Centers for American Indian and Alaska Native Health

Pilot Project for

Patricia Nez-Henderson, Ph.D.

Knowledge, Attitude and Belief Regarding Tobacco Use Among American Indian Elders


Patricia Nez Henderson, M.P.H., M.D., University of Colorado Health Sciences Center, American Indian Alaska Native Programs

While smoking rates are declining within the U.S. general population, many AIAN tribes and communities are experiencing increasing rates of smoking.i,ii,iii Indeed, the smoking prevalence among AI elders is among the highest in the nation, with rates as high as 45%. This smoking rate, nearly 20% greater than that observed in the U.S. general population,3,4 has been accompanied by rising rates of mortality from cardiovascular disease and lung cancer, leading causes of death among the AIAN elders.iv Despite these trends, important potential factors such as knowledge, attitude, and beliefs (KAB) related to tobacco use remain under-investigated in this special population.  

Studies have shown that 50% of AIAN smokers do not believe smoking cessation is important for their health.v Others have suggested that although AIANs have considerable knowledge regarding the detrimental effects of smoking, this has little impact on their attitudes and beliefs about smoking.vi While these studies have been conducted in younger AIANs, but there is no data that describe the tobacco-related KAB held by older AIANs. The health benefits experienced by older smokers upon quitting are significant and include improvements in circulation and respiratory function, and decreased risks of myocardial infarction and stroke.vii,viii Hence, obtaining information pertaining to tobacco-related KAB among AIANs is needed so that culturally appropriate smoking interventions can be developed. Therefore, the overall goal of this study is to explore the KAB of tobacco use among AI elders and use this information to better inform the construction of a tobacco use instrument to be piloted in a Northern Plains AI community. To accomplish this we will address the following Specific Aims:

  1. We will assess and document the knowledge, attitudes, and beliefs regarding tobacco use (both ceremonial and secular uses) among a group of AI elders from the Northern Plains.
  2. We will enhance and render more culturally sensitive a previously developed AI tobacco use instrument using key thematic information generated from focus groups.
  3. We will conduct, using our modified and augmented instrument, a broad, population-based tobacco use survey among AIs in a small Northern Plains city, determining its psychometric properties along with gathering valuable empirical data among this special population.


This pilot project will provide the local AI communities, tribes, and health departments greater insight into the KAB related to cigarette smoking in AI communities. These findings may better inform future smoking prevention and cessation interventions targeting older AIANs, leading to enhanced and better-sustained public health gains.


[i]  US Department of Health and Human Services, Center for Disease Control. Tobacco Use Among US Racial/Ethnic Minority Groups-African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders. A Report of the Surgeon General. Executive Summary. Morb Mortal Wkly Rep 1998;Oct 9:47(RR-18):v-vx,1-16.
[ii]  Kaplan SD, Lanier AP, Merritt RK, Siegel PZ. Prevalence of tobacco use among Alaska Natives: a review. Prev Med 1997 Jul-Aug;26(4):460-5.
[iii]  US Department of Health and Human Services, Center for Disease Control and Prevention. Smoking prevalence among American Indians & Alaska Natives. Morb Mortal Wkly Rep 2000 49(04):79-82,91.
[iv]  Indian Health Service. Trends in Indian Health: 1998. I.H.S. Office of Planning, Evaluation and Legislation. Rockville, MD: US Dept. of Health and Human Services.
[v]  Bashshur R; Quick R. Health attitudes and behaviours of Native Alaskans. Arctic Med Res. 1991;Suppl:313-9.
[vi] Hodge FS; Cummings S; Fredericks L; Kipnis P; Williams M; Teehee K Prevalence of smoking among adult American Indian clinic users in northern California Prev Med 1995 Sep;24(5):441-6
[vii]  Peto R, Darby S, Deo H, Silcocks P, Whitley E, Doll R. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. BMJ 2000 Aug 5;321(7257):323-9.
[viii]  Muller WA. Effect of smoking cessation on mortality of older men and women with coronary artery disease. J Insur Med 1994 Fall;26(3):319-23.