Commercial Tobacco Retailing in Tribal Jurisdictions: A Field Study.

Objectives: Our objective was to provide data contrasting commercial tobacco retailing in Tribal versus non-Tribal jurisdictions, in 3 states. These data may be relevant for US Food and Drug Administration regulation of Tribal retailing. Methods: With Tribal permission, observations were made on commercial tobacco advertising, product variety, pricing, and retail concept for stores within and just outside Tribal jurisdictions in areas of Arizona (AZ), California (CA), and Oklahoma (OK). Results: A total of 87 Tribal (20 AZ, 53 CA, 14 OK) and 67 (10, 43, 14) non-Tribal retailer visits were completed. There was substantial variation across tribes, with sales in AZ and most CA Tribal jurisdictions handled at convenience stores, whereas OK Tribal retailing was done mostly in specialized tobacco-specialty shops. Electronic cigarettes were ubiquitous across Tribal and non-Tribal outlets. Advertising and breadth of cigarette offerings was most extensive in the tobacco specialty retailers of Tribal OK. Surprisingly, Tribally manufactured cigarettes were found only at some CA Tribal retailers. Conclusions: Some Tribal commercial tobacco outlets actually price above their non-Tribal competitors and there is substantial variation in retailing strategy across Tribal jurisdictions. Tribal governments can continue to evaluate and reform commercial tobacco retailing so as to improve Tribal health.

Genetics of Smoking Behaviors in American Indians.

BACKGROUND: The smoking behavior of American Indians (AI) differs from that of non-Hispanic whites (NHW). Typically light smokers, cessation interventions in AIs are generally less effective. To develop more effective cessation programs for AIs, clinicians, researchers, and public health workers need a better understanding of the genetic factors involved in their smoking behavior. Our aim was to assess whether SNPs associated with smoking behavior in NHWs are also associated with smoking in AIs. METHODS: We collected questionnaire data on smoking behaviors and analyzed blood and saliva samples from two Tribal populations with dramatically different cultures and smoking prevalence, one in the Northern Plains (n = 323) and the other in the Southwest (n = 176). A total of 384 SNPs were genotyped using an Illumina custom GoldenGate platform. Samples were also assessed for cotinine and 3-hydroxycotinine as markers of nicotine intake and nicotine metabolite ratio. RESULTS: Among 499 participants, we identified, in the Northern Plains sample only, a variant of the gamma-aminobutyric acid receptor subunit alpha-2 (GABRA2) (rs2119767) on chromosome 4p that was associated with many of the intake biomarkers of smoking we examined, suggesting a role for this gene in modifying smoking behavior in this population. We also identified three SNPs, in the Southwest sample only, as significant correlates of only cigarettes per day: rs4274224, rs4245147 (both dopamine receptor D2 gene), and rs1386493 (tryptophan hydroxylase 2 gene). CONCLUSIONS: The contribution of many genes known to underlie smoking behaviors in NHWs may differ in AIs. IMPACT: Once validated, these variants could be useful in developing more effective cessation strategies.

Effect of the Smoke-Free Illinois Act on casino admissions and revenue.

OBJECTIVE: As part of the Smoke-Free Illinois Act, smoking on the gambling floors of all commercial casinos in Illinois became prohibited. This study examined the effects of the Smoke-Free Illinois Act on casino admissions per-capita and real per-capita adjusted gross receipts using 18 years of data (10 years before and 8 years after the Illinois law went into effect). METHODS: We employed a difference-in-difference regression technique using monthly data for the states of Illinois, Indiana, Iowa and Missouri and control for numerous determinants expected to affect casino admissions and revenue. RESULTS: The Smoke-free Illinois Act was found not to be a statistically significant determinant of per-capita casino admissions and of real per-capita gross adjusted receipts in all the models we estimated. CONCLUSIONS: The estimates from this study clearly indicated that the Illinois law that banned smoking in casinos has had no significant negative economic consequences for casinos in terms of per-capita admissions or revenues.

Relationships Between Smoking Behaviors and Cotinine Levels Among Two American Indian Populations With Distinct Smoking Patterns.

