Abstract

American Indians accept the highest smoking charge per unit of all major racial/indigenous groups in the United states of america, despite significant variation across tribes and regions of the state. All the same, little research has been conducted on smoking initiation among American Indian adolescents. In an effort to identify the mechanisms through which families influence teen smoking, both positively and negatively, 20 focus groups were conducted with 144 not-reservation American Indian teens in Oklahoma. Findings indicated that most of the antismoking messages from family members were given past parents and grandparents, and focused on the long-term health consequences of smoking and habit. Parental responses to teen smoking varied widely, with some responses sending mixed letters to the teens. Many teens discussed obtaining their offset cigarette in a family setting and the teens felt that having smokers in their families influenced them to try smoking. Teens were able to discuss the traditional role of tobacco in their culture and were aware of its presence at Indian events, simply felt ceremonial and traditional use was distinct from recreational use. Additional enquiry is necessary to appraise whether these results are generalizable to other tribes and regions, and to other racial/ethnic groups.

Introduction

Numerous studies take examined the influence of family on adolescent smoking initiation. This research typically focuses on white and African-American youth ( Bauman et al., 1990; Chassin et al., 1990; Johnson and Gilbert, 1991; Botvin et al., 1992; Rowe et al., 1996; Jackson and Henriksen, 1997; Robinson and Klesges, 1997), with a few studies including Asian and Hispanic adolescents ( Flay et al., 1994; Hu et al., 1995; Noland et al., 1996; Griesler and Kandel, 1998). To the best of our knowledge, no studies have examined the possible influence of family in smoking initiation among American Indian youth. This is an important research expanse due to the high prevalence of smoking in many American Indian communities. Although smoking rates vary considerably by tribe and region, national data indicate a smoking rate of 34.one% among American Indians in 1997, in dissimilarity to a smoking charge per unit of 25.3% among whites (Centers for Disease Control and Prevention, 1999a). Similarly, for American Indian high school seniors, the 1990–1994 prevalence of smoking during the previous calendar month was 41.1% for males and 39.4% for females, in dissimilarity to 33.4% for white males and 33.1% for white females (U.s.a. Section of Wellness and Human Services, 1998). These findings were recently replicated in Oklahoma, where 40% of American Indian high schoolhouse students and 34% of white students reported smoking inside the by xxx days (Oklahoma Country Health Department, 1999).

The vast majority of research on family influences in smoking amidst non-American Indian populations examines the relative contribution of parent and peer influences in smoking onset ( Bauman et al., 1990; Reimers et al., 1990; Fergusson et al., 1995; Hu et al., 1995; Oygard et al., 1995; Wang et al., 1995; Cowdery et al., 1997; Jackson, 1997; Williams et al., 1997; Distefan et al., 1998; Flay et al., 1998). Overall, the findings suggest that peer influences are stronger, but family influences are meaning, peculiarly in the earlier stages of smoking (The states Department of Health and Human being Services, 1994). There has likewise been research on the influence of older siblings on adolescent smoking. These studies have generally found positive relationships between older sibling smoking and youth onset (Johnson and Gilbert, 1991; Botvin et al., 1992; US Department of Health and Human being Services, 1994; Dappen et al., 1996).

Researchers accept posited a multifariousness of mechanisms for how family unit members, particularly parents, influence youth smoking. Parental use of tobacco, for example, may contribute to children's employ through direct modeling of smoking behavior ( Jackson et al., 1997) or by influencing an adolescents' expected consequences of smoking, including long-term health consequences and short-term punitive consequences ( Bauman et al., 1990; Flay et al., 1994). Parental employ may communicate the physical and psychological effects of use, every bit well equally convey cigarette smoking equally normative ( Jackson et al., 1997). Additionally, youth living with family members who smoke may have easier access to cigarettes than practice youth who practise not alive with smokers. Sibling use of tobacco may influence adolescent use through these same mechanisms, with the addition of direct offers to smoke.

