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Patricia Nez Henderson, MD, MPH, Shalini Kanekar, PhD, Yang Wen, MS, Dedra Buchwald, MD, Jack Goldberg, PhD, Won Choi, PhD, Kolawole S. Okuyemi, MD, MPH, Jasjit Ahluwalia, MD and Jeffrey A. Henderson, MD, MPH

Patricia Nez Henderson, Shalini Kanekar, Yang Wen, and Jeffrey A. Henderson are with the Black Hills Center for American Indian Health, Rapid City, SD. Dedra Buchwald is with the Center for Clinical and Epidemiological Research, University of Washington School of Medicine, Seattle. Jack Goldberg is with Community Medicine and Public Health, University of Washington, Seattle. Won Choi is with the University of Kansas Medical Center, Kansas City. Kolawole S. Okuyemi and Jasjit Ahluwalia are with the University of Minnesota School of Medicine, Minneapolis.

Correspondence: Correspondence should be sent to Patricia Nez Henderson, MD, MPH, Black Hills Center for American Indian Health, 701 St. Joseph Street, Suite 204, Rapid City, SD 57701 (e-mail: pnhenderson{at}bhcaih.org). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link.

Objectives. To better understand patterns of initiation among American Indians we examined age-related patterns of smoking initiation during adolescence and young adulthood in 2 American Indian tribes.

Methods. We used log-rank comparison and a Cox proportional hazard regression model to analyze data from a population-based study of Southwest and Northern Plains American Indians aged 18 to 95 years who initiated smoking by age 18 years or younger.

Results. The cumulative incidence of smoking initiation was much higher among the Northern Plains Indians (47%) than among the Southwest Indians (28%; P < .01). In the Southwest, men were more likely than women to initiate smoking at a younger age (P < .01); there was no such difference in the Northern Plains sample. Northern Plains men and women in more recent birth cohorts initiated smoking at an earlier age than did those born in older birth cohorts. Southwest men and women differed in the pattern of smoking initiation across birth cohorts as evidenced by the significant test for interaction (P = .01).

Conclusion. Our findings underscore the need to implement tobacco prevention and control measures within American Indian communities.