School of Social and Political Sciences, University of Melbourne, Level 4, John Medley Building, Parkville 3010, Victoria, Australia.
Int J Environ Res Public Health. 2013 May 2;10(5):1747-62. doi: 10.3390/ijerph10051747.
The consequences of starting smoking by age 18 are significant. Early smoking initiation is associated with higher tobacco dependence, increased difficulty in smoking cessation and more negative health outcomes. The purpose of this study is to examine how closely smoking initiation in a well-defined population of American Indians (AI) resembles a group of Non-Hispanic white (NHW) populations born over an 80 year period. We obtained data on age of smoking initiation among 7,073 AIs who were members of 13 tribes in Arizona, Oklahoma and North and South Dakota from the 1988 Strong Heart Study (SHS) and the 2001 Strong Heart Family Study (SHFS) and 19,747 NHW participants in the 2003 National Health Interview Survey. The participants were born as early as 1904 and as late as 1985. We classified participants according to birth cohort by decade, sex, and for AIs, according to location. We estimated the cumulative incidence of smoking initiation by age 18 in each sex and birth cohort group in both AIs and NHWs and used Cox regression to estimate hazard ratios for the association of birth cohort, sex and region with the age at smoking initiation. We found that the cumulative incidence of smoking initiation by age 18 was higher in males than females in all SHS regions and in NHWs (p < 0.001). Our results show regional variation of age of initiation significant in the SHS (p < 0.001). Our data showed that not all AIs (in this sample) showed similar trends toward increased earlier smoking. For instance, Oklahoma SHS male participants born in the 1980s initiated smoking before age 18 less often than those born before 1920 by a ratio of 0.7. The results showed significant variation in age of initiation across sex, birth cohort, and location. Our preliminary analyses suggest that AI smoking trends are not uniform across region or gender but are likely shaped by local context. If tobacco prevention and control programs depend in part on addressing the origin of AI smoking it may be helpful to increase the awareness in regional differences.
18 岁前开始吸烟的后果是严重的。早期吸烟与更高的烟草依赖、增加的戒烟难度和更多的负面健康结果有关。本研究的目的是研究在一个定义明确的美国印第安人（AI）人群中，吸烟开始的时间与一组出生在 80 年期间的非西班牙裔白人（NHW）人群的吸烟开始时间有多接近。我们从 1988 年的“坚强之心研究”（SHS）和 2001 年的“坚强之心家庭研究”（SHFS）以及 2003 年全国健康访谈调查中获得了亚利桑那州、俄克拉荷马州、北达科他州和南达科他州的 13 个部落的 7073 名 AI 成员的吸烟开始年龄数据，以及 19747 名 NHW 参与者。参与者的出生时间最早为 1904 年，最晚为 1985 年。我们根据出生队列、性别对参与者进行分类，对于 AI，还根据地点进行分类。我们估计了每个性别和出生队列组中 18 岁前吸烟的累积发生率，并使用 Cox 回归估计了出生队列、性别和地区与吸烟开始年龄之间的关联的风险比。我们发现，在所有 SHS 地区和 NHW 中，男性的 18 岁前吸烟的累积发生率都高于女性（p<0.001）。我们的结果表明，在 SHS 中，起始年龄存在明显的区域差异（p<0.001）。我们的数据表明，并非所有 AI（在这个样本中）都表现出类似的趋势，即更早地开始吸烟。例如，在俄克拉荷马州 SHS，出生于 20 世纪 80 年代的男性参与者比出生于 1920 年之前的参与者更早开始吸烟的比例为 0.7。结果表明，起始年龄在性别、出生队列和地点之间存在显著差异。我们的初步分析表明，AI 吸烟趋势在区域或性别之间并不统一，但可能受到当地环境的影响。如果烟草预防和控制计划部分依赖于解决 AI 吸烟的起源，那么提高对地区差异的认识可能会有所帮助。
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