title: A history of ashes: an 80 year comparative portrait of smoking initiation in American Indians and Non-Hispanic whites--the Strong Heart Study.
abstract: The consequences of starting smoking by age 18 are significant. Early smoking initiation is associated with higher tobacco dependence, increased difficulty in smoking cessation and more negative health outcomes. The purpose of this study is to examine how closely smoking initiation in a well-defined population of American Indians (AI) resembles a group of Non-Hispanic white (NHW) populations born over an 80 year period. We obtained data on age of smoking initiation among 7,073 AIs who were members of 13 tribes in Arizona, Oklahoma and North and South Dakota from the 1988 Strong Heart Study (SHS) and the 2001 Strong Heart Family Study (SHFS) and 19,747 NHW participants in the 2003 National Health Interview Survey. The participants were born as early as 1904 and as late as 1985. We classified participants according to birth cohort by decade, sex, and for AIs, according to location. We estimated the cumulative incidence of smoking initiation by age 18 in each sex and birth cohort group in both AIs and NHWs and used Cox regression to estimate hazard ratios for the association of birth cohort, sex and region with the age at smoking initiation. We found that the cumulative incidence of smoking initiation by age 18 was higher in males than females in all SHS regions and in NHWs (p < 0.001). Our results show regional variation of age of initiation significant in the SHS (p < 0.001). Our data showed that not all AIs (in this sample) showed similar trends toward increased earlier smoking. For instance, Oklahoma SHS male participants born in the 1980s initiated smoking before age 18 less often than those born before 1920 by a ratio of 0.7. The results showed significant variation in age of initiation across sex, birth cohort, and location. Our preliminary analyses suggest that AI smoking trends are not uniform across region or gender but are likely shaped by local context. If tobacco prevention and control programs depend in part on addressing the origin of AI smoking it may be helpful to increase the awareness in regional differences.
authors: School of Social and Political Sciences, University of Melbourne, Level 4, John Medley Building, Parkville 3010, Victoria, Australia. raymond.orr@unimelb.edu.au
authors: Raymond
authors: R
authors: Orr
authors: Darren
authors: D
authors: Calhoun
authors: Carolyn
authors: C
authors: Noonan
authors: Ron
authors: R
authors: Whitener
authors: Jeff
authors: J
authors: Henderson
authors: Jack
authors: J
authors: Goldberg
authors: Patrica Nez
authors: PN
authors: Henderson
mesh_terms: D000367:Age Factors; D001130:Arizona / Q000453:epidemiology; D015331:Cohort Studies; D005843:Geography; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007198:Indians, North American; D015146:Midwestern United States / Q000453:epidemiology; D012189:Retrospective Studies; D012737:Sex Factors; D012907:Smoking / Q000208:ethnology*; D013997:Time Factors; D044465:White People
references: J Epidemiol Community Health. 2005 May;59(5):395-401
references: 15831689
references: Int J Drug Policy. 2009 May;20(3):230-6
references: 19110409
references: J Adolesc Health. 2001 Jun;28(6):465-73
references: 11377990
references: Int J Environ Res Public Health. 2011 Oct;8(10):3871-88
references: 22073018
references: Addict Behav. 2004 Aug;29(6):1149-54
references: 15236816
references: Addiction. 1996 Nov;91(11):1705-14
references: 8972928
references: MMWR Recomm Rep. 1998 Oct 9;47(RR-18):v-xv, 1-16
references: 9784089
