National Asthma Education and Prevention Program.

Context.—Racial differences in tobacco-related diseases are not fully explained
by cigarette-smoking behavior. Despite smoking fewer cigarettes per day, blacks
have higher levels of serum cotinine, the proximate metabolite of nicotine.Objective.—To compare the rates of metabolism and the daily intake of nicotine
in black smokers and white smokers.Design.—Participants received simultaneous infusions of deuterium-labeled nicotine
and cotinine. Urine was collected for determination of total clearance of
nicotine and cotinine, fractional conversion of nicotine to cotinine, and
cotinine elimination rate. Using cotinine levels during ad libitum smoking
and clearance data, the daily intake of nicotine from smoking was estimated.Setting.—Metabolic ward of a university-affiliated public hospital.Participants.—A total of 40 black and 39 white smokers, average consumption of 14
and 14.7 cigarettes per day, respectively, of similar age (mean, 32.5 and
32.3 years, respectively) and body weight (mean, 73.3 and 68.8 kg, respectively).Main Outcome Measures.—Clearance (renal and nonrenal), half-life, and volume of distribution
of nicotine and cotinine and the calculated daily intake of nicotine.Results.—The total and nonrenal clearances of nicotine were not significantly
different, respectively, in blacks (17.7 and 17.2 mL·min−1·kg−1) compared with whites (19.6 and 18.9 mL·min−1·kg−1) (P=.11
and .20). However, the total and nonrenal clearances of cotinine were significantly
lower, respectively, in blacks (0.56 and 0.47 mL·min−1·kg−1) than in whites (0.68 vs 0.61 mL·min−1·kg−1; P =.009 for each comparison). The
nicotine intake per cigarette was 30% greater in blacks compared with whites
(1.41 vs 1.09 mg per cigarette, respectively; P =.02).
Volume of distribution did not differ for the 2 groups, but cotinine half-life
was higher in blacks than in whites (1064 vs 950 minutes, respectively; P =.07).Conclusions.—Higher levels of cotinine per cigarette smoked by blacks compared with
whites can be explained by both slower clearance of cotinine and higher intake
of nicotine per cigarette in blacks. Greater nicotine and therefore greater
tobacco smoke intake per cigarette could, in part, explain some of the ethnic
differences in smoking-related disease risks.

https://jamanetwork.com/journals/jama/articlepdf/187710/JCI71032.pdf

Nicotine metabolism and intake in black and white smokers.

ContextUntil recently, methicillin-resistant Staphylococcus
aureus (MRSA) infections have been acquired primarily in nosocomial
settings. Four recent deaths due to MRSA infection in previously healthy children
in the Midwest suggest that serious MRSA infections can be acquired in the
community in rural as well as urban locations.ObjectivesTo document the occurrence of community-acquired MRSA infections and
evaluate risk factors for community-acquired MRSA infection compared with
methicillin-susceptible S aureus (MSSA) infection.DesignRetrospective cohort study with medical record review.SettingIndian Health Service facility in a rural midwestern American Indian
community.PatientsPatients whose medical records indicated laboratory-confirmed S aureus infection diagnosed during 1997.Main Outcome MeasuresProportion of MRSA infections classified as community acquired based
on standardized criteria; risk factors for community-acquired MRSA infection
compared with those for community-acquired MSSA infection; and relatedness
of MRSA strains, determined by pulsed-field gel electrophoresis (PFGE).ResultsOf 112 S aureus isolates, 62 (55%) were MRSA
and 50 (45%) were MSSA. Forty-six (74%) of the 62 MRSA infections were classified
as community acquired. Risk factors for community-acquired MRSA infections
were not significantly different from those for community-acquired MSSA. Pulsed-field
gel electrophoresis subtyping indicated that 34 (89%) of 38 community-acquired
MRSA isolates were clonally related and distinct from nosocomial MRSA isolates
found in the region.ConclusionsCommunity-acquired MRSA may have replaced community-acquired MSSA as
the dominant strain in this community. Antimicrobial susceptibility patterns
and PFGE subtyping support the finding that MRSA is circulating beyond nosocomial
settings in this and possibly other rural US communities.

https://jamanetwork.com/journals/jama/articlepdf/194176/JOC00996.pdf

Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community.

