Aboriginal People Research Articles

Health Insurance Type and Access to the Indian Health Service Before, During, and After Childbirth Among American Indian and Alaska Native People in the United States

BackgroundAmerican Indian and Alaska Native (AI/AN) people in the United States face elevated childbirth-related risks when compared with non-Hispanic white people. Access to health care is a treaty right of many AI/AN people, often facilitated through the Indian Health Service (IHS), but many AI/AN people do not qualify for or cannot access IHS care and rely on health insurance coverage to access care in other facilities. Our goal was to describe health insurance coverage and access to IHS care before, during, and after childbirth for AI/AN birthing people in the United States. MethodsWe analyzed 2016 ton 2020 Pregnancy Risk Assessment Monitoring System data (44 states and 2 other jurisdictions) for 102,860 postpartum individuals (12,920 AI/AN and 89,940 non-Hispanic white). We calculated weighted percentages, adjusted predicted probabilities, and percentage point differences for health care coverage (insurance type and IHS care) before, during, and after childbirth. ResultsApproximately 75% of AI/AN birthing people did not have IHS care around the time of childbirth. AI/AN people had greater variability in insurance coverage and more insurance churn (changes in type of insurance, including between coverage and no coverage) during the perinatal period, compared with non-Hispanic white people. Health care coverage differed for rural and urban AI/AN people, with rural AI/AN residents having the lowest prevalence of continuous insurance (60%). ConclusionAI/AN birthing people experience insurance churning and limited access to IHS care during the perinatal period. Efforts to improve care for AI/AN birthing people should engage federal, state, and tribal entities to ensure fulfillment of the trust responsibility of the United States and to address health inequities.

“It’s [gambling] obviously not regulated that well”: insights into Aboriginal peoples’ views on gambling regulation in the Northern Territory of Australia

Abstract Aim This study is the first in-depth qualitative study that has provided insights into Aboriginal (All participants in this study identified as Aboriginal and thus we have not included any reference to the Torres Strait Islander peoples in this paper.) people’s views on current gambling policy and legislation in the Northern Territory (NT), Australia. Subject and methods In-depth semi-structured qualitative interviews were conducted with a targeted selection of participants. The sample comprised 29 participants, aged 18+ years, weekly and nonregular gamblers, and those negatively affected by others’ gambling. An open coding technique (a combination of inductive and deductive analyses) was used for data analysis. Appropriate ethics approval was also obtained. Results Participants described gambling as a revenue-generating product for the government and the gambling industry. Hence, their role in influencing the regulation of gambling for public benefit was debated. Participants provided practical suggestions that the government and the gambling industry could adopt to inform gambling regulation to minimise harm from gambling among Aboriginal people and the wider community in the NT. The suggestions included establishing stricter regulations relating to the licensing and opening hours of venues, limiting bet size and restricting the availability of gaming machines at venues. Participants also encouraged the reinstatement of mandatory formal dress codes at venues and the creation of health promotion resources such as advertisements and awareness campaigns tailored to the needs of the local Aboriginal people. Conclusion Both community-wide and targeted approaches are required to regulate and reduce gambling harm among Aboriginal people in the NT. Although both are important, having more explicit preventive approaches in place may eliminate the need for downstream interventions and strategies.

Changes in suicide literacy and intentions to ask about suicide: “Community Linker” training for those supporting Aboriginal people

ObjectiveGatekeeper training programs are widely used with promising results for suicide prevention. However, studies have found that when delivered to Indigenous communities, outcomes can be variable or ineffective. This study is a feasibility trial of a gatekeeper program based on the standardised ‘Question, Persuade and Refer’ (QPR) approach, which was adapted to the cultural needs of local Aboriginal communities in the Shoalhaven region of New South Wales, Australia. The study aims to identify whether 1) knowledge of suicide and intentions to help increase over the course of completing the gatekeeper program; 2) participants of different educational backgrounds have similar outcomes in suicide literacy and intentions to help; and 3) Aboriginal people and non-Aboriginal people have similar outcomes. MethodsOne hundred individuals participated in the research, of which 50% identified as an Aboriginal person. Pre- and post-training questionnaires assessed whether participants experienced an increase in suicide literacy and intentions to support others at risk of suicide. ResultsAlthough pre-test scores for suicide literacy and intentions to help were high, these increased significantly from pre- to post-test. Those with no prior gatekeeper training showed larger changes in both suicide literacy and intentions to ask about suicide compared to those with prior training. ConclusionOverall, this study highlights that delivery of culturally adapted gatekeeper training is associated with improved suicide literacy and intentions to ask about suicide amongst trainees.

