Qualitative Analysis for American Indian College Students’ Alternative Tobacco Use

by Christina Haswood

The halfway point was around the first week of April where we were coming back from Spring Break. This year, we were all faced with COVID-19 and following social distancing, self-quarantine from traveling, and stay at home orders. Fortunately, this project was not heavily impacted by the COVID-19 pandemic, but our indigenous communities were. American Indian (AI) tribal nations have some of the highest mortality and rate of cases in the United States. Currently, tribes have not received their COVID-19 relief funds from the government.

Christina at her desk in her childhood bedroom.
Here’s a picture of me working in my childhood bedroom that now doubles as my workspace/office. I still try to dress business casual to get me in the work mode.

What affected our alternative tobacco (AT) project was our plan to recruit more survey participants as we hoped to capture about 200 more tribal college students. With COVID-19, our partnering university had sent their students home by the end of March. My team looked into the options of putting the survey online but we all respectfully agreed that sending a survey this early into the pandemic would be inappropriate.

The AT project used a mixed-methods approach which was qualitatively focused. Last semester we ran focus groups where AI students self-identified into three groups (1) current/former AT users, (2) current/former smoker, and (3) non-user. They were then stratified into their self-identified gender that followed a nested sampling approach. Participants took a de-identified survey that captured their knowledge, attitudes, beliefs, and behaviors (KABB) surrounding AT product use.

We completed 20 focus groups then transcribed the audio for qualitative analysis. Once transcriptions were completed an audit was performed by the transcribers. A codebook was then created with primary, secondary, and tertiary codes. Coders were trained to follow coding procedures by the Center for American Indian Community Health (CAICH). The objective of coding was to identify themes to be reviewed by the PI.

A qualitative focused study can be difficult as we needed to reach saturation with the focus groups in order to begin analysis. Reaching saturation, there is no perfect number to groups we could have calculated, and the risk of declaring saturation too early can produce inconsistent results. This was done by frequent team meetings and post focus group briefings. Working and being a student during COVID-19 has provided challenges that I am thankful to have a wonderful team, family, and friends who all uplift each other. My sincere thoughts go out to those impacted by COVID-19 and Indian Country. We are resilient peoples and we will get through this.