Objective. —To summarize theSmoking Cessation Clinical Practice Guidelinethat provides recommendations for 3 groups of professionals: primary care clinicians, smoking cessation specialists, and health care administrators, insurers, and purchasers. Participants. —An independent panel of scientists, clinicians, consumers, and methodologists selected by the US Agency for Health Care Policy and Research. Evidence. —English-language, peer-reviewed literature published between 1975 and 1994 that addresses the assessment and treatment of tobacco dependence, nicotine addiction, and clinical practice. Consensus Process. —Four panel meetings were held over 2 years to evaluate meta-analytic and other results, to synthesize the results, and to develop recommendations. TheGuidelinewas repeatedly reviewed and revised. Conclusions. —The panel recommendations address 3 audiences. Major recommendations for primary care clinicians are to use officewide systems to identify smokers, treat every smoker with a cessation or motivational intervention, offer nicotine replacement except in special circumstances, and schedule follow-up contact to occur after cessation. Major recommendations to smoking cessation specialists are to use multiple individual or group counseling sessions lasting at least 20 minutes each with sessions spanning multiple weeks, offer nicotine replacement, and provide problem-solving and social support counseling. Major recommendations for health care administrators, insurers, and purchasers are that tobacco-user identification systems be used in all clinics and that smoking cessation treatment be supported through staff education and training, dedicated staff, changes in hospital policies, and the provision of reimbursement for tobaccodependence treatment. (JAMA. 1996;275:1270-1280)

https://www.primarycare.theclinics.com/article/S0095-4543(05)70115-9/pdf

The agency for health care policy and research smoking cessation clinical practice guideline

American Indian adults are thought to experience significant depressive symptoms at rates several times higher than adults in the general population, yet we know very little about factors associated with depressive symptoms among this under studied group. Many researchers have argued that depressive symptoms are associated with conflicts between American Indian traditional cultural values, practices, and beliefs and those of the majority culture. This report, based on a sample 287 American Indian adults from the upper Midwest, takes into account two measures of cultural effects: perceived discrimination, as one indicator of culture conflict, and traditional practices, as a measure of cultural identification. The results indicate that discrimination is strongly associated with depressive symptoms among American Indian adults and that engaging in traditional practices is negatively related to depressive symptoms. Moreover, interaction effects between perceived discrimination and traditional practices indicate that engaging in traditional practices buffers the negative effects of discrimination among those who regularly participate in them.

Perceived discrimination, traditional practices, and depressive symptoms among American Indians in the upper midwest.

For two decades, the State of the Art series has provided comprehensive reviews of important topics in respiratory and critical care medicine. These articles have served as reference documents not only to pulmonologists, but also to the general medical community. The length of States of the Art necessary to adequately review broad topics in-depth have required that the articles often are published in sections in successive issues of the journal. The present State of the Art summarizes and interprets the available data concerning the respiratory health of minority populations in our country. This important topic has not received appropriate attention in the past, perhaps due to the lack of available data and a failure to appreciate the diversity of respiratory health in different segments of the population. Because of its importance, this State of the Art is published in toto in a separate binding so that it will be a convenient reference document that presents current information in a single source.

Respiratory Diseases in Minorities of the United States

This article describes the burden of illness of Indians eligible for services from the Indian Health Service (IHS) and discusses strategies for reducing morbidity and mortality related to those conditions. To improve health to an extent that parallels the IHS's past achievements, the illnesses that now are prevelant among Indians require changes in personal and community behavior rather than intensified medical services. Analysis of these conditions leads to the conclusion that much of the existing burden of illness can be reduced or eliminated. IHS is responding to this challenge by continuing to ensure Indians' access to comprehensive health care services, by increasing educational efforts aimed at prevention, and by enlisting the support of other government and private organizations in activities that have as their purpose treating diseases if intervention will lessen morbidity and mortality (such as diabetes and hypertension) and encouraging of dietary changes, cessation of smoking, exercise, reduction in alcohol consumption, and other healthy behavior.

The Indian burden of illness and future health interventions.

In this review we examine infant mortality data for American Indians and Alaska Natives and compare these data with those for the general U.S. population. In some instances comparisons between Indian groups are made. (EXCERPT)

Mortality of American Indian and Alaska Native Infants

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Respiratory Diseases in Minorities of the United States

The Indian burden of illness and future health interventions.

Mortality of American Indian and Alaska Native Infants