Muddy Ground: Native Peoples, Chicago’s Portage, and the Transformation of a Continent

Muddy Ground: Native Peoples, Chicago’s Portage, and the Transformation of a Continent

An Ongoing Presence: Native People in Progressive-Era Connecticut, 1890s to 1910s

An Ongoing Presence: Native People in Progressive-Era Connecticut, 1890s to 1910s

INSPIRE AND IGNITE: ENABLING FACTORS FOR EARLY TOURISM DEVELOPMENT IN SABAH, MALAYSIA

Community-based tourism (CBT) is renowned worldwide as a sustainable economic development and a means of improving rural communities' welfare and standard of living. Successful CBT greatly depends on local communities’ readiness and active participation in ensuring equal distribution of CBT benefits. This study investigates the readiness of rural communities to engage in CBT under the management of Moyog Agrotourism and Tourism Park (MANTAP), a locally empowered organisation. The theoretical concept is framed by social exchange theory and the tourism development model is adjusted to match the local context. The study employs a cross-sectional approach, examining native perspectives on the early stages of CBT development in upper Moyog areas. Using the qualitative method, the findings reveal substantial local support for the CBT development. The study underscores the importance of demonstrating tourism benefits early on, as well as strong leadership and project legitimacy, which foster credibility and access to tourism resources. Native people who can picture themselves gaining benefits and be part of the tourism planning show more apparent support for tourism development in rural Penampang areas.

Who uses cigarette price promotions in the U.S.? examining the combined effect of social identities

IntroductionTobacco industry offers price promotions to promote cigarette smoking. Several social identities (e.g., women, people with low socioeconomic status) are independently associated with exposure and use of these promotions. We examined how combinations of social identities relate to use of cigarette price promotions. MethodsWe analyzed data from adults who reported current cigarette smoking and purchased their own cigarettes in the 1995–2019 U.S. Tobacco Use Supplement to the Current Population Survey (n = 35,749). We applied a statistical-learning boosting algorithm followed by weighted logistic regression models with 3-way interactions to identify combinations of social identities related to cigarette price promotion use. ResultsThis analysis revealed that use of cigarette price promotions varied greatly by combinations of social identities. For example, estimated 39.80% of Asian female adults living in the Midwest used these promotions in their last purchase. Meanwhile, estimated 2.80% of Asian male 31–45-year-old adults reported the same behavior. Additionally, American Indian/Alaskan Native peoples were indicated in four of the ten combinations of social identities with highest prevalence of cigarette price promotion use. DiscussionOur approach allowed for discovery of previously less appreciated social identities (e.g., race/ethnicity) related to high probability of using cigarette price promotions. These findings also revealed how combination of social-identity-related power dynamics may shape use of cigarette price promotions. Adopting this perspective in future surveillance and policy evaluation effort will provide better understanding in commercial tobacco use disparities.

Towards co-creating the praxis of teaching design from decolonial, intersectional and pluriversal approaches1

Across Oceania, design courses within the tertiary education sector remain entrenched in Eurocentric narratives and pedagogical approaches, which omit place-specific contexts, cultural histories, knowledges and diverse ways of designing, including those of First Nations. This concern drove the four authors to create the InterDesigning Network, a supra-institutional network that aims at connecting like-minded educators, practitioners and students. This article reflects on the results of the InterDesigning Network’s first symposium, titled Co-Creating the Praxis of Teaching Decolonial, Intersectional and Pluriversal Design and Histories. As the core team behind the network, we listened and learned from a panel formed by First Nations people that discussed Indigenous design practice, local protocols, connection to place and land, common struggles and ways of integrating Indigenous knowledges into contemporary design education. We also listened and were inspired by the insights shared by another panel made of diverse design educators who discussed how their positionalities and experiences inform their teaching practices. By reflecting on these insights as well as on the rationale behind the formation of a design educators’ network, this article offers actionable suggestions on how to disrupt the status quo for a more diverse and inclusive design education future.