Introduction: Smoking prevalence, cigarettes per day (CPD), and lung cancer incidence differ between Northern Plains (NP) and Southwest (SW) American Indian populations. We used cotinine as a biomarker of tobacco smoke exposure to biochemically characterize NP and SW smokers and nonsmokers and to investigate factors associated with variation in tobacco exposure. Methods: 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, second-hand smoke exposure, and traditional ceremonial tobacco use; plasma and/or salivary cotinine was measured. Results: Cotinine levels were (mean ± 95% confidence interval [CI]) 81.6 ± 14.1 and 21.3 ± 7.3 ng/ml among NP smokers and non-mokers, respectively, and 44.8 ± 14.4 and 9.8 ± 5.8 ng/ml among SW smokers and nonsmokers, respectively. Cotinine levels correlated with CPD in both populations (p < .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 nonsmokers and 10.9% of SW nonsmokers. Ceremonial traditional tobacco use was associated with higher cotinine among NP smokers only (p = 0.004). Second-hand 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. Conclusions: High prevalence of smoking in the Northern Plains and high cotinine levels among nonsmokers in both regions highlights the tribal populations' risk for tobacco-related disease. Implications: There is a high prevalence of smoking in Northern Plains American Indians. Among Northern Plains and Southwest nonsmokers, relatively high cotinine levels, representative of high tobacco exposure, suggest considerable exposure to second-hand smoke. It is critical to highlight the extent of second-hand 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.

Master Settlement Agreement Compliance Tobacco Directories: A Tool to Track Tribally Manufactured Cigarettes.

INTRODUCTION: Little is known about the scope of the tribally manufactured cigarette market. This study illuminates the topic by examining the Master Settlement Agreement Compliance Tobacco Directories, regularly updated documents that list the cigarette manufacturers and brand families that can be legally sold within participating states. METHODS: In July 2014, the latest Tobacco Directories were identified for 43 states and the District of Columbia. Colorado archival tobacco directories were extracted, by month since 2003. Tribal manufacturers and brands were identified in the directories and mapped by state. RESULTS: A total of 11 tribal manufacturers and 39 tribal cigarette brand families were identified in publicly available tobacco directories. Total unique brands were tallied by state, ranging from 1 to 24 unique brands. Historical data from Colorado showed that tribal manufacturers, as a percentage of all manufacturers, increased from 3.2% in 2003 to 20.6% by mid-2014. DISCUSSION: Analysis of Tobacco Directories offers an innovative approach to better understand the tribally manufactured cigarette market. More research is needed to understand reporting and compliance to the Tobacco Directories by manufacturers and retailers, and their usefulness as a research tool to the tobacco control community. IMPLICATIONS: This study aims to make three contributions to the literature: (1) identify tribal tobacco manufacturers and brands in the Master Settlement Agreement Compliance documents; (2) highlight the presence and scope of the tribally manufactured cigarette brands across the United States; and (3) observe any upward or downward trends in tobacco brands and manufacturers since the directories' implementation.

Mercury, autoimmunity, and environmental factors on cheyenne river sioux tribal lands.

Mercury (Hg), shown to induce autoimmune disease in rodents, is a ubiquitous toxicant throughout Cheyenne River Sioux Tribe (CRST) lands. CRST members may be exposed to Hg through fish consumption (FC), an important component of native culture that may supplement household subsistence. Our goals were to ascertain whether total blood Hg levels (THg) reflect Hg exposure through FC and smoking, and determine whether THg is associated with the presence of anti-nuclear antibody (ANA) and specific autoantibodies (sAuAb). We recruited 75 participants who regularly consume fish from CRST waters. Hg exposure through FC and smoking were assessed via questionnaires. Whole blood samples were collected from participants, and THg was measured using ICP-MS. ANA and sAuAb in serum were modeled using demographic and exposure information as predictors. Female gender, age, and FC were significant predictors of THg and sAuAb; self-reported smoking was not. 31% of participants tested positive for ANA ≥ 2+. Although ANA was not significantly associated with Hg, the interactions of gender with Hg and proximity to arsenic deposits were statistically significant (P < 0.05). FC resulted in a detectable body burden of Hg, but THg alone did not correlate with the presence of ANA or sAuAb in this population.

Short-term effects of a smoking prevention website in American Indian youth.

