Spangler, J.G.; M.B. Dignan, and R.M. Michielutte. “Smokeless tobacco use among American Indian women--southeastern North Carolina, 1991.” Morbidity and Mortality Weekly Report 44.6 (February 17, 1995): 113-117.
A study was undertaken by the Department of Family and Community Medicine at Bowman Gray School of Medicine (Wake Forest University) to analyze data collected from a National Cancer Institute-funded cervical cancer prevention project to determine prevalence at that time (1991) of Lumbee women's use of smokeless tobacco. A random sample of 479 Lumbee woman completed a detailed survey during the cervical cancer prevention study which included sections on health behaviors such as tobacco and alcohol. The questions included “Have you ever used chewing tobacco or snuff?” “If yes, how old were you when you started?” Current health status, church attendance, social support, and use of medical services were also investigated.
The survey showed that 64% never used smokeless tobacco, 13% formerly used it, and 23% currently were using it. Prevalence was highest among women over 65 and lowest among women 18-24 and 25-34. [Table 1 shows figures for the sample's demographics, health, and social support.] This rate is nine times the national mean for American Indian women and 38 times that for women in the overall U.S. population. This high rate of smokeless tobacco use increases Lumbee women's risk for oral cancer, leukoplakia, tooth loss, and gingival recession. Nicotine may increase their risk during childbearing for low birth weight, spontaneous abortion, and premature delivery. It was noted that Robeson County (as of a 1994 communication with the N.C. Agricultural Extension Service) was the third largest tobacco-producing county in North Carolina, and high rates of smokeless tobacco use are also found in other tobacco-growing regions of the United States.