title: Patient and smoking patterns in northern California American Indian Clinics. Urban and rural contrasts.
abstract: BACKGROUND
  This article elaborates on an earlier article about a smoking cessation program conducted in Northern California Indian clinics. Whereas the previous article discussed Indian smoking rates in general, this article compares the smoking patterns of Indians who live in urban and rural settings. The differences between the two populations are described, and the implications of these differences for planning, policy, and education are discussed.
  
  
  METHODS
  A self-report questionnaire was administered to 1369 adult Indians seeking health services at 18 American Indian health care clinics in Northern California. Data were collected on demographic characteristics; smoking behaviors; readiness to quit smoking; knowledge, behavior, and attitude; and a social support and "hassles" measures.
  
  
  RESULTS
  Urban Indians were more mobile and reported higher smoking rates, a higher level of education, less social support, and more hassles than rural Indians.
  
  
  CONCLUSIONS
  Indians living in urban areas continue to experience a high degree of stress. Long-term isolation from reservations and traditional homelands may have contributed to the breakdown of social support systems among urban Indians. These and several other factors should be considered when designing tobacco control programs.
authors.affiliation: University of California at Berkeley, School of Public Health, Berkeley, California, USA.
authors.forename: F S
authors.initials: FS
authors.lastname: Hodge
authors.forename: L
authors.initials: L
authors.lastname: Fredericks
authors.forename: P
authors.initials: P
authors.lastname: Kipnis
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D012424:Rural Population / Q000706:statistics & numerical data; D012907:Smoking / Q000208:ethnology*; D016540:Smoking Cessation; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000208:ethnology; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data