Recent empirical research is beginning to shed light on which of these mechanisms is operating to influence youth smoking. Jackson and Henriksen (Jackson and Henriksen, 1997), for instance, studied the relationship betwixt readiness to smoke, smoking onset, parent modeling and several dimensions of antismoking socialization in African-American and white children. They found children's intentions to fume and perceptions of piece of cake admission to cigarettes increased with exposure to parent modeling. In add-on, they establish both parent modeling of smoking and the extent of antismoking socialization (how much the parents had talked to the kid about not smoking, whether the parents immune smoking in the house and whether the kid believed the parents would know if he/she were smoking) to be associated with smoking onset in children.

In focus groups and phone interviews with white and African-American parents, Clark et al. ( Clark et al., 1999) found major racial/ethnic differences in perceptions of parental efficacy in reducing teen tobacco apply. White parents were more likely to believe that all kids will endeavour tobacco, that punishing children for trying tobacco is not likely to continue them from trying once more and that forbidding teens to utilise tobacco will make them want information technology more. Clark and colleagues speculated that these differences in anti-tobacco socialization may contribute to the differences in African-American and white teen smoking rates.

Inquiry on the relationship between household smoking rules and adolescent smoking has produced inconsistent results. Jackson and Henriksen (Jackson and Henriksen, 1997) found that smoking immune in the habitation was associated with smoking onset in children, regardless of whether family members smoked. Biener et al. ( Biener et al., 1997), in contrast, found no relationship between household smoking rules and smoking in teens. Ane caption for this deviation may be that household rules near smoking touch age of onset rather than onset per se. Biener and colleagues examined current smoking behavior in teens, whereas Jackson and Henriksen examined smoking onset in children.

The influence of family unit on tobacco use may be especially circuitous in American Indian civilisation for two reasons. First, the extended family has a ascendant place in the lives of many American Indian adolescents (Cross, 1997). A typical American Indian family unit includes extended family members living inside a single residence. Grandparents frequently assume a leadership role in the rearing of children, including their subject field. Children may view aunts, uncles and grandparents every bit additional parents ( Cerise Equus caballus et al., 1978). Furthermore, terms such as blood brother, sis, aunt, uncle and cousin are widely applied in Native American families, and may not refer to people related through blood or matrimony. Given the importance of the extended family in American Indian civilisation, investigations of family influences in tobacco use must pay attention to the entire family and not focus exclusively on parents.

Another layer of complexity is added by the traditional uses of tobacco in American Indian culture. For many American Indian communities, tobacco is viewed as a souvenir from the Creator (Shorty, 1999). Historically, tobacco was used in prayer, as a gift and in making agreements between parties (Shorty, 1999). During pow wow celebrations, families of dancers and singers often give cartons of cigarettes to the host pulsate. Cigarettes are as well presented equally offerings in prayers, serve a major role in burial services and are used for medicinal purposes in healing ceremonies ( Pego et al., 1995). Because of the sacred nature of tobacco and its embeddedness in American Indian civilisation, conventional tobacco control letters which portray tobacco equally entirely negative may be ineffective, likewise as culturally insensitive.

A meliorate understanding of the dynamics and processes through which American Indian families influence boyish smoking requires that attention be paid to the role of the extended family unit, and possible historical and cultural influences, in add-on to the usual mechanisms through which families influence tobacco apply. Because this is a relatively unexplored area of inquiry, it is appropriate to begin with qualitative methods which can provide a descriptive agreement of an effect from an `insider's' perspective (Patton, 1990). The research presented here uses focus group methodology to investigate the ways in which American Indian families influence adolescents both to and non to smoke. Specifically, we wanted to learn:

  • Who in the family gives antismoking messages and what is the content of these letters?

  • What do teens view as the family-related consequences of their smoking?

  • What rules do families establish related to adults and youth smoking in the domicile?

  • What opportunities exercise families create that may inadvertently facilitate experimentation with cigarettes?

  • What role does family fellow member modeling of smoking take on teens?

