title: Smokeless tobacco use and its relation to panic disorder, major depression, and posttraumatic stress disorder in American Indians.
abstract: BACKGROUND
  Rates of nicotine use are high in American Indians. Anxiety and depression tend to be associated with cigarette use, but the association of anxiety and depression with smokeless tobacco (ST) is less clear. We asked if panic disorder, major depression, and posttraumatic stress disorder (PTSD) are related to lifetime ST use in 2 American Indian tribes.
  
  
  METHODS
  Logistic regression analyses examined the association between lifetime panic disorder, major depression, and PTSD and the odds of lifetime ST use status after controlling for sociodemographic characteristics, smoking status, and alcohol use disorders in 1,506 Northern Plains and 1,268 Southwest tribal members.
  
  
  RESULTS
  Odds of lifetime ST use was 1.6 times higher in Northern Plains tribal members with a lifetime history of PTSD after controlling for sociodemographic variables and smoking (95% CI: 1.1, 2.3; p = .01). This association remained significant after further adjustment for panic disorder and major depression (odds ratio [OR] = 1.5; 95% CI: 1.0, 2.2; p = .04) but was diminished after accounting for alcohol use (OR = 1.3; 95% CI: 0.9, 1.9; p = .23). In the Southwest, lifetime psychiatric disorders were not associated with lifetime ST use status. Increasing psychiatric comorbidity was significantly linked to increased odds of ST use in both tribes.
  
  
  CONCLUSIONS
  This study is the first to examine psychiatric conditions and lifetime ST use in a large, geographically diverse American Indian community sample. Although approximately 30% of tribal members were lifetime users of ST, the association with lifetime psychiatric disorders was not as strong as those observed with cigarette smoking. Understanding shared mechanisms between all forms of tobacco use with anxiety and depressive disorders remains an important area for investigation.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. sawchuk@uw.edu
authors.forename: Craig N
authors.initials: CN
authors.lastname: Sawchuk
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
authors.forename: Carolyn
authors.initials: C
authors.lastname: Noonan
authors.forename: Andy
authors.initials: A
authors.lastname: Bogart
authors.forename: Jack
authors.initials: J
authors.lastname: Goldberg
authors.forename: Spero M
authors.initials: SM
authors.lastname: Manson
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000208:ethnology* / Q000523:psychology; D001294:Attitude to Health / Q000208:ethnology*; D015897:Comorbidity; D016001:Confidence Intervals; D003866:Depressive Disorder / Q000208:ethnology* / Q000523:psychology; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000523:psychology* / Q000706:statistics & numerical data; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012907:Smoking / Q000208:ethnology; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology* / Q000523:psychology; D014030:Tobacco, Smokeless / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult