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Background: The Cheyenne River Sioux Tribe (CRST) is affected by high nicotine use and disease burden. Understanding nicotine exposure is important to recognize what groups may be at higher risk for negative health outcomes, including COVID-19. Objective: To compare self-reported health outcomes and nicotine use between exclusive electronic cigarette (e-cig) users, users of combustible cigarettes, dual e-cig/cigarette users, and nonusers among adult residents on the CRST. Methods: The CRST “COVID-19 – Wayakta He study” (“Are you on guard against COVID-19?”) recruited 562 participants on the reservation who filled out a 97-item survey. Regression models were used to analyze nicotine exposure, demographic characteristics, and health outcomes. Results: Prevalence of nicotine use among participants was 53%. Reported median puffs per day was 15 for e-cig, 100 for cigarette, and 20 for dual users (p< 0.001). The odds of having COVID-19 were lower for nicotine users compared to nonusers (p< 0.001). The odds of hypertension (p= 0.04) and high cholesterol (p= 0.03) were lower for nicotine users compared to nonusers. The proportional odds were higher for nicotine users for longer COVID-19 recovery time (p= 0.046) and lower for more severe COVID-19 infection (p= 0.001). Significance: This study provides critical data on self-reported COVID-19, chronic disease outcomes, and exposure to commercial nicotine products. Results from this unique Tribal community–driven study with a large sample size (N= 562 participants from 289 households) will help understand the role that environmental exposures played on increased COVID-19 mortality, help target public health interventions, and inform Tribal public health policies on emergency preparedness and exposure analyses.

IntroductionAmerican 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.MethodsSelf-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.ResultsFrom 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.ConclusionsOur results show decrease in cotinine concentrations in CRST participants since implementation of their ‘Smoke-Free Clean Air Act’ in 2015.

Asthma is recognized as a complex, multifactorial disease with a genetic component that is well recognized. Certain genetic variants are associated with asthma in a number of populations.