  • How may cultural influences promote or discourage smoking among American Indian teens.

Methods

This enquiry is part of a large, multi-site, qualitative study exploring ethnic and gender differences in adolescent smoking. The larger study, funded past the Centers for Illness Command and Prevention, involves xi prevention research centers and focuses on white, African-American, Hispanic, Native American and Asian/Pacific Islander youth ( Mermelstein et al., 1999). Data presented here are from non-reservation American Indian youth in Oklahoma.

20 focus groups were conducted with American Indian teens in Oklahoma between the Spring of 1996 and Summertime of 1997. The groups ranged in size from five to x participants, and were stratified by gender and smoking status. Eight groups were conducted with teens who reported never smoking (non-smokers), four groups with teens who had tried cigarettes only had not smoked inside the past 30 day (experimenters) and 8 groups with electric current smokers, defined every bit having smoking at least one cigarette in the past 30 days. During the focus group discussions, information technology was revealed that some of the non-smoking teens had in fact experimented with cigarettes. Despite the blurred boundaries between the non-smoker and experimenter groups, these labels are used in reporting of results. In cases where a non-smoker had clearly tried a cigarette, the quote is labeled non-smoker/experimenter.

Table I presents descriptive information on the participants. All of the 144 participants were American Indian, with 24 tribes represented. Xc-2 percent of the participants were enrolled in a tribe, but only 41.3% reported living in an Indian community. Participants were recruited from three regions of Oklahoma—western, primal and eastern. The participants from western and eastern Oklahoma lived in rural areas, and were recruited through public schools. Youth from fundamental Oklahoma were recruited through summer job programs for American Indian youth in the Oklahoma City area. Signed parental consent and youth assent forms were obtained from all participants, and each participant was paid $20. The report protocol was reviewed and approved by the Institutional Review Board for the Protection of Human Subjects of the University of Oklahoma Wellness Sciences Eye.

Of the 144 participants, 73 (50.vii%) were female and 71 (49.iii%) male person. Mean age was xiv.four and all of the participants were in Grades 6–xi. Seventy-nine percentage of the participants lived with at least one smoker. Table Ii shows the smoking status of family members living with the teens past teen smoking status. Eighty-seven pct of the smokers lived with at least one family unit fellow member who smoked and 88% of the experimenters lived with at least i smoker. Amongst not-smokers, 68% lived with at least ane family fellow member who smoked.

A focus grouping give-and-take guide was adult collaboratively with the CDC-funded prevention research centers and covered several broad research areas. 16 of the focus groups were conducted using this discussion guide. Because of the stiff emergence of family-related issues as a theme amid the American Indian teens in Oklahoma, four more focus groups were conducted to explore family influences in greater depth ( Kegler et al., 1999).

A trained facilitator and observer moderated each discussion, which lasted approximately 90 min. The discussions were structured using a set of open-ended questions outlined in the focus grouping discussion guide. The moderator would pose a question to the grouping, so the teens would take turns answering it, edifice upon each other's comments. For example, the moderators asked, `Call up back to the showtime fourth dimension you thought nigh whether or not to fume. Where were you and who were you with?'. The moderator would then probe for additional detail, using follow-upward questions such every bit `What made y'all want to try it? What did you lot like about it? How did you get the cigarette?'.

All of the discussions were audio-taped, then transcribed verbatim. The inquiry squad verified transcripts past listening to the original tapes. A qualitative data analysis software package, NUD*-IST, facilitated the analysis. A coding scheme was developed jointly by the prevention research centers and additional codes were added to capture themes from site-specific questions. Each transcript was coded by two independent coders. The codes were then compared and discrepancies resolved through discussion and consensus. Post-obit coding, text retrievals on specific codes or combinations of codes were completed. These retrievals enabled content analysis of particular topics, which was followed past displaying the information in a series of matrices to facilitate the identification of similarities and differences in themes by gender and smoking status.

