title: Stressful life events, ethnic identity, historical trauma, and participation in cultural activities: Associations with smoking behaviors among American Indian adolescents in California.
abstract: BACKGROUND
  American Indian (AI) adolescents have the highest prevalence of commercial tobacco use of any ethnic group in the United States. This study examines ethnic identity (EI), participation in cultural activities, and stressful life events (SLEs) as correlates of smoking and examines historical trauma (HT) as a mediator of these associations.
  
  
  METHODS
  California AI youth (N = 969, ages 13-19, recruited from 49 tribal youth organizations and cultural activities in urban and reservation areas in California) completed a tobacco survey. Structural equation modeling was used to test a model examining HT as a potential mediator of the associations of EI, participation in cultural activities, and SLEs with cigarette smoking.
  
  
  RESULTS
  Model fit was adequate. EI, participation in cultural activities, and SLEs predicted HT. HT mediated the associations of participation in cultural activities and SLEs with past-month smoking. Stronger EI predicted greater past-month smoking and this effect was mediated by greater HT. The direct effects from HT to both smoking outcomes were positive and the direct effect from EI to past-month smoking was negative.
  
  
  CONCLUSIONS
  HT is a risk factor for cigarette smoking both directly and in mediating the links of EI, cultural activities, and SLEs. More efforts are needed to help AI youth to process these thoughts and empower themselves to contribute to their own lives and those of their families and communities without resorting to unhealthy addictive behaviors such as commercial tobacco use.
authors.affiliation: Institute for Prevention Research, University of Southern California, Keck School of Medicine, 2001 N. Soto Street, Los Angeles, CA 90032, United States. Electronic address: toya@usc.edu.
authors.forename: Claradina
authors.initials: C
authors.lastname: Soto
authors.affiliation: Institute for Prevention Research, University of Southern California, Keck School of Medicine, 2001 N. Soto Street, Los Angeles, CA 90032, United States. Electronic address: baezcond@usc.edu.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Baezconde-Garbanati
authors.affiliation: Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, 1425 NW 10th Avenue, Miami, FL 33136, United States. Electronic address: sschwartz@med.miami.edu.
authors.forename: Seth J
authors.initials: SJ
authors.lastname: Schwartz
authors.affiliation: Institute for Prevention Research, University of Southern California, Keck School of Medicine, 2001 N. Soto Street, Los Angeles, CA 90032, United States. Electronic address: unger@usc.edu.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Unger
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000328:Adult; D002140:California / Q000453:epidemiology; D003469:Culture; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000523:psychology* / Q000706:statistics & numerical data; D008016:Life Change Events; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D012933:Social Identification; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D055815:Young Adult
keywords: Adolescent; American Indian; Cultural activities; Ethnic identity; Historical trauma; Smoking