HHS Department, U of M Seek to Reduce Disparities in Tobacco-Related Illness

Scientists from the University of Minnesota are teaming up with the Band’s Health and Human Services (HHS) Department to investigate health effects of commercial tobacco that may be unique to American Indians in Minnesota.
The pilot studies will be conducted at clinics operated by the Band, and they have the enthusiastic support of Commissioner of Health and Human Services Rebecca St. Germaine.

“This is a welcome initiative that creates a partnership with American Indian tribal health initiatives to broaden our scope of clinical practices and change the future on disabling chronic conditions,” said Rebecca.

The University researchers are part of the Minnesota Precision Medicine Collaborative (MPMC). According to the National Cancer Institute, precision medicine is “a form of medicine that uses information about a person’s genes, proteins, and environment to prevent, diagnose, and treat disease.”

Precision medicine has been central to the progress made in cancer treatment in recent years, and advances in medicine and technology have caused cancer mortality rates in the U.S. to decline for many. However, American Indians in Minnesota are not seeing the decline in cancer mortality rates that has occurred among the general population, nor even the lower death rate ratio of American Indians in other regions.

The MPMC researchers decided to zero in on lung cancer, which is one of the most common forms of cancer for American Indians in Minnesota. Studies show that 59 percent of urban American Indians in Minnesota smoke, compared to 16 percent of the state’s overall population. The researchers thought precision medicine could improve smoking cessation rates, and they approached the Band about a possible partnership.

One of the pilot studies focuses on the rate of nicotine me- tabolism in current Mille Lacs Band smokers. (If interested in participating, please see below.) Studies show variations in the effectiveness of different smoking cessation treatments like the patch and Chantix depending on how quickly the body absorbs and processes nicotine.

Dana Carroll and Ellen Meier, post-doctoral scientists in the Masonic Cancer Center’s Tobacco Research Program led by renowned researcher Dorothy Hatsukami, are conducting the study. They note that success with cessation isn’t the only factor affected by rate of metabolism. In fact, faster metabolism of nicotine has been shown to predict heavier smoking, greater exposure to carcinogens and toxicants from tobacco smoke, and a higher risk for lung cancer.

Meanwhile, the disparities in lung cancer mortality rates may result from poor access to screening. In the second pilot study, pulmonologist and assistant professor of medicine Abbie Begnaud is working closely with the Band’s medical staff to test a new approach to lung cancer treatment and early detection. Begnaud — who directs the Lung Cancer Screening Program at the University of Minnesota — says the most important advance in the treatment of lung cancer has been discovery of genetic mutations that drive lung cancer progression, along with therapies targeted to those mutations.

She is also looking at data on American Indians treated for lung cancer at five Minnesota health systems, to see if lung cancers which carried a special mutation were treated with precision therapies — or even if they were tested for the mutation at all.

Pamala Jacobson, one of the main investigators of the MPMC, says it is necessary for researchers to take the time to establish authentic, honorable working relationships within communities affected by health disparities.

“For precision medicine approaches to be effective, we have to know how to apply this exciting new science to all populations, not just healthcare systems in metropolitan or those serving high income patients,” says Jacobson. “Conducting the needed research and implementing precision medicine to benefit the health of American Indians and other minority populations is a priority.”

MPMC investigators and the Band have been planning their work together for nearly a year to ensure that the research is not only respectful of Ojibwe beliefs and practices, but will be valuable to the tribe.

Interested in Participating?

Who are we looking for? Healthy American Indian men and women who are regular commercial cigarette smokers.

What is the purpose of the study? We want to learn how Minnesotan American Indians process nicotine and toxins from tobacco. We also want to look at markers for tobacco addiction.

When and where does it take place? The first step is to complete a short phone screening for eligibility. Phone screenings can be completed at your convenience. If you are eligible, we can set up a time with you to complete the study in one of the Mille Lacs Health Clinics.

How long does the study last? One in-person visit lasting 1–2 hours.

Any follow-ups? You will be asked to track your tobacco use for one week and mail a “diary card” to our office.

Will I be compensated? You will receive payment: $25 at the in-person visit and $25 for tracking your tobacco use for one week.

Who do I contact for more information or to enter the study? Call Dana Caroll at 612-624- 4511 or email dcarroll@umn.edu. Please leave a contact number in your email.

What will I be doing in the study? You will be interviewed or asked to complete questionnaires that ask personal questions such as demographics, tobacco use history, health history, prescription and over-the-counter medication use, occupational exposure to chemicals and tobacco smoke, and use of alcohol. Cells from your mouth, urine, and saliva samples will be collected from you. Additionally, you will be asked to complete a diary card to track your tobacco use over 7 days.

Do I need to stop smoking? No, but we are happy to get you connected with resources if you are interested in quitting.

Who owns my data? The Mille Lacs Band and the University of Minnesota co-own the collective data and decide how it will be used. You are free to withdraw your answers to questionnaires, biological samples, and any other data you provide at any time before or after the study has been completed.