references: MMWR Morb Mortal Wkly Rep. 2011 Sep 9;60(35):1207-12
references: 21900875
references: Trials. 2011 May 18;12:126
references: 21592347
references: J Sch Health. 1999 Oct;69(8):326-31
references: 10544366
references: Public Health. 2012 Jun;126(6):482-9
references: 22560408
references: J Cancer Educ. 2005 Spring;20(1 Suppl):97-100
references: 15916529
references: J Am Med Womens Assoc (1972). 1996 Jan-Apr;51(1-2):67-9
references: 8868553
references: Przegl Lek. 2008;65(10):562-4
references: 19189548
references: Can J Public Health. 2009 Jan-Feb;100(1):51-4
references: 19263984
references: Yale J Biol Med. 2005 Jan;78(1):37-44
references: 16197728
references: Am J Health Promot. 2011 May-Jun;25(5 Suppl):S66-9
references: 21510789
references: Am J Public Health. 2009 Nov;99(11):2020-5
references: 19820215
references: Am J Prev Med. 2008 Dec;35(6 Suppl):S449-56
references: 19012838
references: Tob Control. 2003 Sep;12 Suppl 2:ii5-8
references: 12878767
references: Int J Ment Health. 2011 Spring;40(1):7-21
references: 21701696
references: East Mediterr Health J. 2003 Sep-Nov;9(5-6):923-34
references: 16450522
references: Drug Alcohol Depend. 1997 Mar 14;44(2-3):69-78
references: 9088778
references: Nicotine Tob Res. 2007 Aug;9(8):845-52
references: 17654297
references: Public Health Rep. 2005 Mar-Apr;120(2):192-9
references: 15842122
references: N Y State J Med. 1985 Jul;85(7):335-40
references: 3900827
references: Korean J Fam Med. 2012 Jan;33(1):1-8
references: 22745882
references: Tob Control. 2005 Jun;14(3):172-80
references: 15923467
references: Prev Chronic Dis. 2012;9:E05
references: 22172172
references: J Adolesc Health. 2002 Jun;30(6):426-32
references: 12039512
references: Soc Sci Med. 1991;32(9):989-1005
references: 2047903
references: BMC Public Health. 2012 May 18;12:303
references: 22537139
references: J Behav Med. 2009 Feb;32(1):20-47
references: 19030981
references: Public Health. 2010 Feb;124(2):65-70
references: 20060987
references: PLoS One. 2012;7(8):e42843
references: 22952617
references: Drug Alcohol Depend. 2012 Sep 1;125(1-2):140-5
references: 22564873
references: Am J Prev Med. 2003 Oct;25(3):219-25
references: 14507528
references: Bull World Health Organ. 2011 Mar 1;89(3):195-202
references: 21379415
references: Addict Behav. 2012 Oct;37(10):1093-100
references: 22673155
references: Cent Eur J Public Health. 2008 Dec;16(4):178-81
references: 19256286
references: MMWR Morb Mortal Wkly Rep. 2000 Oct 6;49(39):881-4
references: 11055740
references: Addiction. 2006 Dec;101(12):1805-13
references: 17156180
references: Subst Use Misuse. 2007;42(4):591-601
references: 17558952
references: Am J Prev Med. 2006 Jun;30(6):474-9
references: 16704940
references: Health Promot Pract. 2011 Sep;12(5):673-80
references: 21511998
references: Nicotine Tob Res. 2006 Apr;8(2):217-26
references: 16766414
references: Nicotine Tob Res. 2008 Jan;10(1):69-76
references: 18188747
references: Patient Educ Couns. 2006 Jun;61(3):411-8
references: 16125357
references: Addiction. 2006 Jan;101(1):128-36
references: 16393199
references: Am J Public Health. 1991 Mar;81(3):372-7
references: 1994746
references: J Cult Divers. 2006 Winter;13(4):181-5
references: 17338487
references: Drug Alcohol Depend. 2009 Jan 1;99(1-3):160-8
references: 18804924
references: Drug Alcohol Depend. 2010 Jan 15;106(2-3):126-32
references: 19765916
references: Taehan Kanho Hakhoe Chi. 2004 Jun;34(4):646-54
references: 15502430
references: Arch Pediatr Adolesc Med. 2000 Oct;154(10):1025-33
references: 11030855
references: N Z Med J. 1995 Mar 8;108(995):85-7
references: 7891950
references: Nicotine Tob Res. 2011 Nov;13(11):1106-13
references: 21849408