Diabetes is the fourth leading cause of death for U.S. American Indians and the major independent risk factor for cardiovascular disease, the leading cause of death for American Indians. Smoking has been shown to complicate glycemic management of Type 2 diabetes, is positively related to diabetic complications and may be a cause of diabetes. Moreover, American Indians have the highest reported tobacco use of any ethnic group in the U.S., which includes use of commercial, sacred, and smokeless products. However, among tribal populations, rates of both diabetes and tobacco exposure vary considerably. Tobacco use assessment for American Indians is confounded by measures which have not been properly developed to incorporate cultural attitudes, rituals, behaviors, and tribal government policies. American Indian tribes are sovereign nations with unique histories, languages, and cultures which must be respected, observed in context, and consulted when conducting health related research. Existing studies of diabetes and tobacco exposures in tribal populations have mainly used self-reported data. No studies using clinical measures designed to validate self-report of smoking history or secondhand smoke exposures have been conducted in American Indian communities, and many studies of diabetes in tribal groups have not used glucose measures to define diabetes status.
The proposed study will consist of two parts. The first component will be a study of tobacco use patterns with tribal members involved in the formulation of the questionnaire. Tribal tobacco control policies will be assessed to determine what new policies might be needed to curb smoking on reservation properties, eliminate secondhand smoke exposures, and restrict Indian youth access to tobacco products. The second part of the proposed study will use the questionnaire developed in the first component and will investigate cultural perspectives to determine current tobacco use, secondhand smoke exposure and Type 2 diabetes status. The sample will be 800 California Indians 18 years and older recruited from two health clinic facilities located in rural/reservation areas in San Diego County.
Self-reported current smoking and secondhand smoke exposures will be validated by a blood test to measure cotinine. Serum cotinine is a by-product of nicotine with an 18-20 hour half life and is used as a biomarker to validate smoking history and secondhand smoke exposure in non-smokers. Diabetes status will be validated with a measure of fasting blood sugar, and control of blood sugar over time in those with diabetes will be measured by testing the level of hemoglobin A1c. It is expected that serum cotinine will be higher than expected in those with diabetes, and that control and management of diabetes over time will be hampered due to high levels of cotinine. It is also expected that smoking prevalence and patterns of use will vary by age, gender, and tribal affiliation.
Clinical measures of current tobacco and secondhand smoke exposures will be collected for the first time in any tribal group and will allow for the validation of self-report of tobacco exposures and diabetes status. Such information will be useful for a wide array of researchers, community educators, clinicians, and community prevention programs to effectively target and reduce health disparities in Southern California Indians. |