Native Americans and higher cigarette use: Stereotype goes up in smoke

TUCSON, Ariz. – Multiple past studies have reported that, compared to whites, Native Americans have relatively high cigarette use, and this has contributed to speculation that Native Americans might be inherently prone to such use.

A new study at the University of Arizona College of Medicine – Tucson, however, found that after adjusting for differences in the income and education levels of the two groups, whites were more likely than Native Americans to use cigarettes daily, to consume larger numbers of cigarettes per month and to be nicotine dependent.

In these adjusted comparisons, the estimated percentage of daily cigarette users among whites was 15.3%, compared to 13.0% for Native Americans; the percentage of individuals consuming more than 300 cigarettes in the past month was 13.6% for whites, compared to 9.9% for Native Americans; and nicotine dependence was 10.3% for whites, compared to 7.1% for Native Americans.

The study, conducted by the Native American Research and Training Center (NARTC) in the Department of Family and Community Medicine, was published today in Drug and Alcohol Dependence (DAD). NARTC researchers analyzed data from a survey of more than 4,000 Native Americans and 160,000 whites from 2013 through 2017. Called the National Survey on Drug Use and Health, the survey was administered by the U.S. Substance Abuse and Mental Health Services Administration.

The research team included lead author James K. Cunningham, PhD, associate professor, Department of Family and Community Medicine and NARTC member; Teshia Arambula Solomon, PhD, associate professor, Department of Family and Community Medicine and NARTC member; and Jamie Ritchey, PhD, MPH, director, Tribal Epidemiology Center, Inter Tribal Council of Arizona, Inc.

Previous research, both in the United States and throughout the world, has shown that lower income and educational attainment are among the factors most strongly associated with cigarette use. Native Americans have the highest poverty rate of any major U.S. ethnic group, but their cigarette use levels typically have been reported without adjusting for income and education. This can leave the mistaken impression that being Native American itself means higher use.

“Tobacco use and tobacco-related disease and deaths are intertwined with the poverty facing many Native Americans,” Dr. Solomon said. “A critical need exists to increase and improve Native American tobacco prevention and treatment programs, while also addressing poverty.”

“Despite lower cigarette use when income and education are considered, Native Americans are dying from cigarettes at a much higher rate than whites,” Dr. Ritchey said.

The study noted that the smoking-attributable death rate for Native Americans has been estimated at 414 per 100,000, substantially higher than that for whites – 264 per 100,000.

“Beliefs such as Native Americans being distinctly prone to cigarette use are widespread but rarely tested,” Dr. Cunningham said. In 2016, the study’s research group debunked the “Native American elevated alcohol use” belief when they found that alcohol use among Native Americans was comparable to or less than that of whites.

“The consequences of substance misuse are too serious to allow for myths and misinformation,” Dr. Cunningham said.