Results

The major focus of this investigation was the exploration of family unit influences in adolescent smoking amid not-reservation American Indian teens. Six general topics are reported here: letters from family members near smoking and not smoking, expected family unit-related consequences of smoking, household smoking restrictions, opportunities for experimenting with cigarettes in family settings, modeling of smoking by family unit members, and possible cultural influences promoting or discouraging teen smoking. Themes related to each of these topics will exist presented along with illustrative quotes.

Messages from family members

The vast majority of verbal letters from adult family unit members were antismoking in content. Parents were the most likely to talk to the teens about not smoking, but many teens also described conversations with their grandparents. The messages were nigh often related to the negative health effects of smoking. Sometimes the messages were general, such as `smoking can kill you,' only they were often personalized stories about a relative who suffered from a smoking-related illness. Addiction was some other strong theme in these antismoking messages. Parents talked to the teens nigh how addictive cigarettes were and the potent likelihood of becoming fond if one starts smoking.

My grandma tells me about smoking considering my granddaddy had lung problems because of that and he died a couple of years ago considering mostly of smoking cigarettes all the time because he used to fume all the time constantly and she tells me nigh that. She says you don't desire to finish up similar your grandpa smoking all the fourth dimension and stuff like that. [Experimenting girl]

They tell me not to practise it because it'southward bad and you could become addicted or something like that and you lot could dice from it, but give me examples of dissimilar things and they tell me similar if y'all want to become to college and stuff and smoking you could die and you lot couldn't get to stop all your goals and stuff. [Experimenting girl]

Family-related consequences of smoking

Many of the teens told stories about what their parents did when they constitute out the teen had been smoking. Parental responses varied widely. Ane of the strong themes emerging from these discussions was the parent not wanting the teen to smoke behind his or her back. There was a desire on the behalf of some parents to know what their teens were doing rather than have them hiding their beliefs. A related theme was parents albeit to their teens that they could practise nothing to terminate them from smoking:

My parents told me they can't terminate me from smoking so they'd rather me practice it to where they know instead of behind their backs. [Smoking girl]

My dad said if y'all want to come smoke, then you come up and cough and hack on my cigarettes. He said don't ever do it backside my back. [Experimenting boy]

I didn't accept to worry about being caught because my mom told me if I was going to do it to tell her, that way she would know and I wouldn't have to do it behind her back. [Smoking daughter]

Other parental responses which may accept sent mixed messages to the teens included telling the teen not to smoke around the parents, telling the teens they must support their own addiction, and telling the teens not to get caught or arrive trouble considering of smoking. Other teens spoke of parents not saying anything to them about their smoking.

My parents told me I could smoke just every bit long as I wasn't around them and if they caught me I was going to be in deep trouble. [Non-smoking daughter]

But she won't give me the money to buy them. She said I accept to buy my own. [Smoking daughter]

My dad just said similar you tin do it because I can't stop yous, just don't get in problem past the police for it. [Smoking girl]

I know she knows I smoke, only she don't say nothing. [Smoking male child]

They don't say nix about information technology. [Smoking boy]

At the other end of the spectrum are the parents who more actively endeavor to stop their teens from smoking. Many of the teens, both non-smoking and smoking, related stories of their parents getting mad most their smoking. Others spoke of their parents talking to them about not smoking. Parents appeared to employ grounding and yelling equally the most frequent penalty for smoking; hit, forced smoking and forced eating of cigarettes were likewise mentioned by the teens.

He'd (male parent) probably have a long talk with me like he did to my sister. [Experimenting girl]

Well the last time they defenseless me with a cigarette (I got) grounded for like a week. [Non-smoking/experimenting daughter]

Got yelled at and grounded. [Non-smoking/experimenting girl]

They made me smoke a whole carton of cigarettes. I was kind of sick. [Non-smoking/experimenting girl]

My mom made my brother consume his (cigarette). [Smoking girl]

Household smoking restrictions

Family rules nigh smoking in the domicile ranged from full smoking bans to unrestricted smoking in the domicile. Lenient family rules near adult smoking in the home appeared to be the norm. For the well-nigh part, parents did non want teens to exist smoking in the home. Most teens described their parents not wanting them to smoke anywhere or at least non wanting them to smoke in front end of the parents. As discussed earlier, however, there were some parents who preferred their teens smoked in forepart of them rather than behind their backs. A few of these teens were allowed to smoke in or around the home.

