Background: Varenicline and oral nicotine replacement therapy (NRT) have each been shown to increase the likelihood of smoking cessation, but their combination has not been studied. In addition, smoking cessation medication adherence is often poor, thus, challenging the ability to evaluate medication efficacy. Objective: This study examined the effects of combined varenicline and oral NRT and smartphone medication reminders on pharmacotherapy adherence and smoking abstinence among adults enrolled in smoking cessation treatment. Methods: A 2×2 factorial design was used. Participants (N=34) were randomized to (1) varenicline + oral NRT (VAR+NRT) or varenicline alone (VAR) and (2) smartphone medication reminder messages (REM) or no reminder messages (NREM) over 13 weeks. Participants assigned to VAR+REM received varenicline reminder prompts, and those assigned to VAR+NRT+REM also received reminders to use oral NRT. The other 2 groups (VAR+NREM and VAR+NRT+NREM) did not receive medication reminders. Participants were not blinded to intervention groups. All participants received tobacco cessation counseling. Smartphone assessments of smoking as well as varenicline and NRT use (if applicable) were prompted daily through the first 12 weeks after a scheduled quit date. Descriptive statistics were generated to characterize the relations between medication and reminder group assignments with daily smoking, daily varenicline adherence, and daily quantity of oral NRT used. Participants completed follow-up assessments for 26 weeks after the quit date. Results: Participants were predominantly White (71%), and half were female (50%). On average, participants were 54.2 (SD 9.4) years of age, they smoked an average of 19.0 (SD 9.0) cigarettes per day and had smoked for 34.6 (SD 12.7) years. Descriptively, participants assigned to VAR+NRT reported more days of smoking abstinence compared to VAR (29.3 vs 26.3 days). Participants assigned to REM reported more days of smoking abstinence than those assigned to NREM (40.5 vs 21.8 days). Participants assigned to REM were adherent to varenicline on more days compared to those assigned to NREM (58.6 vs 40.5 days), and participants assigned to VAR were adherent to varenicline on more days than those assigned to VAR + NRT (50.7 vs 43.3 days). In the subsample of participants assigned to VAR+NRT, participants assigned to REM reported more days where ≥5 pieces of NRT were used than NREM (14.0 vs 7.4 days). Average overall medication adherence (assessed via the Medication Adherence Questionnaire) showed the same pattern as the daily smartphone-based adherence assessments. Conclusions: Preliminary findings indicated that smoking cessation interventions may benefit from incorporating medication reminders and combining varenicline with oral NRT, though combining medications may be associated with poorer adherence. Further study is warranted. Trial Registration: ClinicalTrials.gov NCT03722966; https://classic.clinicaltrials.gov/ct2/show/NCT03722966

Objectives This study describes the collaborative design and implementation of the Indigenous MIND (IM) program, a culturally adapted mindfulness intervention developed in partnership with Indigenous communities in the USA. The aim was to explore the program’s acceptability and cultural resonance and to document the processes by which IM evolved in each of our partner communities and explore how the program may be exported to other Indigenous communities. Method Indigenous MIND was developed with close cooperation and oversight from tribal communities through two-step participant-driven adaptation. A standard Mindfulness-Based Stress Reduction (MBSR) program was initially delivered to two culturally distinct Indigenous communities—one coastal and one alpine. Participant feedback informed the tailored 8-week IM program, which was implemented online with 20 participants across both tribal communities. Results Thematic analysis of recorded classes and feedback sessions indicated high acceptability and alignment with cultural values. Emergent themes included (a) coping strategies (for stress, anxiety, and depression); (b) mindfulness for relief of stress, anxiety, and depression; and (c) elements specific to Indigenous people, such as spirituality, tradition, and community identity. Conclusions Importantly, this project underscores the value of co-creating wellness interventions that are grounded in sovereignty, relational accountability, and cultural continuity. By centering Indigenous knowledge systems and investing in community-led sustainability through teacher training, such efforts can serve as models for future culturally resonant health promotion program development.

Introduction: Indigenous holistic theory (IHT) is a multi-faceted framework grounded in traditional cultural knowledge that emphasizes Indigenous world views, cultures, and traditions with a focus on the spiritual, emotional, mental, and physical elements of health and wellness (Absolon, 2010). Objective: To describe the role of historical trauma and health-related behaviours among Two-Spirit and Indigenous lesbian, gay, bisexual, transgender, and queer or questioning (2S/LGBTQ+) Elders and how the emergence of IHT and its guiding constructs could work to inform culturally responsive interventions for the study population. Method: IHT constructs were applied to historical trauma intervention tailoring among Indigenous 2S/LGBTQ+ Elders, including a relevant theoretical model. Results: Applying the IHT framework to Indigenous 2S/LGBTQ+ Elder interventions could be an effective pathway for understanding the population while helping to inform more culturally responsive health promotion efforts that will lead to wellness in later life. Discussion/Conclusion: The paper concludes with a discussion of how IHT helps to advance our knowledge about addressing historical trauma most responsively, along with future research recommendations.

The Human Immunodeficiency Virus (HIV) epidemic is a serious yet under-addressed health concern for Native American communities across Indian Country (a reclaimed governmental reference for the con...