BACKGROUND: The rate of smoking commercial tobacco products among American Indian youth is double the rate for white youth. Interventions are needed to reduce this disparity. OBJECTIVE: To test the feasibility of a Web-based intervention to influence attitudes toward and intentions about smoking cigarettes among American Indian youth who attended a Native summer camp in the Northern Plains. METHODS: The study website, the SmokingZine, was originally developed and tested in Canadian youth, then adapted to be appropriate for American Indian youth. We conducted a randomized controlled trial to test the influence of exposure to the adapted SmokingZine website on smoking attitudes and behaviors among American Indian youth 12-18 years of age. Participants assigned to the intervention group were given access to the website for 1 hour per day during their camp experience and asked to sign in to the site and use it. Control group participants were not given access to the site. RESULTS: A total of 52% of intervention youth signed in to the website at least once. Among nonsmokers, intentions to try a cigarette in the intervention group declined from 16% to 0%, and increased from 8% to 25% in the control group (P < .05). Compared with the control group, youth in the intervention group were more likely to help others quit (21 percentage point change in intervention versus no change in control; P < .05) and had less positive attitudes about the drug effects of smoking (-0.19 change in intervention versus 0.67 in control; P < .05). CONCLUSION: These data indicate that SmokingZine needs more long-term, rigorous investigation as a way to keep American Indian youth from becoming regular smokers. Because the intervention group could use computers only 1 hour per day, increasing access might result in more visits and a greater effect of the website on smoking behaviors.

Access, relevance, and control in the research process: lessons from Indian country.

OBJECTIVE: To illustrate successful strategies in working with American Indian (AI) and Alaska Native (AN) communities in aging and health research by emphasizing access, local relevance, and decision-making processes. METHODS: Case examples of health studies involving older AIs (greater than or equal to 50 years) among Eastern Band Cherokee Indians, a federally recognized reservation; the Cherokee Nation, a rural, nonreservation, tribal jurisdictional service area; and Lakota tribal members living in Rapid City, South Dakota. RESULTS: Local review and decision making reflect the unique legal and historical factors underpinning AI sovereignty. Although specific approval procedures vary, there are common expectations across these communities that can be anticipated in conceptualizing, designing, and implementing health research among native elders. CONCLUSIONS: Most investigators are unprepared to address the demands of health research in AI communities. Community-based participatory research in this setting conflicts with investigators' desire for academic freedom and scientific independence. Successful collaboration promises to enhance research efficiencies and move findings more quickly to clinical practice.

Smoking cessation and its determinants among older American Indians: the Strong Heart Study.

OBJECTIVE: To examine the relationship between sociodemographic, clinical, and smoking history factors, and smoking cessation among older American Indians. DESIGN: Nested cohort study of cigarette smokers in the Strong Heart Study, a longitudinal study of cardiovascular disease among American Indians. SETTING: Thirteen American Indian tribes from Arizona, Oklahoma, and North and South Dakota. PARTICIPANTS: American Indian men and women (N = 998), aged 45-74 years, who identified themselves as smokers at the initial Strong Heart Study examination. MEASUREMENTS AND MAIN RESULTS: Twenty-one percent of smokers quit during the 4-year follow-up period. Multivariate logistic regression was used to assess the relationship between baseline sociodemographic, clinical, and smoking history factors, and smoking cessation. Factors associated with smoking cessation included being 65-74 years old (odds ratio [OR] 2.1; 95% confidence interval [CI], 1.3 to 3.3), being examined at the Arizona regional center (OR 2.2; 95% CI 1.3, 3.7), being non-daily smokers (OR 5.4; 95% CI 1.3, 18.5), smoking fewer than 6 cigarettes daily (OR 2.8; 95% CI 1.3, 4.7), being a smoker for fewer years(OR 2.0; 95% CI 1.0, 3.9), beginning to smoke at an older age (17 years or older, OR 1.6; 95% CI 1.1, 2.4), and having a history of diabetes (OR 1.7; 95% CI 1.2, 2.3). Factors not associated with smoking cessation included gender, level of education, childhood exposure to tobacco smoking, and a history of cardiovascular diseases, cancer, or respiratory diseases. CONCLUSION: Several determinants of smoking cessation among older American Indians identified in this study may have important implications for designing appropriate interventions for this special population.