Regional and gender differences in tobacco use among American Indian youth.

Tobacco use is among the top preventable causes of death in the United States, and American Indian (AI) adolescents tend to use tobacco at higher rates compared to the general population. To examine regional and gender differences in rates of smoked, smokeless, and poly-tobacco use among AI adolescents as compared to White counterparts, participants were sampled as part of a larger ongoing study examining substance use among American Indian adolescents who completed the American Drug and Alcohol Survey. A multilevel analytic approach was used to examine the effects of demographic variables on tobacco use. AI disparities were present for past month and lifetime rates of smoked and smokeless tobacco use, and these disparities varied by region and gender. AI disparities in smoked tobacco use were largest in the Upper Great Lakes region, with odds of current and ever smoking among AIs 3.34 to 4.15 times that of Whites, respectively, p < .001. Regional differences in AI disparities were not significant for lifetime smokeless or poly-tobacco use, p ≥ .675. With regard to gender differences, AI disparities in reports of ever smoking were largest among females, OR = 2.61, p < .001. Similar to cigarette smoking, AI disparities in reports of ever using smoked, smokeless, or poly-tobacco were largest among females, OR = 2.51 and 2.56, respectively, p < .001. Our results suggest a need for prevention and intervention programs to be implemented with consideration for adolescents' demographic characteristics, including geographic region, gender, and AI status.