With socioeconomic status controlled, cigarette use is lower among American Indians/Alaska Natives than whites

Higher crude prevalence of cigarette use among American Indians/Alaska Natives (AI/AN) than non-Hispanic whites (NHW) has helped engender an assumption that race/ethnicity explains the difference. This study examines whether being AI/AN versus NHW predicts greater use when socioeconomic status and demographics are controlled.

Data came from the National Survey on Drug Use and Health (2013-2017). Using logistic regressions with socioeconomic (income, education) and demographic (gender, age, marital status) controls, differences between AI/AN (n = 4,305) and NHW (n = 166,348) regarding heavier cigarette use (past month daily use, past month use of 300+ cigarettes, and nicotine dependence) and current cigarette use (past month use plus 100+ cigarettes in lifetime) were assessed. Adjusted predicted probabilities were also constructed.

NHW, compared to AI/AN, had greater odds of daily use: adjusted odds ratio (AOR) = 1.23 (95% CI: 1.03-1.49); predicted probabilities-15.3% and 13.0%, respectively. NHW had greater odds of using 300+ cigarettes: AOR = 1.47 (CI: 1.19-1.83); predicted probabilities-13.6% and 9.9%. NHW had greater odds of being nicotine dependent: AOR = 1.57 (CI: 1.31-1.89); predicted probabilities-10.3% and 7.1%. A difference in current use was not found. As controls, income and education were especially impactful.

With controls, particularly for socioeconomic status, heavier cigarette use was lower among AI/AN than NHW, and a current cigarette use difference was not indicated. This contradicts the idea that being AI/AN versus NHW independently predicts greater cigarette use, and it underscores the importance of socioeconomic status for understanding cigarette use among AI/AN.