University of Kentucky UKnowledge Nursing Faculty Publications College of Nursing 3-2012 Gender Identity, Ethnic Identity, and Smoking among First Nations Adolescents Lorraine Greaves British Columbia Centre of Excellence for Women’s Health, Canada Joy Johnson University of British Columbia, Canada Annie Qu British Columbia Centre of Excellence for Women’s Health, Canada Chizimuzo T.C. Okoli University of Kentucky, [email protected] Natalie Hemsing British Columbia Centre of Excellence for Women’s Health, Canada See next page for additional authors Right click to open a feedback form in a new tab to let us know how this document benefits oy u. Follow this and additional works at: https://uknowledge.uky.edu/nursing_facpub Part of the Nursing Commons, Public Health Commons, and the Race and Ethnicity Commons Repository Citation Greaves, Lorraine; Johnson, Joy; Qu, Annie; Okoli, Chizimuzo T.C.; Hemsing, Natalie; and Barney, Lucy, "Gender Identity, Ethnic Identity, and Smoking among First Nations Adolescents" (2012). Nursing Faculty Publications. 12. https://uknowledge.uky.edu/nursing_facpub/12 This Article is brought to you for free and open access by the College of Nursing at UKnowledge. It has been accepted for inclusion in Nursing Faculty Publications by an authorized administrator of UKnowledge. For more information, please contact [email protected]. Authors Lorraine Greaves, Joy Johnson, Annie Qu, Chizimuzo T.C. Okoli, Natalie Hemsing, and Lucy Barney Gender Identity, Ethnic Identity, and Smoking among First Nations Adolescents Notes/Citation Information Published in Journal of Aboriginal Health, v. 8, no. 2, p. 37-46. The opc yright holder has granted the permission for posting the article here. This article is available at UKnowledge: https://uknowledge.uky.edu/nursing_facpub/12 Gender Identity, Ethnic Identity, and Smoking among First Nations Adolescents Lorraine Greaves, PhD, British Columbia Centre of Excellence for Women’s Health, Vancouver, British Columbia Joy Johnson, PhD, RN, School of Nursing, University of British Columbia, Vancouver, British Columbia Annie Qu, British Columbia Centre of Excellence for Women’s Health, Vancouver, British Columbia Chizimuzo T. C. Okoli, PhD, MPH, British Columbia Centre of Excellence for Women’s Health, Vancouver, British Columbia Natalie Hemsing, MA, British Columbia Centre of Excellence for Women’s Health, Vancouver, British Columbia Lucy Barney, RN, MSN, Lillooet Nation, Aboriginal Lead, Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, British Columbia ABSTRACT Smoking rates among Aboriginal adolescents are the highest of any population group in British Columbia, Canada. Recent studies suggest that substance use is affected by gender and ethnic identity among youth. The purpose of our study was to explore the association of gender and ethnic identity with smoking behaviour among First Nations adolescents. This study is based on a convenience sample (i.e., an on-hand, readily available sample) of 124 youth (123 First Nations and 1 Métis) recruited at youth drop-in centres, health fairs, and cultural activities. We obtained information on demographics, smoking history, Bem Sex Role Inventory (BSRI), composite measure of gender and gender identification (GID), and Moran’s Bicultural Ethnic Identity Questionnaire (Bicultural ID). We examined the associa- tions between gender role identification and cultural identification on current smoking status among First Nations youth by using logistic regression analyses stratified by gender. In stratified multivariate regression analysis among girls, current smoking was significantly associated with lower scores on the aggressive masculinity index of the Gender ID scale and the White/Canadian index of the Bicultural ID scale. Among boys, current smoking was significantly associated with higher scores on the affective femininity index of the Gender ID scale and lower scores on the White/Canadian index of the Bicultural ID scale. Reducing smoking among First Nations groups remains an important priority for tobacco control in Journal of Aboriginal Health, March 2012 37 Gender Identity, Ethnic Identity, and Smoking among First