摘要：There are great differences in smoking- and tobacco-related mortality between American Indians on the Northern Plains and those in the Southwest that are best explained by (1) ecological differences between the two regions, including the relative inaccessibility and aridity of the Southwest and the lack of buffalo, and (2) differences between French and Spanish Indian relations policies. The consequence was the disruption of inter- and intratribal relations on the Northern Plains, where as a response to disruption the calumet (pipe) ceremony became widespread, whereas it did not in the Southwest. Tobacco was, thus, integrated into social relationships with religious sanctions on the Northern Plains, which increased the acceptability of commercial cigarettes in the 20th century. Smoking is, therefore, more deeply embedded in religious practices and social relationships on the Northern Plains than in the Southwest. Open in a separate window John Richard Coke Smyth, Indians Bartering with Trader, Sketches of Canada , 1842. It has been known for several decades that American Indians on the Northern Plains smoke cigarettes at higher rates and suffer higher smoking-related death rates than do American Indians in the Southwest ( Table 1 presents a list of the states and tribes in each region). In the 1960s it was noted that smoking was less common among Southwestern than non-Southwestern American Indians, 1 and data from 1980 to 1982 revealed great differences in smoking-related health conditions. The ratios of death rates of American Indians on the Northern Plains and in the Southwest were myocardial infarction, 3.1; lung cancer, 5.9; cerebrovascular diseases, 1.9; and all-cause mortality, 1.4. 2 TABLE 1— Largest American Indian Populations on the Northern Plains and in the Southwest: 2000 Tribe Population, No.a Northern plains Sioux 79 511 Chippewa 51 240 Blackfeet 10 336 Crow 7 041 Menominee 7 488 Iroquois 7 556 Southwest Navajo 255 485 Pueblo 48 303 Apache 30 386 Tohono O’Odham 15 812 Pima 6 402 Ute 5 949 Open in a separate window Note. The states included in the Northern Plains are Montana, Wyoming, North and South Dakota, Iowa, Nebraska, Minnesota, Wisconsin, Indiana, Illinois, and Michigan. The Southwest includes Arizona, New Mexico, Colorado, Utah, and Nevada. aUS Census Bureau, 2000 Census of Population and Housing, Characteristics of American Indians and Alaska Natives by Tribe and Language (Washington, DC, 2003), PHC-5. I attempt to account for these patterns. There are three possible explanations for this: There may be greater poverty, less education, and more alcohol misuse on the Northern Plains than in the Southwest, all associated with, or leading to, an increased likelihood of cigarette use. Exposure to both native and commercial tobacco may be greater on the Northern Plains. There may be a greater association on the Northern Plains of tobacco use with social relationships and religious practices. Table 2 displays recent data on regional patterns of tobacco use and smoking-related mortality. The differences in the prevalence of smoking and its health-related consequences are consistent with those observed in the 1980s. Conversely, education, poverty, and median income do not differ between regions; neither does alcohol-related mortality, although American Indian women on the Northern Plains report drinking more heavily than do women in the Southwest. Thus, whatever the associations at the individual level, 10 at a regional level there is not a persuasive association of cigarette use with education, income, poverty, or alcohol use. That leaves exposure to various forms of tobacco and the social functions of tobacco. TABLE 2— Cigarette and Alcohol Use and Income, American Indians on the Northern Plains and in the Southwest: Early 2000s Northern Plains Southwest Rate Ratio Tobacco use 2000–2009 3 Current smoker, % Male 42.1 18.8 2.23 Female 42.1 14.8 2.84 Former smoker, % Male 28.3 29.0 0.97 Female 22.7 15.4 1.47 Never smoked, % Male 29.7 52.2 0.56 Female 35.2 69.7 0.5 All-cause mortality 1999–2009 4 Male 1 748.8 1 251.4 1.4 Female 1 243.4 828.1 1.5 Smoking-related deaths 1999–2009 Lung cancer Male 5 113.4 20.1 5.6 Female 81.6 11.6 7 Heart disease: underlying cause of death 6 Male 778.0 446.7 1.7 Female 481.0 266.7 1.8 Heart disease: multiple cause of death Male 1 373.7 852.0 1.6 Female 916.0 548.0 1.7 Stroke 7 Male 129.2 84.9 1.5 Female 124.0 73.7 1.7 Alcohol use Alcohol-related mortality 2005–2009 8 Male 167.0 177.2 0.94 Female 85.3 69.3 1.23 Binge drinker, 3 % Male 23.1 19.1 1.2 Female 18.0 8.9 202.0 Heavy drinker, 3 % Male 8.1 6.4 1.26 Female 5.0 2.6 1.92 Below poverty line, 2000, 9 % 32 32.5 Median income, 2000, 9 $ 24 957 24 605 High school graduate, 2000, 9 % 74.3 64.7 Open in a separate window
