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Tobacco Use and Cardiovascular Disease among American Indians: The Strong Heart Study
Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, CHB Rm. 354, 801 NE 13th St., Oklahoma City, OK 73104, USA
Center for American Indian Health Research, University of Oklahoma Health Sciences Center, 801 NE 13th St., Oklahoma City, OK 73104, USA
Missouri Breaks Industries Research, Inc., HCR 64 Box 52, Timber Lake, SD 57656, USA
* Author to whom correspondence should be addressed.
Received: 8 September 2010; in revised form: 12 October 2010 / Accepted: 18 October 2010 / Published: 25 October 2010
Abstract: Tobacco use among American Indians has a long and complicated history ranging from its utilization in spiritual ceremonies to its importance as an economic factor for survival. Despite this cultural tradition and long history, there are few studies of the health effects of tobacco in this population. The Strong Heart Study is a prospective observational study of cardiovascular disease (CVD) in 13 American Indian tribes in Arizona, Oklahoma, and North and South Dakota with 4,549 participants. Baseline examinations were followed by two examinations at regular intervals and 16 years of morbidity and mortality follow-up. Hazard ratios (HRs) for non-fatal CVD for current smokers vs. non-smokers after adjusting for other risk factors were significant in women (HR = 1.94, 95% CI 1.54 to 2.45) and men (HR = 1.59, 95% CI 1.16 to 2.18). Hazard ratios for fatal CVD for current smokers vs. non-smokers after adjusting for other risk factors were significant in women (HR = 1.64, 95% CI 1.04 to 2.58), but not in men. Individuals who smoked and who were diagnosed with diabetes mellitus, hypertension or renal insufficiency were more likely to quit smoking than those without these conditions. On average, American Indians smoke fewer cigarettes per day than other racial/ethnic groups; nevertheless, the ill effects of habitual tobacco use are evident in this population.
Keywords: American Indians; tobacco use; cardiovascular disease; Strong Heart Study
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Eichner, J.E.; Wang, W.; Zhang, Y.; Lee, E.T.; Welty, T.K. Tobacco Use and Cardiovascular Disease among American Indians: The Strong Heart Study. Int. J. Environ. Res. Public Health 2010, 7, 3816-3830.
Eichner JE, Wang W, Zhang Y, Lee ET, Welty TK. Tobacco Use and Cardiovascular Disease among American Indians: The Strong Heart Study. International Journal of Environmental Research and Public Health. 2010; 7(10):3816-3830.
Eichner, June E.; Wang, Wenyu; Zhang, Ying; Lee, Elisa T.; Welty, Thomas K. 2010. "Tobacco Use and Cardiovascular Disease among American Indians: The Strong Heart Study." Int. J. Environ. Res. Public Health 7, no. 10: 3816-3830.