Anger types and the use of cigarettes and smokeless tobacco among Native American adolescents

Background Although tobacco use appears common among Native Americans, the study of dual use of cigarettes and smokeless tobacco has been neglected. The current study examines tobacco use among a sample of Native American adolescents. Also, it considers how the psychological factor of anger may relate to tobacco use. Methods The participants were 513 Native American students from a national sample in grades 6, 8, and 10 in the United States. Cluster analysis was used to identify anger types, and these types were compared on their tobacco use. Results Cluster analysis identified four anger types. One type was the Externalizing Type, characterized by the tendency to show externalizing behaviors such as fighting and yelling. This type had an elevated rate of tobacco use. In terms of an odds ratio, the Externalizing Type was about 10 times more likely to smoke, about 6 times more likely to use smokeless tobacco, and about 8 times more likely to show dual use. The majority of dual users were the Externalizing Type. Conclusions The results suggest that externalizing anger types are more likely to use tobacco, and that smoking cessation programs for teens could be more effective when they address anger issues.