title: Dual Tobacco use among Native American adults in southeastern North Carolina.
abstract: OBJECTIVE
  While patterns of smokeless tobacco (ST) use and cigarette smoking are well documented, the epidemiology of simultaneous use of both tobacco products is less well studied, particularly among Native American populations. This study examines correlates of dual tobacco use among Lumbee Indian adults in southeastern North Carolina.
  
  
  METHODS
  A telephone survey among 400 adult Lumbee Indians in Pembroke, North Carolina, collected information on demographics, current tobacco use, amounts of tobacco used, and tobacco related attitudes.
  
  
  RESULTS
  Total of 241 (60.3%) individuals did not currently use tobacco, 104 (26%) currently smoked, 74 (18.5%) currently used ST, and 19 (4.8%) used both products. Thus, 19 of 104 (18.3%) current smokers and 19 of 74 (25.7%) current ST users reported dual tobacco use. Compared to exclusive users of either tobacco product, dual tobacco users were intermediate in age and frequency of church attendance, had lower levels of education, and were the highest proportion of subjects reporting no friends and few close relatives. There was no difference by gender or marital status by tobacco use categories. While exclusive cigarette smokers reported smoking more cigarettes per day than dual tobacco users, overall, dual tobacco users had higher estimated daily nicotine exposure levels. Logistic regression analysis showed that younger age and infrequent church attendance predicted exclusive cigarette smoking, while older age and less education predicted exclusive ST use. Dual tobacco use was predicted only by less education.
  
  
  CONCLUSIONS
  Simultaneous use of ST and cigarettes is comparatively more common among Lumbee Indian adults than the general population and has an epidemiology distinct from either exclusive cigarette smoking or ST use. These data are the first to explore social support as well as tobacco-related attitudes among dual tobacco users in a Native American population. Recognition of these patterns of dual tobacco use would be important in any future tobacco intervention among Lumbee Indian adults.
authors.affiliation: Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA. jspangle@wfubmc.edu
authors.forename: J G
authors.initials: JG
authors.lastname: Spangler
authors.forename: R
authors.initials: R
authors.lastname: Michielutte
authors.forename: R A
authors.initials: RA
authors.lastname: Bell
authors.forename: S
authors.initials: S
authors.lastname: Knick
authors.forename: M B
authors.initials: MB
authors.lastname: Dignan
authors.forename: J H
authors.initials: JH
authors.lastname: Summerson
mesh_terms: D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010947:Plants, Toxic; D012307:Risk Factors; D012907:Smoking / Q000208:ethnology* / Q000523:psychology; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D014030:Tobacco, Smokeless