Exploring demographics, health conditions, and other characteristics of commercial smokeless tobacco and Iqmik users from the Norton Sound region participating in the Healing and Empowering Alaskan Lives Toward Healthy-Hearts (HEALTHH) Project

Background: Smokeless tobacco (SLT), including chewing tobacco or moist snuff, contains a high concentration of nicotine and tobacco-specific nitrosamines. SLT is associated with cancers including that of the head, neck, stomach, and cervix; ischemic heart disease; stroke; gum disease; and tooth loss. In Alaska, alternative to commercial SLT is Iqmik, comprised of firecured or air-dried tobacco leaves and ash from fungus (punk ash), drift wood, or willow bush. The prevalence of any form of SLT use among Alaskan Native (AN) people is significantly higher (10.7%) than the U.S. general population (2.6%).

Aims: The current study aimed to: 1) examine demographic and cultural correlates with use of a form of SLT in addition to cigarettes in a sample of AN smokers residing in the Norton Sound Region, and 2) explore health conditions correlated with established SLT-use in the sample.

Methods: Baseline data were analyzed from the Healing and Empowering Alaskan Lives Toward Healthy-Hearts (HEALTHH) project, a randomized controlled trial of an intervention for tobacco use and cardiovascular disease risk behaviors. A total of 299 AN men and women cigarette smokers were recruited from the Norton Sound region. Social demographic and tobacco use-related measures included age, gender, income, residence, AN heritage, traditional language speaking status, identification with a spiritual group, allowance of smoking in the home, and tobacco-related quitting behaviors. SLT use measures included ever use and established (100+ times) use status. Health conditions of interest were hypertension, high cholesterol, cancer, type II diabetes, mouth sores, asthma, emphysema, and H. pylori. Chi-squared and analysis of variance (ANOVA) tests were used.

Results: More than half of the sample (60%) had ever tried a form of SLT; 23% were established SLT users. There was a lower percentage of females among established commercial SLT users (18%), but there was a higher percentage of females among established Iqmik users (86%). There was a lower percentage of participants residing outside of Nome (76%) among established commercial SLT users than among established Iqmik users (86%). With regard to health conditions, established SLT use was associated only with hypertension (p=0.016). Established SLT users did not significantly differ from non-established-SLT-users in their desire to quit cigarettes and confidence in their ability to quit cigarettes.

Conclusion: Demographic associations with SLT use vary by SLT type: commercial versus Iqmik. Established use of any form of SLT may be associated with cardiovascular risk factors, in particular hypertension. Smoking cessation interventions tailored for AN men and women should assess and address dual use with SLT for optimizing health.