My relatives, like the older ones—not whatever young kids, are immune (to smoke in the home), but my mom and my dad, and my uncles and stuff come over and smoke. [Experimenting girl]

My mom (smokes in the business firm) and sometimes my aunts and them come up over and smoke. [Experimenting boy]

My dad says I know that cigarette is for you, because I'll go in the kitchen to lite it because we usually never have a lighter, and I'll just go in the sleeping room and smoke because I can't smoke in front of him and my mom. [Smoking girl]

I'm allowed to smoke outside, but I'm not allowed to fume within because I'll go out cigarette butts in the ashtray. So they told me to smoke exterior. [Smoking daughter]

My mom said, y'all want to smoke, smoke outside. [Experimenting boy]

Access to cigarettes in family unit settings

Another fashion families influence teen smoking is by providing admission to cigarettes. Some of this is indirect such as leaving cigarettes around the house and the teens stealing them:

I used to steal packs from my parents because I couldn't buy them and none of my friends could. [Smoking girl]

I was at my grandma's business firm and I was with all my cousins and my grandma had went to sleep and she'south a heavy smoker and she has cigarettes so we tried information technology and information technology didn't actually sense of taste that proficient. [Experimenting girl]

Family members also play more than direct roles in teen smoking. For example, siblings and cousins requite teens cigarettes, and older relatives sometimes buy cigarettes for the younger teens. In nigh cases, information technology is not the parents who are ownership cigarettes for the teens, but uncles, older cousins or siblings.

My cousin smokes and nosotros were similar driving around and he lit up and everything. He asked me if I wanted i. [Non-smoking girl]

My sister had a pack and I asked her for one and she said become ane so I did. [Smoking boy]

You have your brother or somebody purchase it for yous. [Smoking boy]

Become to the store with my uncle and he buyin' information technology. [Smoking boy]

My sister-in-police buys them for me. [Smoking girl]

My grandpa gives me a carton every time I go down there. GPCs and Marlboro Mediums. [Smoking girl]

Modeling of smoking behavior

The teens were quite articulate in explaining how having smokers in their family influenced them to attempt smoking. Some spoke of being curious considering so many people in their family smoked, others talked of how information technology seemed inevitable that they would smoke since then many of their family members smoked.

I started considering of my dad and everybody I looked at was smoking. And then when I showtime tried information technology and then subsequently a while started getting used to it and started smoking regularly. [Smoking girl]

I think it has to do with how you're brought up. Some people don't fume considering their parents don't smoke or their friends don't fume. If you abound upwardly with parents and older sisters or brothers that smoke then you smoke. [Smoking boy]

My mom did it, why can't I? [Smoking girl]

My mom and all the other family unit, I mean I don't know anybody in my family that doesn't smoke. They all smoke and I thought it would be cool and I tried it and I got sick. [Non-smoking/experimenting girl]

My parents accept smoked always since I can remember and I ever wondered what information technology was like and everything. [Non-smoking daughter]

Cultural influences on cigarette smoking

The traditional use of tobacco did non emerge on its own as a reason for cigarette smoking amidst American Indian teens. Merely when prompted for a possible explanation for the relatively high prevalence of smoking among American Indians did some of the youth explain that tobacco was traditional in Indian culture. The teens understood the difference between smoking for ceremonial purposes and recreational cigarette smoking, and many were able to articulate traditional uses of tobacco. They discussed how their families would not heed if their smoking `had to practice with tribal stuff'. Some of the teens besides mentioned noticing a fair corporeality of smoking at Indian events, such as pw wows, stomp dances and lord's day dances.

