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Active smoking, secondhand smoke exposure and serum cotinine levels among Cheyenne River Sioux communities in context of a Tribal Public Health Policy
  1. Elena R. O'Donald1,
  2. Curtis P. Miller1,
  3. Rae O'Leary2,
  4. Jennifer Ong1,
  5. Bernadette Pacheco1,
  6. Kathryne Foos1,
  7. Kendra Enright2,
  8. Marcia O'Leary2,
  9. Patricia Nez Henderson3,
  10. Johnnye Lewis1,
  11. Esther Erdei1,
  12. Jeffrey A. Henderson3
  1. 1 Pharmaceutical Sciences, Community Environmental Health Program, University of New Mexico Health Sciences Center College of Pharmacy, Albuquerque, New Mexico, USA
  2. 2 Missouri Breaks Industries Research Inc, Eagle Butte, South Dakota, USA
  3. 3 Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
  1. Correspondence to Dr Esther Erdei, Ph.D., M.P.H., Pharmaceutical Sciences, University of New Mexico, Albuquerque, NM 87131-0001, USA; EErdei{at}


Introduction American Indians and Alaska Natives face disproportionately high rates of smoking and secondhand smoke (SHS) exposure. The Cheyenne River Sioux Tribe (CRST) is among the few Tribal Nations controlling commercial tobacco exposures in public and work places. We had an opportunity to explore effects of the new commercial tobacco-free policy (implemented in 2015) in an environmental health study (2014–2016) that collected information about commercial tobacco use and SHS prevalence and examined predictor variables of serum cotinine concentrations.

Methods Self-reported survey data were used in quantile regression statistical modelling to explore changes in cotinine levels, based on smoking status, smokeless tobacco consumption and SHS exposure.

Results From enrolled 225 adults, 51% (N=114) were current smokers. Among 88 non-tobacco users, 35 (40%) reported current SHS exposure. Significant differences in cotinine median concentrations were found among participants with and without current SHS exposure. Extremely high cotinine concentrations (~100 times larger than the median) were detected in some non-tobacco users. After implementing the new smoke-free air Tribal policy, cotinine decreased in participants with intermediate (3–15 ng/mL, non-tobacco users with SHS exposure) and high (>15 ng/mL, mainly tobacco users) cotinine levels showing association with an abatement of opportunities for SHS exposure. Significant predictors of cotinine levels were sampling year, current smoking and tobacco chewing. No gender differences were observed in cotinine.

Conclusions Our results show decrease in cotinine concentrations in CRST participants since implementation of their ‘Smoke-Free Clean Air Act’ in 2015.

  • public policy
  • cotinine
  • disparities
  • secondhand smoke

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  • Contributors As corresponding author I state that all members of the team who named as authors on this paper agreed to the submission, reviewed the text and tables and are in agreement with the manuscript’s conclusions.

  • Funding This work was supported by NARCHVII study 'Complex metal exposures and immune status on the Cheyenne River'—of which data were presented in this paper—U261IHS0076 IHS/NIH/NIAID; Black Hills Center for American Indian Health (Director: Dr Jeffrey A Henderson, MD, MPH) and subaward to UNM HSC PI: Dr Erdei.

  • Competing interests No, there are no competing interests.

  • Patient consent for publication Not required.

  • Ethics approval This community-academic collaboration, including community-based outreach, recruitment and enrolment was approved by UNM HSC HRRC (HRPO# 08–486) and CRST Tribal Executive Resolution (E-135–2014-CR).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.