American Indian Cultural Adaptation to the Intervention for Nicotine Dependence: Education, Prevention, Tobacco, and Health (INDEPTH) Curriculum: A Collaborative Approach.

BACKGROUND: American Indian and Alaska Native (AIAN) youth experience disproportionately high rates of commercial tobacco use, including vaping electronic cigarettes, compared to non-AIAN youth. Despite this disparity, culturally relevant prevention interventions remain limited and often inaccessible. OBJECTIVES: This study describes the community-based participatory process used to culturally adapt a vaping prevention intervention for AIAN youth, in collaboration with a community organization and local schools. This paper focuses on the formative, qualitative phase of the intervention adaptation. METHODS: Participatory research methods were used to collect data through stakeholder interviews and focus groups with AIAN youth and adult community members. A community advisory board guided the study's implementation. Procedures were collaboratively developed to ensure cultural relevance. The community organization led local activities, while the academic partner managed regulatory requirements and analyzed the data using reflexive thematic analysis. RESULTS: Adult participants expressed the need for culturally relevant education on vaping, addiction, and communication with youth. They also recommended addressing the root causes and dangers of vaping through storytelling and AIAN imagery. Youth participants expressed ambivalence toward nicotine, discussed the role of mental health, and described witnessing harsher school consequences for AIAN students. Interviewees reported limited availability of school-based resources and stressed the importance of healthy coping skills. CONCLUSION: Findings highlight the need for accessible, culturally informed interventions that support AIAN youth through education, community engagement, and holistic approaches to prevention. Community perspectives are essential for creating effective, relevant programs that address the unique needs of AIAN youth and the complex factors influencing vaping.