people of East Arnhem Land experience smoking related stigma associated with local and regional tobacco control strategies? An Indigenous qualitative study from Australia. Global Public Health, 15(1), 111–120. https://doi.org/10.1080/17441692.2019.1649446

86.

Taualii

Bush

Bowen

Forquera

(2010). Adaptation of a smoking cessation and prevention website for urban American Indian/Alaska Native youth. Journal of Cancer Education, 25, 23–31. https://doi.org/10.1007/s13187-009-0004-2

87.

Unger

Soto

Baezconde-Garbanati

(2006). Perceptions of ceremonial and nonceremonial uses of tobacco by American-Indian adolescents in California. Journal of Adolescent Health, 38(4), 443.E9–443.E16. https://doi.org/10.1016/j.jadohealth.2005.02.002

88.

Varcoe

Bottorff

Carey

Sullivan

Williams

(2010). Wisdom and influence of elders: Possibilities for health promotion and decreasing tobacco exposure in First Nations communities. Canadian Journal of Public Health, 101(2), 154–158.

89.

Weaver

Jackson

(2010). Healthy living in two worlds: Testing a wellness curriculum for urban Native youth. Child and Adolescent Social Work Journal, 27, 231–244. https://doi.org/10.1007/s10560-010-0197-6

90.

Angstman

(2009). Tobacco use among Alaska Native and American Indian college students (Graduate student thesis, dissertations, & professional papers 1123). https://scholarworks.umt.edu/etd/1123

91.

Doucette

(2007). A study of the social factors contributing to youth smoking in an Inuit community [Master’s thesis]. Lakehead University.

92.

Haring

(2007). Describing the process of meaningful change: Seneca stories of becoming smoke free [Doctoral dissertation]. State University of New York at Buffalo.

93.

Lukasewich

(2015). “It was a once in a lifetime opportunity”: The power of participating in a video research project for Aboriginal youth [Master’s thesis]. University of Alberta.

94.

Mutch

(2011). Bringing it back: The meaning of tobacco to Manitoba’s Metis Peoples [Master’s thesis]. University of Manitoba.

95.

Rollins

(2016). A culturally tailored tobacco cessation program for American Indians: Program development [Doctoral dissertation]. University of Kansas.

96.

Stevensen

(2013). Traditional and non-traditional tobacco use among First Nations Persons living on reserve in Canada: Distinctions, emotions, and visions of best-case future realities [Master’s thesis]. Lakehead University.