Tobacco use among American Indian tribal college students

Background: American Indians (AI) have a complex relationship with tobacco. Tobacco has long been a sacred plant for many AI tribes, used traditionally for ceremonial and spiritual purposes. Today, AIs have the highest rates of recreational smoking of any ethic group and suffer disproportionately from tobacco related illnesses. Racial/ethnic smoking prevalence is highest among AI high school seniors. Despite high prevalence rates of smoking among AI adolescents, there is little research on initiation patterns and possible socio-cultural and environmental differences that may contribute to smoking initiation. Objective: Establish a cohort of AI tribal college students to determine the predictors of smoking initiation (non-use to experimentation) and progression (experimentation to established use). Methods: In this ongoing observational cohort study, we are recruiting four consecutive freshman cohorts (N=1250). Using a web based survey, students at two different tribal colleges, are surveyed twice a year. The survey examines major risk factors for smoking and smokeless tobacco usage, specifically environmental, personal, cultural, and psychosocial. We will report the results to the tribal colleges and work with them to create programing for their students that address reducing and ultimately eliminating recreational tobacco use. Results: We present here the study design, recruitment methods, and preliminary data for our initial cohort (N=231). Results from this initial cohort reveal AI tribal college students' knowledge, attitudes and beliefs about recreational and traditional tobacco use.