Int. J. Environ. Res. Public Health 2010, 7(10), 3816-3830; doi:10.3390/ijerph7103816
Article

Tobacco Use and Cardiovascular Disease among American Indians: The Strong Heart Study

Received: 8 September 2010; in revised form: 12 October 2010 / Accepted: 18 October 2010 / Published: 25 October 2010
(This article belongs to the Special Issue Tobacco Smoking: Public Health, Science and Policy)
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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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MDPI and ACS Style

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.

AMA Style

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.

Chicago/Turabian Style

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.

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