title: The Association of Panic Disorder, Posttraumatic Stress Disorder, and Major Depression With Smoking in American Indians.
abstract: BACKGROUND
  Rates of cigarette smoking are disproportionately high among American Indian populations, although regional differences exist in smoking prevalence. Previous research has noted that anxiety and depression are associated with higher rates of cigarette use. We asked whether lifetime panic disorder, posttraumatic stress disorder, and major depression were related to lifetime cigarette smoking in two geographically distinct American Indian tribes.
  
  
  METHODS
  Data were collected in 1997-1999 from 1506 Northern Plains and 1268 Southwest tribal members; data were analyzed in 2009. Regression analyses examined the association between lifetime anxiety and depressive disorders and odds of lifetime smoking status after controlling for sociodemographic variables and alcohol use disorders. Institutional and tribal approvals were obtained for all study procedures, and all participants provided informed consent.
  
  
  RESULTS
  Odds of smoking were two times higher in Southwest participants with panic disorder and major depression, and 1.7 times higher in those with posttraumatic stress disorder, after controlling for sociodemographic variables. After accounting for alcohol use disorders, only major depression remained significantly associated with smoking. In the Northern Plains, psychiatric disorders were not associated with smoking. Increasing psychiatric comorbidity was significantly linked to increased smoking odds in both tribes, especially in the Southwest.
  
  
  CONCLUSIONS
  This study is the first to examine the association between psychiatric conditions and lifetime smoking in two large, geographically diverse community samples of American Indians. While the direction of the relationship between nicotine use and psychiatric disorders cannot be determined, understanding unique social, environmental, and cultural differences that contribute to the tobacco-psychiatric disorder relationship may help guide tribe-specific commercial tobacco control strategies.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; sawchuk.craig@mayo.edu.
authors.forename: Craig N
authors.initials: CN
authors.lastname: Sawchuk
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA;
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA;
authors.forename: Carolyn
authors.initials: C
authors.lastname: Noonan
authors.affiliation: Group Health Cooperative, Center for Health Studies, Seattle, WA;
authors.forename: Andy
authors.initials: A
authors.lastname: Bogart
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA;
authors.forename: Jack
authors.initials: J
authors.lastname: Goldberg
authors.affiliation: American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Aurora, CO.
authors.forename: Spero M
authors.initials: SM
authors.lastname: Manson
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA;
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000208:ethnology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D015205:Northwestern United States / Q000208:ethnology; D016584:Panic Disorder / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology; D015995:Prevalence; D012907:Smoking / Q000208:ethnology* / Q000523:psychology; D015206:Southwestern United States / Q000208:ethnology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology; D055815:Young Adult
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