title: Tobacco use among American Indian or Alaska Native middle- and high-school students in the United States.
abstract: BACKGROUND
  An estimated 0.5 million American Indian or Alaska Native (AI/AN) adolescents under the age of 18 years smoked cigarettes during their entire lifetime. Using a national sample of AI/AN middle- and high-school students, this study examines prevalence rates and relative impacts of individual, familial, and social predictors of different types of tobacco use.
  
  
  METHODS
  A national sample of 305 (weighted N = 142,989) AI/AN middle- and high-school students in Grades 6 through 12 were selected from the 2006 National Youth Tobacco Survey.
  
  
  RESULTS
  During their entire life, most of the respondents used cigarettes (54%), followed by cigars (24%), smokeless tobacco (16%), pipes (13%), and menthol cigarettes (12%). One in 3 (32%) used 2 or more forms of tobacco. High-school students reported significantly higher for all types of tobacco use than middle-school students, while the rates did not differ by gender. Multivariate analyses showed that age, family members' smoking, and refusal to smoke predicted tobacco users with one product. Family members' smoking and refusal to smoke remained significant in predicting more than 2 forms of tobacco use (polytobacco users), while age was no longer significant. School truancy and receptivity to tobacco marketing uniquely predicted polytobacco users.
  
  
  CONCLUSIONS
  Findings underscore that tobacco control programs for AI/AN students need to address the multiple predictors of different types of tobacco use. Implications of the findings are discussed.
authors.affiliation: School of Social Work and Public Health Program, 720 Clark Hall, University of Missouri, Columbia, MO 65211-4470, USA. yuma@missouri.edu
authors.forename: Mansoo
authors.initials: M
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000413:Alaska / Q000453:epidemiology; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D012907:Smoking / Q000453:epidemiology*; D013334:Students / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology