title: Church-related correlates of tobacco use among Lumbee Indians in North Carolina.
abstract: BACKGROUND
  Although minority populations suffer a disproportionately higher burden of tobacco-attributable morbidity and mortality, the church appears to be a promising avenue through which to pursue tobacco-cessation interventions in these communities. This report describes church-related correlates of tobacco use among the Lumbee Indians in North Carolina, a population with a high prevalence of tobacco use, strong ties to tobacco-related agriculture, and high levels of church participation.
  
  
  METHODS
  A cross-sectional telephone survey of 400 adult Lumbee Indians was carried out in Pembroke, a town in Robeson County, NC. The questionnaire elicited information on tobacco use, demographic and social support information, knowledge and practices related to tobacco agriculture and traditional Native American tobacco use and church participation.
  
  
  RESULTS
  Sixty-three percent of participants were church members and 82% said the church is "very important" to the Lumbee community. In bivariate analysis, church attendance over the past year correlated with age, education, gender, number of close friends and relatives, marital status and current smoking status. Church attendance was not related to current smokeless tobacco use or participation in tobacco-related agriculture. Current smokers who had not attended church in the past year smoked significantly more cigarettes per day than current smokers attending church more often. In logistic regression, participants attending church weekly or more often were 73% less likely to be current smokers (adjusted odds ratio [AOR] = 0.27, 95% confidence interval [CI] = 0.11-0.68). Among ever-smokers, participants having attended church infrequently in the past year were 79% less likely to have quit (AOR = 0.21, 95% CI = 0.07-0.65). Having participated in tobacco agriculture as a child predicted current Christian views on tobacco use.
  
  
  CONCLUSIONS
  Tobacco use, common among Lumbee adults, correlates with a variety of demographic and social support variables. In addition, these data are the first to uncover a dose-response relationship between church attendance and number of cigarettes smoked per day by current smokers, and the relationship between childhood participation in tobacco agriculture and Christian views on tobacco use. Our results should be useful in designing a church-based tobacco-cessation intervention among Lumbee Indians.
authors.affiliation: Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. jspangle@bgsm.edu
authors.forename: J G
authors.initials: JG
authors.lastname: Spangler
authors.forename: R A
authors.initials: RA
authors.lastname: Bell
authors.forename: S
authors.initials: S
authors.lastname: Knick
authors.forename: R
authors.initials: R
authors.lastname: Michielutte
authors.forename: M B
authors.initials: MB
authors.lastname: Dignan
authors.forename: J H
authors.initials: JH
authors.lastname: Summerson
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002835:Christianity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D016017:Odds Ratio; D011159:Population Surveillance; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D012944:Social Support; D011795:Surveys and Questionnaires