The purpose of this study was to compare the prevalence of cigarette smoking and smoking cessation among American Indians living on or near Montana's seven reservations to those of non-Indians living in the same geographic region.
Methods.
Data for Montana Behavioral Risk Factor Surveillance System (BRFSS) respondents (n = 1,722) were compared to data from a BRFSS survey of American Indians living on or near Montana's seven reservations in 1999 (n = 1,000). Respondents were asked about smoking and smoking cessation as well as cardiovascular disease (CVD) and selected risk factors. Quit ratios were calculated for both groups.
Results.
American Indians were more likely to report current smoking (38%) than non-Indians (19%; p<0.001). Thirty-seven percent of Indian respondents with CVD risk factors reported current smoking, compared with 17% of non-Indians with CVD risk factors. However, there was no significant difference in reported smoking rates between Indians (21%) and non-Indians (27%) with a history of CVD. Indian smokers were more likely to report quitting for one or more days in the past year (67%), compared with non-Indians (43%). Quit ratios were significantly lower among Indians (43%) than among non-Indians (65%).
Conclusions.
High smoking rates in Indians, particularly among those with other CVD risk factors, demonstrate an urgent need for culturally sensitive smoking cessation interventions among Northern Plains Indians and highlight the need for the Surgeon General's focus on smoking in minority populations.
References
1.
Centers for Disease Control (US), Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Reducing the health consequences of smoking: 25 years of progress: A report of the Surgeon General. Rockville (MD): Department of Health and Human Services (US)1989. DHHS Pub. No.: (CDC) 89-8411.
2.
Centers for Disease Control (US), Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. The health benefits of smoking cessation: A report of the Surgeon General. Rockville (MD): Department of Health and Human Services (US)1990. DHHS Pub. No.: 90-8416.
3.
American Medical Association. American Medical Association guidelines for the diagnosis and treatment of nicotine dependence: How to help patients stop smoking. Washington: American Medical Association; 1994.
4.
Agency for Health Care Policy and Research (US). Smoking cessation clinical practice guideline no. 18. Rockville (MD): Department of Health and Human Services (US); 1996. AHCPR Pub. No.: 96-0693.
5.
Centers for Disease Control and Prevention (US), Center for Chronic Disease Prevention and Health Promotion. Chronic diseases and their risk factors: The nation's leading causes of death. Atlanta: CDC1999 Dec.
Centers for Disease Control and Prevention (US), National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Tobacco use among US racial/ethnic minority groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A report of the Surgeon General. Atlanta: CDC1988.
8.
SieversMLFisherJR. Diseases of North American Indians. In: RothschildHR, editor. Biocultural aspects of disease. New York: Academic Press; 1981. p. 191–252.
9.
HamptonJWMaherJFKeyCRRhoadesER. Cancer among American Indians and Alaska Natives. In: RhoadesER, editor. American Indian health: Innovations in health care, promotion, and policy. Baltimore: Johns Hopkins University Press; 2000. p. 179–200.
10.
GohdesD. Diabetes in American Indians: A growing problem. Diabetes Care1986; 9:609–13.
11.
GillelandFDMahlerRDavisSM. Non-ceremonial tobacco use among Southwestern rural American Indians: The New Mexico American Indian Behavioral Risk Factor Survey. Tob Control1998; 7:156–60.
12.
MendleinJMFreedmenDSPeterDGAllenBPercyCABallewC, Risk factor for coronary heart disease among Navajo Indians: Findings from the Navajo Health and Nutrition Survey. J Nutr1987; 127:2099S–2105S.
13.
NelsonRGGohdesDMEverhartJEHartnerJAZwemerFLPettittDJKnowlerWC. Lower-extremity amputations in NIDDM: 12 year follow-up study in Pima Indians. Diabetes Care1988; 11:8–16.
14.
SieversML. Cigarette and alcohol usage by southwestern American Indians. Am J Public Health1968; 58:71–82.
15.
GoldbergHIWarrenCWOgeLLHelgersonSDPepionDDLaMereEFriedmanJS. Prevalence of behavioral risk factors in two American Indian populations in Montana. Am J Prev Med1991; 7:155–60.
16.
LanierAPBulkowLRNovotnyTEGiovinoGADavisRM. Tobacco use and its consequences in northern populations. Arctic Med Res1990; 49(suppl 2):17–22.
17.
SternMP. Cardiovascular mortality in American Indians: Paradox explained?Am J Epidemiol1998; 147:1009–10.
18.
HowardBVLeeETCowanLDDevereuxRBGallowayJMGoOT, Rising tide of cardiovascular disease in American Indians: The Strong Heart Study. Circulation1999; 100:2389–95.