Randomized controlled trial of frailty and disease stage in older people living with Chronic Kidney Disease

IntroductionThe GOAL trial, a cluster-randomised controlled trial, investigated the effect of comprehensive geriatric assessment (CGA) on frail older people with chronic kidney disease (CKD). This paper describes (1) participant baseline characteristics, and (2) their relationship with CKD stage and frailty severity. MethodsSixteen kidney outpatient clinics (clusters) were randomly allocated 1:1 to CGA or usual care. Enrolled frail older people with CKD (Frailty Index >0.25; aged ≥65 years or ≥55 if First Nations people) received the intervention allocated to their cluster. CKD was defined as moderate (stages 3/4) or severe (stage 5/5D), and frailty categorised as moderate (>0.25 to <0.36), severe (0.36 to <0.45) or very severe (≥0.45). Participant characteristics were analysed using descriptive statistics. Statistical methods appropriate for type of outcome were used to describe the association of frailty and CKD categories with participant characteristics. ResultsOver a 27-month period, 240 people were recruited (55.7% male, 82.9% white/European). Mean age was 76.9 (SD: 6.6) and median FI was 0.39 (IQR: 0.32 – 0.47). The median EQ-5D-5L quality of life index score was worse in those with very severe frailty (0.57, IQR: 0.28 – 0.83) compared to severe frailty (0.85, IQR: 0.67 – 0.92) and moderate frailty (0.90, IQR: 0.82 – 0.93) (overall P <0.001). Median EQ-5D-5L was also worse in those with severe CKD (0.79, IQR: 0.40 – 0.89), compared to moderate CKD (median 0.87, IQR: 0.73 – 0.92; P 0.001). ConclusionThis cohort demonstrated poorer quality of life scores in those with more severe frailty and more advanced CKD.

Sharing the Care: One Aboriginal Community-Controlled Organisation’s Approach to Out-of-Home Care of Aboriginal and Torres Strait Islander Children

ABSTRACT This article critically examines safety and innovation in out-of-home care, with a particular focus on addressing the entrenched overrepresentation of Aboriginal and Torres Strait Islander children and young people in the child welfare system. Grounded in the practical insights of safe house workers and managers, the purpose of this article is to share an innovative practice case study—the Tangentyere Safe House in Alice Springs, Northern Territory, Australia. As a case study within an Aboriginal Community-Controlled Organisation, Tangentyere Safe House emerges as a site for understanding the confluence of cultural safety, familial connections, and strategies to mitigate overrepresentation. Key themes explored include promoting cultural safety and supporting connections with the family of origin. Through a methodological lens that privileges practice-based knowledge, this article captured the on-the-ground experiences of those actively engaged in child safety. The findings underscore the innovative practices employed by Tangentyere Safe House in navigating out-of-home care within an Indigenous context to argue for a holistic and culturally informed approach to child protection interventions, drawing attention to the practical strategies employed by safe house workers. The article showcases the central role of Aboriginal Community-Controlled Organisations in providing care alongside families in out-of-home care. IMPLICATIONS The innovative approach of the Tangentyere Safe House highlights the importance and unique role of Aboriginal Community-Controlled Organisations in out-of-home care. The role of Aboriginal Community-Controlled Organisations should be formally recognised in the Aboriginal and Torres Strait Islander Child Placement Principle hierarchy. Frontline safe house workers’ knowledge and expertise regarding Aboriginal and Torres Strait Islander children in out-of-home care can inform all stakeholder involvement including police interventions.

Criminalising Coercive Control in New South Wales: Misunderstandings and Missed Opportunities

In 2022, New South Wales (‘NSW’) became the first Australian jurisdiction to criminalise coercive control, with the offence commencing on 1 July 2024. This follows the creation of similar offences overseas. These novel offences are designed to respond to the extensive critique of the criminal law which has largely focused on discrete incidents of physical violence leaving absent the full range and pattern of abuse experienced as domestic and family violence. In legislating in this area, the NSW Government sought to balance key tensions that emerged in the debates about criminalisation, such as: not to over-reach; the risk of victims being misidentified as offenders; the over-criminalisation of Aboriginal and Torres Strait Islander peoples; while at the same time addressing coercive control. In this article, I critically examine the NSW offence drawing attention to various misunderstandings about coercive control and misidentification that appear to underpin the NSW approach.