...it came down from family to family. [Smoking daughter]

I think that if mine (her parents) caught me smoking like something that had to do with tribal stuff then I don't think they'd care as much. [Non-smoking daughter]

They accept the pipes and they go smoke it with their grandpas. [Experimenting girl]

I don't really know if it'due south traditional, but like when my dad gives his grandad stuff, or like whoever helps him, they give him like unremarkably a carton of cigarettes. [Experimenting girl]

In general, teens seemed enlightened of the part of tobacco in their culture, but felt that was quite split up from their own experimentation with cigarettes.

Discussion

This report used qualitative methods to explore the ways in which families may influence adolescent smoking from the perspective of American Indian teens. Past developing a more than thorough understanding of how families influence tobacco use, and variations in these mechanisms across ethnicities, nosotros may gain insight into how to design more effective interventions. This inquiry is particularly important for American Indians due to the high prevalence of smoking in some tribes and the expanded role of family in American Indian culture.

One of the topics explored in this written report was the source and content of antismoking messages in American Indian families. These letters were usually from parents and grandparents, and focused on the negative health effects of smoking. It is interesting to note that family antismoking messages emphasized the long-term bug arising from tobacco use over the brusque-term consequences (bad breath, bad smell, decreased athletic ability and the negative consequence of environmental tobacco smoke on others). Additional research is needed to make up one's mind whether consistency between messages emanating from family, which focus on long-term consequences, and mass media campaigns, which oftentimes focus on short-term consequences, would testify beneficial. It is possible that antismoking messages from family would be more effective if they covered both short and long-term consequences of smoking.

Another insight gained through this research is the of import function grandparents play in transmitting antismoking messages to American Indian teens. This finding supports the premise that family unit-based smoking prevention programs for American Indian teens should target the extended family. A promising intervention strategy may exist to emphasize the harmful furnishings of environmental tobacco fume on the entire family, from infants to grandparents. It also suggests the need to brainwash grandparents and aunts and uncles, in add-on to parents, to provide antismoking socialization to young people in their families.

Many youth reported parental actions consistent with low perceptions of parental efficacy in reducing teen tobacco use. Although we did not include parents in our study, based on these focus groups, it appears that American Indian parents may be more like to white than African-American parents in terms of their approaches to teen smoking ( Clark et al., 1999). Additional inquiry is needed to learn whether improved antismoking socialization in American Indian families, or families of any race/ethnicity for that matter, would decrease teen smoking.

Household smoking restrictions are another indicator of anti-tobacco socialization. Although lenient household rules about adult smoking appeared to be the norm amidst American Indian families in our report, teens themselves were usually not allowed to smoke in the home. Studies of household smoking restrictions show that home smoking bans are becoming more common, but vary by smoking status, number of friends who smoke, presence of children, age, race and household income ( Norman et al., 1999).

Families may also influence teen smoking by providing access to cigarettes. The youth in our study did non talk over easy access as an explicit reason for their experimentation with cigarettes. Yet, many of the teens obtained their offset cigarette from an adult relative—usually taking one without permission. Others described relatives giving them cigarettes. This relatively risk-gratuitous access to cigarettes may contribute to earlier commencement tries than if a immature person lives in a home with limited admission to cigarettes. Because the age at which a child first tries a cigarette predicts regular smoking later in life ( Chassin et al., 1990; Fergusson, 1995), any intervention which delays smoking initiation may lead to lower prevalence of smoking. Our inquiry lends back up to the need for intervention research on restricting access to tobacco in the home.

This study has several limitations. Descriptions of parent communication about smoking and parental responses to teen smoking were obtained only from the teens themselves. Obtaining parental perspectives on their communication with teens about smoking would provide a more balanced, and perhaps different, view of the role of parents in adolescent smoking. Due to the non-random selection of focus group participants, it is non advisable to generalize findings from this type of research (Kreuger, 1994). This is especially truthful for this report, because participants were not-reservation American Indian teens from a large number of Oklahoma tribes. This, combined with the relatively high prevalence of smoking among American Indian youth in Oklahoma, may limit the extent to which these findings are applicative to American Indian youth in other parts of the country. Information technology is also possible that the findings here have little to do with race and ethnicity, but rather, are common across families where smoking prevalence is relatively loftier.