19.
WeltyTKCoulehanJ. Cardiovascular disease in American Indians and Alaska Natives. Diabetes Care1993; 16(suppl 1):277–83.
20.
SieversMLNelsonRGBennettPH. Sequential trends in overall and cause specific mortality in diabetic and non-diabetic Pima Indians. Diabetes Care1996; 19:107–11.
21.
HarwellTSGohdesDMooreKMcDowallJMSmilieJGHelgersonSD. Cardiovascular disease and risk factors in Montana American Indians and non-Indians. Am J Prev Med2001; 20:196–201.
22.
DennyCHHoltzmanD. Health behaviors of American Indians and Alaska Native: Findings from the BRFSS 1993–1996. Atlanta: Centers for Disease Control and Prevention (US); 1999.
23.
Prevalence of selected risk factors for chronic disease and injury in American Indians and Alaska Natives, United States, 1995–1998. MMWR Morb Mortal Wkly Rep2000; 49:79–82.
24.
WeltyTKLeeETYehJCowanLDGoOFabsitzRR, Cardiovascular risk factors among American Indians: The Strong Heart Study. Am J Epidemiol1995; 142:269–87.
25.
SPSS. SPSS base 8.0 for Windows user's guide. Chicago: SPSS, Inc.; 1998.
26.
Bureau of the Census (US). 1990 population and housing: Summary tape file 3A. Washington: Bureau of the Census; 1990.
27.
Bureau of the Census (US). Statistical brief: Phoneless in America, SB/94-16. Washington: Bureau of the Census; 1994 Jul.
28.
PearsonDCheadleAWagnerETonsbergRPsatyBM. Differences in sociodemographic, health status, and lifestyle characteristics among American Indians by telephone coverage. Prev Med1994; 23:461–4.
29.
FordES. Characteristics of survey participants with and without a telephone: Findings from the Third National Health and Nutrition Examination Survey. J Clin Epidemiol1998; 51:55–60.
30.
KehoeRWuSYLeskeMCChylackLTJr., Comparing self-reported and physician-reported medical history. Am J Epidemiol1994; 139:813–18.
31.
JacksonCJatulisDEFortmannSP. The Behavioral Risk Factor Survey and the Stanford Five-City Project Survey: A comparison of cardiovascular risk behavior estimates. Am J Public Health1992; 82:412–16.
32.
MartinLMLeffMCalongeNGarrettCNelsonDE. Validation of self-reported chronic conditions and health services in a managed care population. Am J Prev Med2000; 18:215–18.
33.
NelsonDEMoonRWHoltzmanDSmithPSiegelPZ. Patterns of health risk behaviors for chronic disease: A comparison between adolescent and adult American Indians living on or near reservations in Montana. J Adolesc Health1997; 21:25–32.
34.
SugarmanJRWarrenCWOgeLHelgersonSD. Using the national Behavioral Risk Factor Surveillance System and community-specific surveys to monitor year 2000 behavioral risk objectives in adult American Indians: Baseline estimates from 1985 to 1988. Public Health Rep1992; 107:449–56.
35.
Centers for Disease Control and Prevention (US). Inter-Tribal Heart Project: Results from the Cardiovascular Health Survey. Atlanta: CDC; 1996.
36.
Indian Health Service (US). Regional differences in Indian Health 1998–99. Rockville (MD): IHS; 2000.
37.
PinkertonREBadkeFR. Coronary heart disease: An epidemiologic study of Crow and Northern Cheyenne Indians. Rocky Mountain Med1974; 71:577–83.
38.
HodgeFFredricksLKipnisP. Patient smoking patterns in northern California American Indian clinics. Cancer1996; 78(Suppl):1623–8.
39.
OckeneISMillerNH, For the American Heart Association Task Force on Risk Reduction. Cigarette smoking, cardiovascular disease, and stroke: A statement for healthcare professionals from the American Heart Association. Circulation1997; 9:3243–7.
40.
HenselMRCavanaghTLanierAPGleasonTBouwensBTanttilaH, Quit rates at one year follow-up of Alaska Native Medical Center tobacco cessation program. Alaska Med1995; 37:43–7.
41.
JoeJ. Health: Traditional Indian health practices and cultural views. In: ChampagneD, editor. Native America: Portrait of the peoples. Detroit (MI): Visible Ink Press; 1994. p. 525–47.
42.
Department of Health and Human Services (US). Healthy people 2010: Understanding and improving health. 2nd ed.Washington: Government Printing Office; 2000 Nov.