Child Protection Staff Perspectives of the SOFT Program: Touch, Textures, Weights, and Pressures

ABSTRACT Aboriginal children are overrepresented in Australia’s child protection system, and limited tools are available to assist with connecting these children to their culture. The Stitching Our Future Together (SOFT) Program, developed in consultation with Aboriginal and non-Aboriginal peoples, services, and other specialists, is used within the Department of Communities’ Child Protection and Family Support (CPFS) Division in Western Australia to address big emotions and safe behaviours with Aboriginal children in care. This study used phenomenology and social constructivism to explore CPFS staff’s perspectives and experiences of the SOFT Program. Seven semistructured in-depth interviews took place with CPFS staff. Five themes were identified: the SOFT Program and its use, culturally responsive practice, facilitating relationships, communication, and recommendations and implementation challenges. Participants expressed that the SOFT Program fostered an understanding of, and communication about, pertinent issues such as family and domestic violence, drug and alcohol addiction, mental health, and child neglect and abuse. The findings show how staff described the program’s capacity to help them navigate complex situations, highlighting the need to incorporate more culturally centred and creative-based work into child protection practice. IMPLICATIONS The SOFT Program positively supports culturally responsive practice and facilitates relationships and communication for child protection workers and children in care. The integration of creative and legislated practices assists with personalising and enhancing the effectiveness of child protection work with children in care.

Training community members to deliver an intervention for substance use disorder: Overcoming implementation barriers in American Indian communities

IntroductionAlthough American Indian and Alaska Native (AI/AN) people have high rates of abstinence from alcohol and other drugs, there also is evidence of greater rates of substance use disorders (SUDs) in Native communities. Health disparities associated with substance use are compounded by inadequate access to evidence-based treatments (EBTs). Lack of mental health providers is one notable barrier to EBT implementation in rural AI reservation communities. Our Indigenous Recovery Planning (IRP) intervention merges cultural lessons and culturally adapted relapse prevention strategies to facilitate SUD recovery in the reservation environment. One key implementation strategy is training non-specialist community-based facilitators to deliver IRP, thereby increasing its acceptability and sustainability. This manuscript reports the facilitator training, supervision, and fidelity monitoring procedures used in our ongoing clinical trial of IRP. MethodThe study recruited four AI non-specialist providers from the community to serve as IRP facilitators. Initial training involved an introductory motivational interviewing workshop followed by a 2-day workshop in the IRP curriculum. Then we conducted an open trial of the 6-week intervention with weekly supervision meetings as part of the facilitator training process. During the open trial we also assessed participant and facilitator receptivity to the IRP intervention and pilot tested our fidelity monitoring protocol. ResultsThe initial training workshops provided facilitators with information they needed to understand the rationale behind IRP and determine whether the facilitator role was a good fit; however, additional training and supervision during the open trial was needed to ensure proper treatment delivery. Although participant and facilitator feedback ratings were positive, the open trial helped us identify revisions needed to improve our approach to facilitator training, supervision, and fidelity monitoring. We revised these procedures, and also developed a protocol to train new facilitators who join the study midstream. ConclusionThe open trial was an important aspect of the facilitator training process and helped our team identify several areas of improvement. Our approach to training, supervising, and monitoring community member facilitators may serve as an example of how to overcome one barrier to implementing evidence-based SUD treatments in rural reservation communities with few mental health professionals.

Representation, Settler Colonialism and ‘the Aboriginal Child’: a Politics of Subalternity?

Gayatri Chakravorty Spivak famously thematised the question ‘can the subaltern speak?’ through the dual meanings of ‘representation,’ as both depiction and political proxy. This paper draws on Spivak’s analysis to question the capacity of the settler-colonial Australian imagination to represent (or recognise) the sovereignty of Aboriginal peoples – and especially of children, as infants (in-fans, literally speechless). The former sense of representation (depiction) bears implications for the second, as Indigenous sovereignty is displaced by settler representations of indigeneity – and particularly of Indigenous ‘childhood’ and ‘children’ as neglected ‘piccaninnies,’ without parentage or inheritance. Such portrayals, in this light, may even be read as continuous with colonial logics of elimination, as strategies to sever the connection to land that undergirds Indigenous conceptions of sovereignty and to thwart Indigenous futures. The article interrogates settler colonial investments in representing Aboriginal childhood in the context of recent public discourse about the constitutional recognition of First Peoples, and a political imperative to re-present the Australian ‘nation’ as post- (rather than currently) colonial. The questions that animate this inquiry include: what, if anything, can a settler-Australian politics of recognition offer First Peoples? Is it possible to represent (or recognise) Blak sovereignty through modifications to the settler constitution? And how does the settler image repertoire of Aboriginal children speak to this possibility? If that fabricated ‘Aboriginal child’ could speak, what would this ultimate ‘subaltern’ say?

