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Open Access Study protocol

A longitudinal study of tobacco use among American Indian and Alaska Native tribal college students

Babalola Faseru12, Christine M Daley12, Byron Gajewski23, Christina M Pacheco12 and Won S Choi12*

Author Affiliations

1 Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS, USA

2 Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, USA

3 Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA

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BMC Public Health 2010, 10:617  doi:10.1186/1471-2458-10-617

Published: 18 October 2010



American Indians (AI) have the highest smoking rates of any ethnic group in the US (40.8%), followed most closely by African Americans (24.3%) and European Americans (23.6%). AI smokers also have more difficulty quitting smoking compared to other ethnic groups, evidenced by their significantly lower quit ratios, and are among the least successful in maintaining long term abstinence. While health disparities like these have existed for years among AI, the epidemiology of smoking and nicotine dependence has not been optimally described among this underserved population.

Our overarching hypothesis is that the susceptibility of AI to cigarette smoking and nicotine dependence and its consequences has both an underlying nicotine metabolism component as well as psychosocial, cultural, and environment causes. We are well-positioned to explore this issue for the first time in this population. Our objective is to establish a cohort of AI tribal college/university students to determine the predictors of smoking initiation (non-use to experimentation), progression (experimentation to established use), and cessation (established use to cessation). Much of what is known about the process of smoking initiation and progression comes from quantitative studies with non-Native populations. Information related to smoking use among AI tribal college/university (TCU) students is entirely unknown and critically needs further investigation. This study will be the first of its kind among AI college students who are at the highest risk among all ethnic groups for tobacco dependence.


First year students at Haskell Indian Nations University in Kansas will be recruited over four consecutive years and will be surveyed annually and repeatedly through year 5 of the study. We will use both longitudinal quantitative surveys and qualitative focus group methods to examine key measures and determinants of initiation and use among this high risk group.