Abstract
Tobacco use among American Indians has a long and complicated history ranging from its utilization in spiritual ceremonies to its importance as an economic factor for survival. Despite this cultural tradition and long history, there are few studies of the health effects of tobacco in this population. The Strong Heart Study is a prospective observational study of cardiovascular disease (CVD) in 13 American Indian tribes in Arizona, Oklahoma, and North and South Dakota with 4,549 participants. Baseline examinations were followed by two examinations at regular intervals and 16 years of morbidity and mortality follow-up. Hazard ratios (HRs) for non-fatal CVD for current smokers vs. non-smokers after adjusting for other risk factors were significant in women (HR = 1.94, 95% CI 1.54 to 2.45) and men (HR = 1.59, 95% CI 1.16 to 2.18). Hazard ratios for fatal CVD for current smokers vs. non-smokers after adjusting for other risk factors were significant in women (HR = 1.64, 95% CI 1.04 to 2.58), but not in men. Individuals who smoked and who were diagnosed with diabetes mellitus, hypertension or renal insufficiency were more likely to quit smoking than those without these conditions. On average, American Indians smoke fewer cigarettes per day than other racial/ethnic groups; nevertheless, the ill effects of habitual tobacco use are evident in this population.
Highlights
Tobacco has a long and complicated history for American Indians, having been used for religious and therapeutic purposes early on and later cultivated and traded with European settlers [1]
The present study focuses on tobacco use and its role as a contributor to cardiovascular disease (CVD) among participants in the Strong Heart Study
Variation is seen in the smoking rates among American Indians at the Strong Heart Study sites as seen in Figures 1 and 2
Summary
Tobacco has a long and complicated history for American Indians, having been used for religious and therapeutic purposes early on and later cultivated and traded with European settlers [1]. It is still used today in cultural practices, such as burial offerings, for spiritual protection, or as a gift [1]. Due to this history, a mystique surrounding tobacco and American Indians has evolved over time. American Indians have high rates of habitual tobacco use, smoking, chewing and dipping are practiced. Smoking rates among adult American Indians are the highest for any race/ethnicity in the United States. In 1999–2001, 40.4% of American Indians aged 18 years and above reported cigarette use during the preceding month compared to the national average of
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