Addressing colorectal cancer among Alaska Native peoples: A community and subject matter expert symposium

Addressing colorectal cancer among Alaska Native peoples: A community and subject matter expert symposium

Amitav Ghosh’s The Living Mountain: A Tale of Green Imperialism

Amitav Ghosh’s The Living Mountain: A Fable for Our Times (2022) is a kind of ecotopian speculative fiction that posits a cryptic study of human-environment relationship in the form of a fable. This novella offers a critical insight into the harsh reality of the present anthropological capitalism and its pernicious impacts on ecology as a whole. It criticizes the growing insensitivity of human towards nature in the clamour for material advancement. Ghosh envisions a caveat against the eco-colonial hegemony. Flummoxed by the injustices meted out to the nature by men, Ghosh implores the human race to get aware of the repercussions of environmental degradation and eco-colonialism. The novella, in a form of a dream tale, tells about how the predator nations expropriate the land and loot the bountiful resources of the prey nations. In the process of gaining upper-hand, they force the native people to disclose their mystic knowledge of their ancestors making it easier for them to encroach their land and natural resources. Obliged by a pressing need to awaken the entire human race from the delusions of grandeur and its aftermath, Ghosh pens down the narrative as a commentary on the rapidly growing exploitation of nature’s treasures on an unprecedented scale and its dire consequences. Ghosh has masterfully mingled history, myth, and fiction to unmask the hegemony and hierarchy percolating through the human society and how the malice of human has disturbed harmonious cohabitation of the natives and their environment. The paper aims at exploring the detrimental effects on the environment of the land of the colonised by the colonisers. At its root, it examines how the colonizers abuse not only the natives, their land, resources but even devalue their traditional knowledge. The anthropomorphic view of the colonizers has endangered the natural resources, and if not cured, may invite an ecological crash.

How universities can support Aboriginal and Torres Strait Islander peoples to achieve self-determination and improved wellbeing.

The right to self-determination is enshrined in international law, affirming Aboriginal people have the right to make decisions about matters that affect their lives, including meeting their social, political, cultural and economic needs. This paper explores the role of universities in supporting Aboriginal self-determination, including an examination of the importance of the social and cultural determinants of wellbeing and the impacts of assimilation on Aboriginal people’s ability to live in accord with cultural traditions. Insights into how universities can create more culturally appropriate learning environments are also reviewed with a particular focus on the fundamental differences between Western and Aboriginal culture, pedagogy, epistemology, ontology, and axiology. The paper suggests that by undertaking a process of truth telling, universities will be able to create improved learning and research environments for Aboriginal students and staff that better support self-determination. By doing this, universities will leverage their unique position of influence to create improved wellbeing for Aboriginal people and the nation as a whole. This is an invited article based on a HERDSA keynote address, which was presented at the 2024 conference held in Adelaide, 8-11 July. Dr Callaghan was also invited to provide a video introduction to the article. The video link may be found on the ASRHE journal site next to the link to the PDF.

"If They Help Us, We Can Help Them": First Nations Peoples Identify Intercultural Health Communication Problems and Solutions in Hospital in Northern Australia.

Effective intercultural communication between First Nations peoples and healthcare providers in colonised countries is required to deliver equitable healthcare and improve patient experiences and health outcomes. This paper presents First Nations peoples' perspectives and proposed solutions to problematic communication experiences at Royal Darwin Hospital in northern Australia. The study's methodological foundations comprise decolonising principles rooted in Critical Race Theory, Freirean pedagogy, and cultural safety. Eleven individuals from diverse First Nations backgrounds receiving treatment at the largest hospital in the Northern Territory, participated in in-depth interviews conducted in their preferred languages. Data were inductively analysed, adapted from a constructivist grounded theory approach and guided by First Nations knowledges. First Nations patients at Royal Darwin Hospital described a culturally unsafe hospital due to ineffective intercultural communication. Patient "counterstories" recounted instances of confusion, aggression, healthcare provider resistance to shared decision-making opportunities, pressure to abandon cultural protocols, and institutional neglect. Poor communication incited anger among staff and patients, and contributed to experiences of racism, missed appointments, clinical mistakes, patients prematurely discharging before completing treatment, and patients experiencing financial troubles and homelessness. In a spirit of generosity, patients proposed solutions focused on relationship building and mutual understanding so that new decolonised systems, which draw on First Nations and Western knowledges, can be codesigned. This study serves as a call to action for policymakers, administrators, and healthcare providers to prioritise improving intercultural communication by addressing the behaviour of staff and changing systemically racist policies in the pursuit of health equity and cultural safety for First Nations peoples.

