Smokeless tobacco use among American Indian women - Southeastern North Carolina, 1991

Morbidity and Mortality Weekly Report, Feb 17, 1995

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Editorial Note: Based on the findings of this survey, the prevalence of smokeless tobacco use among Lumbee women in North Carolina in 1991 was nine times the national mean prevalence for American Indian women (2.5%) and 38 times that for women in the total U.S. population (0.6%)[1]. Robeson County, where most of the Lumbee reside, is the third largest tobacco-producing county in North Carolina (E. Davis, Robeson County [North Carolinal Agricultural Extension Service, personal communication, 1994), and the high prevalence of smokeless tobacco use among the Lumbee women may reflect, in part, the tobacco-based local economy. High prevalences of smokeless tobacco use also have been documented in other tobacco-producing regions of the United States[2,3]. However, the prevalence of smokeless tobacco use among these women was more than twice that of women in Pitt County, North Carolina[3], the leading tobacco-producing county in the United States, and approximates the prevalence among some male adolescent populations[4].

Cultural factors specific to American Indians and the economic impact of tobacco on residents of this region may be associated with this unusually high prevalence of smokeless tobacco use. For example, use of tobacco has been a part of American Indian culture, including medicinal uses such as trestment of gastrointestinal symptoms[5], since before the arrival of Europeans[6,7]. Such uses of tobacco, combined with the availability of tobacco leaf among tobacco-farming families, may be associated with initiation of nicotine addiction in young children.

The findings in this study are subject to at least two limitations. First, respondents were asked to recall their use of smokeless tobacco as children; because early age at initiation among younger women was more recent and, therefore, more likely to be remembered, the high prevelence of early onset of use among younger women may partly reflect this biss. Second, family use of tobacco and family or personal involvement in tobacco production were not analyzed. Employment in tobacco production may play a role in attitudes toward smokeless tobacco use[3] because personal involvement in growing tobacco has been associated with a high prevalence of smokeless tobacco use among adolescents[2].

The high prevalence of smokeless tobacco use among Lumbee women increases the risk for health hazards, including gingival recession, tooth loss, leukoplakia, and oral cancer. Nicotine use may also increase the risk for cardiovascular disease[8] and reproductive risks such as low birthweight, premature delivery, and spontaneous abortion[9]. Further assessment of parents' attitudes toward childhood smokeless tobacco use, the anthropologic characteristics of smokeless tobacco use among the Lumbee, and the influence of a tobacco-based economy on early initiation and high prevalence of smokeless tobacco use should assist in the development of culturally and economically acceptable interventions.