Smoking Across Adolescence and Adulthood With Cardiovascular Risk Among American Indian Peoples

Objective: American Indian peoples (AIs) have high smoking rates and cardiovascular risk factor burden. The present study aimed to (a) investigate latent smoking classes across adolescence and adulthood, (b) investigate adolescent predictors of smoking classes, and (c) assess how smoking class is related to adult cardiovascular risk in a sample of AIs. Method: A sample of AIs (N = 338) from the National Adolescent to Adult Health Study self-reported on smoking across four assessment waves (W1: 7th-12th grade; W2: 8th-12th grade; W3: ages 18-26; W4: ages 24-32). The socioecological framework for addressing tobacco-related disparities was used to identify potential adolescent (W1) risk and resource factors. C-reactive protein, blood pressure, and lipids were collected at W4. Growth mixture modeling and regressions were used. Results: Six smoking classes were identified: light smoking (36%), nonsmoking (23%), escalating, adult daily smoking (13%), chronic heavy smoking (12%), escalating, young adult daily smoking (9%), and reducing smoking (7%). Risk factors for being in the chronic heavy smoking class included peer smoking and older age at W1. Compared with the chronic heavy smoking class, AIs in the reducing smoking class lived in in more impoverished neighborhoods during adolescence. Relative to several classes with less smoking, being in the chronic heavy smoking class was associated with higher C-reactive protein and less favorable lipid levels. W1 social support was a resource factor for adult diastolic blood pressure and some lipids. Conclusions: Socioecologically informed tobacco interventions have the potential to reduce smoking and cardiovascular risk among AIs, and bolstering social support may be important.