Spangler, John Given; Bell, Ronny Antonio; Dignam, Mark Boberg; and Michielutte, Robert. “Prevalence and predictors of tobacco use among Lumbee Indian women in Robeson County, North Carolina.” Journal of Community Health 22.2 (April 1997): 115-25.
Smokeless tobacco use among Lumbee women in Robeson County (22.5%) is 38 times the rate of women in the U.S. overall and 9 times the national average for Native American women. These results come from a 5-year study sponsored by the National Cancer Institute to assess the effects of an individual education program on Lumbee women's knowledge, practices, and attitudes related to cervical cancer.
This study, involving a sample of 982 women, had questions on its pretest and posttest concerning smokeless tobacco. Prevalence of smokeless tobacco use was highest (41%) in the 55 or older age group, was inversely related to educational level, did not correlate to household income, was most prevalent (46.5%) among widowed women, was higher among women in fair to poor health who had not had a physical in the last year, and increased with the number of close friends the woman had. Former users of smokeless tobacco were twice as likely to be current smokers as were women who had never used smokeless tobacco. Alcohol use was not related to smokeless tobacco use. Unlike cigarette smoking, there was no inverse relationship between church attendance and smokeless tobacco use.