Some of the implications for future inquiry stem from the limitations of this study. Additional qualitative research is needed to identify the full range of antismoking message content, too equally the range of parental responses to smoking. It is unknown to what extent the preventive efforts of American Indian families parallel efforts of other families. Information technology would be helpful to replicate the current research with youth from other ethnic/racial groups, and with American Indian youth from other tribes and regions of the country. As mentioned before, it is also important to explore family influences on youth tobacco use from the perspective of other family unit members, including parents and grandparents. This should be washed with both American Indian and other cultures.

Additional quantitative research is needed to appraise whether certain family-based interventions are more effective than others in delaying the onset of smoking, disrupting the experimentation procedure, or preventing any use of tobacco. For example, should parents emphasize short-term consequences of tobacco utilise in addition to or instead of long-term consequences? Does restricting access to cigarettes in the home delay the onset of smoking? Do youth who know their parents disapprove of smoking exhibit different experimentation patterns than youth who receive ambiguous messages from their parents? Knowing the answers to these questions would help guide interventions to reduce teen smoking.

This research too has implications for practitioners. Much of the recent try to forbid teen smoking focuses on building individual resistance to social influences, changing peer norms, counter-advertising and restricting youth access to cigarettes through public policy initiatives (Lynch and Bonnie, 1994; The states Department of Health and Man Services, 1994; Centers for Disease Control and Prevention, 1999b; Glantz, 1996). Our research suggests a complementary strategy would be to focus on the family and smoking in the dwelling. Families appear to play important roles in teen smoking past modeling the behavior, providing admission to cigarettes, influencing norms, creating curt-term consequences and educating teens about long-term consequences. Our research also suggests that parents do not want their children to fume, but could do good from an intervention to aid them socialize their children against smoking.

The part of the extended family is likewise highlighted in this research. Grandparents are a fairly mutual source of antismoking messages for American Indian teens. Relatives such as cousins, siblings, aunts and uncles announced to provide cigarettes to teens and could be an appropriate target for intervention. Finally, interventions that promote smoke-free homes may have numerous benefits. In addition to reducing exposure to environmental tobacco smoke, it would restrict youth access to cigarettes, reduce modeling of smoking and send clear messages about parental disapproval of smoking. In summary, this research demonstrates the various ways in which families influence youth smoking, from the perspective of the youth themselves. It appears articulate that family-based interventions have the potential to be an important component of comprehensive efforts to battle the complex and multicausal public health trouble of adolescent smoking amidst American Indians, and quite likely, all populations.

Tabular array I.

Demographic characteristics of focus group participants

Characteristic
Gender (Northward, %)
male 71 (49.three)
female person 73 (50.7)
Age
mean (SD) 14.4 (one.09)
range 11–17
Grade (N, %)
6 11 (7.half dozen)
seven xix (13.2)
8 40 (27.eight)
ix 62 (43.1)
x eleven (7.half-dozen)
11 1 (0.7)
Tribal enrollment (N, %)
yep 132 (92.3)
no xi (7.7)
Live in Indian community (N, %)
yes 59 (41.three)
no 84 (58.vii)
No. of smokers in the home (N, %)
0 30 (21.ane)
1 41 (28.ix)
2 37 (26.1)
3+ 34 (23.9)
Characteristic
Gender (N, %)
male person 71 (49.iii)
female 73 (fifty.vii)
Historic period
mean (SD) fourteen.four (one.09)
range 11–17
Grade (N, %)
6 11 (7.6)
7 19 (13.two)
8 twoscore (27.eight)
9 62 (43.1)
10 11 (7.6)
eleven i (0.7)
Tribal enrollment (N, %)
yes 132 (92.iii)
no 11 (7.7)
Alive in Indian community (North, %)
yes 59 (41.3)
no 84 (58.7)
No. of smokers in the dwelling (Due north, %)
0 30 (21.1)
i 41 (28.9)
2 37 (26.1)
3+ 34 (23.nine)

Table I.

