Environmental and interpersonal risk factors of smoking among American Indian adolescents in California

Interpersonal and environmental factors play a significant role in tobacco use behavior among American Indian (AI) adolescents in California. This paper examines the associations between the smoking behavior of adolescents' friends and family (parent, sibling, grandparent, teacher, and cousin) with their own past-month and lifetime smoking behavior. Additionally, exposure to secondhand smoke is examined as a correlate of smoking. Methods: 880 AI youths between the ages of 13-19 years (mean age=16, 44% male) were recruited from approximately 50 tribal youth organizations and cultural events throughout urban and rural areas of California. Cross-sectional data was collected with a 40-minute paper and pencil tobacco survey. Questions included personal smoking behaviors, peer and family smoking, and exposure to secondhand smoke in the home, car, or outdoors. Logistic regression was used for analysis. Results: Respondents were more likely to report lifetime and past-month smoking if they had friends (lifetime OR=3.01 (2.18, 4.16), past-month OR=5.41 (3.36, 8.69)) or cousins (lifetime OR=1.42 (1.02, 1.97), past-month OR=1.66 (1.13, 2.44)) who smoked cigarettes. However, there were negative and marginally negative associations of grandparent smoking to past-month (OR=06.5 (0.43, 0.98)) and lifetime smoking respectively (OR=0.71 (0.49, 1.01)). Additionally, being in the same room (OR=1.63 (1.04, 2.56)) or car (OR=1.53 (1.01, 2.01)) with a smoker was associated with past-month smoking. Conclusions: It is important to address interpersonal and environmental influences of smoking behavior in the development of prevention programs for AI adolescents and to understand how the role of elders/grandparents within the AI community may affect adolescent smoking behavior.