Anxiety disorders and depression often co-occur in epidemiologic studies, including American Indian samples (Beals et al., 2005), and rates of nicotine dependence appear to increase with greater psychiatric comorbidity (Grant, find more Hasin, Chou, Stinson, & Dawson, 2004). The synergistic effects of behavioral and biological factors invite further inquiry as they may contribute to both the mediation and moderation of the psychiatric disorder�Cnicotine use relationship in different populations (Ziedonis et al., 2008). This study explored the relationships between lifetime anxiety disorders and major depression with lifetime ST use among American Indians residing in the Northern Plains and Southwest regions.
Our primary goals were to (a) describe rates of lifetime ST use among respondents with a lifetime history of panic disorder, major depression, PTSD, and alcohol abuse/dependence; (b) determine if panic disorder, major depression, and PTSD are independently associated with lifetime ST use after accounting for sociodemographic factors and lifetime alcohol use disorders; and (c) ascertain if comorbid panic disorder, major depression, PTSD, and alcohol use increases the odds ratio (OR) of lifetime ST use risk beyond its association with individual psychiatric disorders. Methods Study Design, Sample, and Procedures The primary objective of the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) was to estimate the prevalence of psychiatric disorders and health service use among tribal members residing on two closely related Northern Plains reservations and one in the Southwest.
The AI-SUPERPFP was patterned after the National Comorbidity Survey (Kessler et al., 1994) in order to allow for comparisons with other large-scale epidemiologic studies. A sample of individuals listed on tribal rolls (the legal record of tribal membership) that were between the ages of 15 and 54 in June 1997 and lived on or within 20 miles of their reservation at the time of the study were selected for participation. The total sample size for the Northern Plains cohort was 1,638, and 1,446 for the Southwest tribe. The sample was grouped by age (four strata) and sex (two strata) using stratified random sampling procedures (Cochran, 1977). Sample weights were used to account for differential probabilities of selection and nonresponse within strata (Kish, 1965).
Considerable efforts were made by the AI-SUPERPFP team during the project development phase to involve participating communities in constructing content-valid, culturally relevant interview questions. A structured, comprehensive interview was administered by tribal members, intensively trained in research methods, and assisted by laptop computers. Extensive quality control efforts Cilengitide were made to ensure all phases of the interview process were conducted in a standardized, reliable manner.