Relationships between social determinants of health and healthy body composition among Aboriginal and Torres Strait Islander youth in the Next Generation: Youth Well-being study.

Little is currently known about the relationships between body composition and the social determinants of health among Aboriginal and Torres Strait Islander youth in Australia, which could help inform policy responses to address health inequities. This study aimed to explore the relationship between various social factors and healthy body mass index (BMI) and waist/height ratio (WHtR) among Aboriginal and Torres Strait Islander youth aged 16-24 years. Baseline survey data from 531 participants of the 'Next Generation: Youth Well-being study' were used. Robust Poisson regression quantified associations between healthy body composition and self-reported individual social factors (education, employment and income, government income support, food insecurity, home environment, relationship status, racism), family factors (caregiver education and employment) and area-level factors (remoteness, socioeconomic status). Healthy body composition was less common among those living in a crowded home (healthy WHtR aPR 0.67 [0.47-0.96]) and those receiving government income support (healthy BMI aPR 0.74 [0.57-0.95]). It was more common among those with tertiary educated caregivers (healthy BMI aPR 1.84 [1.30-2.61]; healthy WHtR aPR 1.41 [1.05-1.91]) and those in a serious relationship (healthy BMI aPR 1.33 [1.02-1.75]). Social factors at the individual and family level are associated with healthy body composition among Aboriginal and Torres Strait Islander youth. SO WHAT?: The findings of this study highlight the potential for health benefits for youth from policies and programs that address social inequities experienced by Aboriginal and Torres Strait Islander people in Australia.

A randomized controlled trial evaluation of a smoking cessation and physical activity intervention delivered via telemedicine in the Norton Sound region of Alaska

ObjectivesTobacco use disproportionately affects Alaska Native people. Physical activity may aid quitting smoking and provides health benefits. We tested telemedicine-delivered heart health interventions in Alaska’s Norton Sound region. MethodsAlaska Native adults (N = 299, 51.5 % male, 60.5 % Inupiaq) with hypertension and/or hypercholesterolemia who smoked daily were randomized to intervention on smoking and physical activity (group 1) or traditional diet and medication adherence (group 2). Intention to change was not required for participation. Stage-tailored mailed workbooks and personalized reports were supported by telehealth counseling at baseline, 3, 6, and 12 months. Study outcomes were assessed at baseline, 3-, 6-, 12-, and 18-months (i.e., 6-months after the final counseling session). Smoking outcomes were self-reported 7-day point prevalence abstinence (7d-PPA),11Abbreviations:7d-PPA: 7-day point prevalence abstinenceMET: Metabolic equivalent of taskMVPA: Moderate-to-vigorous physical activityNRT: Nicotine replacement therapy. bioconfirmed with urine anabasine; 24-hour quit attempts; and 50 % reduction in smoking. Self-reported physical activity outcomes were metabolic equivalent of task (MET) minutes and meeting moderate-to-vigorous physical activity (MVPA) guidelines. ResultsAt baseline, participants averaged 12.4 (SD = 10.0) cigarettes/day, with 19.4 % prepared to quit smoking, and 81.6 % meeting MVPA guidelines. During the study, most (70.2 % group 1; 63.5 % group 2) reported a 24-hr quit attempt (p = 0.219), and Group 1 (53.6 %) was more likely than Group 2 (28.4 %) to use nicotine replacement therapy (NRT), OR = 2.92, p < 0.001. At 18-months, 40.5 % (group 1) and 32.5 % (group 2) had reduced their smoking by half or more (p = 0.343), and 10.8 % vs. 7.9 % (group 1 vs. 2) reported 7d-PPA with 4 % vs. 6 % (group 1 vs. 2) bioconfirmed. Time and baseline stage of change predicted 7d-PPA (p’s≤.015), with no group effect (p = 0.325). Activity levels did not significantly differ by group or time. ConclusionsTelemedicine counseling supported NRT use but did not significantly affect behavioral outcomes.