Cigarette Smoking, Social Support, and Workplace Smoke-free Policies among an Urban American Indian Population

Abstract

Background: Despite a high prevalence of cigarette smoking and smoking-related morbidity and mortality among U.S. American Indians (AI), few studies have investigated tailored community and workplace interventions, including cessation programs. The purpose of this study was to determine the association of (1) the presence of a workplace smoke-free policy and (2) perceived social support among family and friends for quitting smoking with current smoking in a representative sample of urban AI adults. Methods: Data collected using respondent-driven sampling (RDS) from the 2011 Tribal Tobacco Use Prevalence Study was used to analyze the risk of being a current smoker when exposed to (1) workplace smoke-free policies and (2) perceived social support using two log multinomial regression models, adjusted for potential confounders based upon exposure-specific Directed Acyclic Graphs. Study-eligible participants were: self-identified AI, aged 18+, and residents of Hennepin or Ramsey Counties, Minnesota with a separate residence from the recruiter. Data were weighted to account for variation in participant network size using RDS Analysis Tool, V. 5.6., and participant demographics using U.S. Census 2010, yielding 940 of 964 completed interviews with full demographics. Results: Lack of a workplace smoke-free policy was associated with a 36 percent increase in risk of being a current smoker (PR = 1.36, 95% CI = 1.29 to 1.42) compared to a former smoker and a 41 percent decrease in risk of being a former smoker (PR = 0.59, 95% CI = 0.55 to 0.64) compared to a nonsmoker. Additionally, exposure to quite a bit or a lot of social support for quitting or staying smoke-free was associated with an 11 percent decrease in the risk of being a current smoker (PR = 0.89, 95% CI = 0.86 to 0.91) and an eight percent decrease in risk of being a former smoker (PR = 0.92, 95% CI = 0.88 to 0.95) compared to being a nonsmoker, respectively. There was also an eight percent decrease in risk of being a current smoker (PR = 0.92, 95% CI = 0.90 to 0.94) compared to a former smoker with exposure to quite a bit or a lot of social support for quitting or staying smoke-free versus no social support. Conclusions: Further study of Minnesota AI work environments and strategies for encouraging employers to implement and enforce complete smoking bans is warranted. AI smoking cessation programs may benefit from inclusion of family and friend support mechanisms.