Prevalence, frequency, age at first time tobacco usage among non-Hispanic American Indian/Alaska Native youth compared to non-Hispanic White youth - 2019 National Youth Tobacco Survey

Thesis (Master's)--University of Washington, 2020Introduction:Tobacco use is a leading risk factor for death among adults in the US, and cancer remains one of the top 2 leading causes of death. There is little data on tobacco use among American Indian/Alaska Native (AI/AN) adolescents. Using a national sample of youth in middle and high school, this study will examine self-reported cigarette and e-cigarette use, frequency of current use of cigarettes and e-cigarettes and age at first-time usage of these products among non-Hispanic AI/AN youth compared with non-Hispanic White (NH-White) youth. Methods: Data were abstracted from the 2019 National Youth Tobacco Survey (NYTS), a publicly available dataset. The proportions of self-report of cigarette and e-cigarette use among youth respondents were compared between AI/AN and NH-White youth using chi-square tests. Frequency of use was compared between groups using rank-sum tests. The proportions of youth who started using cigarettes and e-cigarettes in elementary, middle and high school were summarized. Results: Two-hundred and twenty-one AI/AN and 8,536 NH-White youth participated in the survey. There was a higher proportion of AI/AN youth who used cigarettes (9 vs 5%; P=0.002). E-cigarette usage was similar in both groups 23 vs 22%; P=0.7). Small proportions of AI/AN (8-39%) provided data on frequency of use and age at start. In exploratory analysis, cigarette and e-cigarette use frequencies were similar in AI/AN vs NH-White. Proportions of AI/AN youth who started use of cigarettes and e-cigarettes in elementary vs middle school vs high school were 21%, 41% and 37%, respectively, compared with 20%, 33% and 48% in NH-White youth. For e-cigarettes, AI/AN youth who started use in elementary vs middle school vs high school were 13%, 44%, 44%, respectively, compared to 4%, 28%, and 67% in NH-White youth. Conclusions: Available national survey data on cigarette and e-cigarette usage in AI/AN youth is limited but suggests cause for concern. Exploratory findings suggest a need for prevention intervention at earlier stages of school level for AI/AN youth. Inclusion of culturally relevant questions in the NYTS may improve understanding of tobacco use in the AI/AN demographic