Demographic characteristics of focus group participants

Characteristic
Gender (N, %)
male 71 (49.3)
female 73 (l.vii)
Age
hateful (SD) 14.4 (ane.09)
range 11–17
Course (Due north, %)
half-dozen xi (7.half-dozen)
7 19 (13.2)
8 xl (27.8)
9 62 (43.1)
10 11 (7.vi)
11 1 (0.7)
Tribal enrollment (N, %)
yes 132 (92.iii)
no eleven (7.7)
Live in Indian community (N, %)
yep 59 (41.3)
no 84 (58.7)
No. of smokers in the home (Due north, %)
0 thirty (21.1)
one 41 (28.9)
two 37 (26.ane)
3+ 34 (23.9)
Characteristic
Gender (N, %)
male 71 (49.iii)
female 73 (l.7)
Historic period
mean (SD) 14.4 (1.09)
range xi–17
Grade (Due north, %)
half dozen 11 (seven.six)
7 19 (xiii.two)
viii 40 (27.8)
ix 62 (43.1)
10 eleven (seven.6)
xi 1 (0.7)
Tribal enrollment (N, %)
yeah 132 (92.iii)
no eleven (vii.7)
Live in Indian community (N, %)
yes 59 (41.iii)
no 84 (58.7)
No. of smokers in the abode (N, %)
0 thirty (21.1)
1 41 (28.ix)
2 37 (26.1)
iii+ 34 (23.9)

Table 2.

Number of smokers in the dwelling house past smoking condition of teen participant

No. of smokers in the home Smoking condition
Not-smokers N (%) Experimenters N (%) Smokers Due north (%)
0 xx (31.vii) 3 (12.0) 7 (13.0)
i 26 (41.iii) 5 (20.0) 10 (eighteen.5)
two eleven (17.5) eleven (44.0) 15 (27.viii)
3+ 6 (9.5) half-dozen (24.0) 22 (forty.7)
Totals 63 (100) 25 (100) 54 (100)
No. of smokers in the home Smoking condition
Non-smokers N (%) Experimenters N (%) Smokers N (%)
0 20 (31.7) 3 (12.0) 7 (xiii.0)
1 26 (41.3) 5 (20.0) 10 (18.5)
two 11 (17.v) 11 (44.0) 15 (27.viii)
3+ 6 (ix.5) vi (24.0) 22 (40.7)
Totals 63 (100) 25 (100) 54 (100)

Table 2.

Number of smokers in the abode by smoking status of teen participant

No. of smokers in the habitation Smoking status
Non-smokers Northward (%) Experimenters N (%) Smokers N (%)
0 20 (31.7) 3 (12.0) 7 (13.0)
i 26 (41.3) 5 (20.0) 10 (xviii.5)
2 11 (17.v) 11 (44.0) 15 (27.8)
3+ 6 (9.5) 6 (24.0) 22 (40.7)
Totals 63 (100) 25 (100) 54 (100)
No. of smokers in the dwelling house Smoking status
Not-smokers North (%) Experimenters Northward (%) Smokers N (%)
0 xx (31.7) 3 (12.0) 7 (13.0)
i 26 (41.iii) 5 (twenty.0) 10 (18.five)
two 11 (17.v) 11 (44.0) xv (27.viii)
three+ 6 (9.5) 6 (24.0) 22 (40.7)
Totals 63 (100) 25 (100) 54 (100)

At the time of this research, all authors were affiliated with the Center for Prevention Enquiry in Native Americans, Higher of Public Health, Academy of Oklahoma Health Sciences Centre. This report was supported by the Function on Smoking and Health, Centers for Disease Control and Prevention, as part of the Prevention Enquiry Centers Tobacco Network Project, award no. 48/CCU 610817.

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