Cigarette Smoking Among American Indians and Alaskan Natives --- Behavioral Risk Factor Surveillance System, 1987-1991

Cardiovascular disease and cancer are two of the leading causes of premature death among American Indians and Alaskan Natives (1). Although cigarette smoking contributes to these diseases, cigarette smoking behaviors among American Indians and Alaskan Natives have not been well characterized nationally (2,3). To better assess the impact of smoking on these populations, CDC analyzed data obtained from the Behavioral Risk Factor Surveillance System (BRFSS) during 1987-1991. This report summarizes the findings from this study.

Data were analyzed for 3102 American Indians and Alaskan Natives and for 297,438 white persons aged greater than or equal to 18 years from 47 states and the District of Columbia. Data were from the BRFSS, a telephone interview survey that uses a standardized, multistage, cluster sampling design. Data were weighted to provide estimates representative of each state. Current smokers were defined as persons who reported current smoking and who had smoked at least 100 cigarettes. Survey participants were asked the average number of cigarettes smoked per day. SESUDAAN (4) was used to calculate prevalence estimates, standard errors, and confidence intervals (5).

During 1987-1991, the prevalence of smoking was higher among American Indian and Alaskan Native men (33.4%) and women (26.6%) than among white men (25.7%) and women (23.0%). Although the prevalence of smoking declined with increasing education and income for white men, among American Indian and Alaskan Native men with a college education or more, the rate of smoking was substantially higher (37.5%) than for whites (14.6%) (Table 1).

The average number of cigarettes smoked per day among smokers was lower for American Indian and Alaskan Native men (19.4) and women (15.5) than for white men (21.4) and women (17.7) -- a relation that was consistent across age, education, and income categories (Table 2).

Reported by: Epidemiology Br, Office on Smoking and Health, and Behavioral Risk Factor Surveillance Br, Office of Surveillance and Analysis, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The higher prevalence of smoking among American Indians and Alaskan Natives described in this report is consistent with findings from other national surveys (6,7). However, because many American Indians and Alaskan Natives in rural areas do not have telephones (8), this telephone survey may overrepresent urban respondents.

Explanations for the higher smoking prevalence among American Indians and Alaskan Natives may include lower educational attainment, lower income levels, traditional cultural practices involving tobacco use, and concurrent alcohol use (2,9). Culturally sensitive and empirically tested prevention and cessation efforts may be necessary to adequately address tobacco use in these populations.

The year 2000 national health objectives have targeted a smoking prevalence of 20% or less among American Indians and Alaskan Natives (objective 3.4f) (15% among the total population objective 3.4) (10). To achieve this objective, smoking-cessation and smoking-prevention efforts must be targeted and intensified for these groups.

References

1. Indian Health Service. Trends in Indian health, 1990. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1990.

2. US Department of Health and Human Services. Report of the Secretary's Task Force on Black and Minority Health. Vol 1: executive summary. Washington, DC: US Department of Health and Human Services, 1987; DHHS publication no. 86-621-604.

3. CDC. Reducing the health consequences of smoking: 25 years of progress -- a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

4. Shah BV. SESUDAAN: standard errors program for computing of standardized rates from sample survey data. Research Triangle Park, North Carolina: Research Triangle Institute, 1981.

5. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM, Hogelin GC. Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-1987. Public Health Rep 1988;103:366-75.

6. Lefkowitz D, Underwood C. Personal health practices: findings from the Survey of American Indians and Alaska Natives. Rockville, Maryland: Public Health Service, Agency for Health Care Policy and Research, 1991; AHCPR publication no. (PHS)91-0034. National Medical Expenditure Survey research findings no.10.

7. CDC. Cigarette smoking among adults -- United States, 1990. MMWR 1992;41:354-5,361-2.

8. Sugarman JR, Warren CW, Oge L, Helgerson SD. Using the Behavioral Risk Factor Surveillance System to monitor year 2000 objectives among American Indians. Public Health Rep 1992;107:449-

10. Schinke SP, Moncher MS, Holden GW, Botvin GJ, Orlandi MA. American Indian youth and substance abuse: tobacco use problems, risk factors and preventive interventions. Health Educ Res 1989;4:137-44.

11. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

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