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NAQC Newsroom: Research

Relationships Between Smoking Behaviors and Cotinine Levels Among Two American Indian Populations wi

Wednesday, June 7, 2017  
Posted by: Natalia Gromov
Julie-Anne Tanner, BSc, Jeffrey A. Henderson, MPH, MD, Dedra Buchwald, PhD, Barbara V. Howard, PhD, Patricia Nez Henderson, MPH, MD, Rachel F. Tyndale, PhD.
Relationships Between Smoking Behaviors and Cotinine Levels Among Two American Indian Populations with Distinct Smoking Patterns.
Nicotine Tob Res 2017 ntx114. doi: 10.1093/ntr/ntx114

Smoking prevalence, cigarettes per day (CPD), and lung cancer incidence differ between Northern Plains (NP) and Southwestern (SW) American Indian populations. We used cotinine as a biomarker of tobacco smoke exposure to biochemically characterize NP and SW smokers and non-smokers, and to investigate factors associated with variation in tobacco exposure. American Indians (N=636) were recruited from two different tribal populations (NP and SW) as part of a study conducted as part of the Collaborative to Improve Native Cancer Outcomes P50 project. For each participant, a questionnaire assessed smoking status, CPD, secondhand smoke exposure, and traditional ceremonial tobacco use; plasma and/or salivary cotinine was measured. Cotinine levels were (mean ±95% CI) 81.6 ± 14.1 and 21.3 ± 7.3 ng/ml among NP smokers and non-smokers, respectively, and 44.8 ± 14.4 and 9.8 ± 5.8 ng/ml among SW smokers and non-smokers, respectively. Cotinine levels correlated with CPD in both populations (P<0.0001). Cotinine ≥15 ng/ml was measured in 73.4% of NP smokers and 47.8% of SW smokers, and in 19.0% of NP non-smokers and 10.9% of SW non-smokers. Ceremonial traditional tobacco use was associated with higher cotinine among NP smokers only (P=0.004). Secondhand smoke exposure was associated with higher cotinine among NP non-smokers (P<0.02). More secondhand smoke exposure was associated with smoking more CPD in both populations (P=0.03–0.29). Linear regression modeling mirrored these findings. High prevalence of smoking in the Northern Plains and high cotinine levels among non-smokers in both regions highlights the tribal populations’ risk for tobacco-related disease. There is a high prevalence of smoking in Northern Plains American Indians. Among Northern Plains and Southwest non-smokers, relatively high cotinine levels, representative of high tobacco exposure, suggest considerable exposure to secondhand smoke. It is critical to highlight the extent of secondhand smoke exposure among the Northern Plains and Southwest American Indians, and to enhance efforts to initiate smoke-free policies in tribal communities, which are not subject to state-level polices.

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