Nations Adolescents Canada. Understanding the gendered and cultural aspects of smoking may be instrumental in improving prevention and cessation efforts among First Nations youth. KEYWORDS Gender, ethnicity, identity, tobacco use, First Nations, adolescents INTRODUCTION of others) (Bem, 1974). GID is set over the course of adolescence (Adams, Gullotta, & Montemayor, moking rates among Aboriginal adolescents are 1992), and is dynamic during adolescence relative the highest of any population group in British to other ages ( Johnson, Roberts, & Worrell, 1999). Columbia (BC), Canada. Among Aboriginal Gender role identification has been linked to youth, 15 per cent of females and 9 per cent of substance use (Anderson, Stevens, & Pfost, 2001; S Möller-Leimkühler, Schwarz, Burtscheidt, & Gaebel, males smoke, compared to 6 per cent of all BC non-Aboriginal teens (van der Woerd et al., 2005). 2002) and smoking (Kulis, Marsiglia, & Hurdle, However, 65 per cent of Aboriginal youth who smoke 2003). Relationships between GID and smoking report attempting to quit in the past 6 months (van remain largely unexplored in adolescents but may be der Woerd et al., 2005). Youth smoking prevention related independently to a number of risk factors for and cessation interventions are particularly important smoking, such as depression, self-esteem, and weight because 46 per cent of the Aboriginal population is control behaviours (Greaves, 1996). A recent study of 24 years or younger (British Columbia Provincial Mexican-American adolescents found that GID was a Health Officer, 2009). In fact, BC’s Aboriginal people better predictor of drug use than gender alone (Kulis already bear a disproportionate burden of disease; et al., 2003); boys and girls who showed aspects of reducing smoking would significantly decrease their masculine GID (such as dominance and control of overall smoking-related morbidity and mortality as others) were more likely to use cigarettes (Kulis et well as associated personal, community, economic, and al., 2003). In addition, GID was found to moderate health system costs. the relationship between ethnic identity (EID) and Traditionally, teen smoking has been explained in smoking status (Kulis et al., 2003). GID is likely also terms of the accumulation of statistical risk factors, related to smoking in First Nations girls and boys. including parent and peer smoking (Tyas & Pederson, Current models of EID assume that cultural 1998), history of abuse/trauma (LeMaster, Connell, identities are formed to varying degrees in several Mitchell, & Manson, 2002), and low-self esteem and cultures. In the US literature, increasing acculturation depression (Pederson, Koval, & O’Connor, 1997; to (i.e., adoption of ) American norms is positively Vogel, Hurford, Smith, & Cole, 2003). However, associated with smoking in several ethnic groups, these risk factors explain only a part of the variance such as Hispanics (Epstein, Botvin, & Diaz, 1998), observed in youth smoking. Other factors such as African-Americans (Klonoff & Landrine, 1999), gender and cultural affiliations are also linked to and immigrant Chinese (Chen, Unger, & Johnson, substance use (Lifrak, McKay, Rostain, Alterman, & 1999). Language acculturation alone is one of the O’Brien, 1997). most important predictive variables and is a powerful Psychological gender identity (GID), as described predictor of smoking in Hispanic youth (Epstein et by Bem (1974), consists of two unrelated and al., 1998). According to the bidimensional model empirically validated dimensions—masculinity and of acculturation (Berry, 2003), EID in minority femininity. In general, masculinity is associated with groups can be defined by levels of acculturation an instrumental orientation (i.e., a focus on getting (identification with mainstream culture) and the job done), whereas femininity is related to an enculturation (identification with indigenous expressive orientation (i.e., a concern for the welfare culture). Basic EID is thought to form between ages 4–8 (Zimmerman, Ramirez-Valles, Washienko, 38 Journal de la santé autochtone, mars 2012 Gender Identity, Ethnic Identity, and Smoking among First Nations Adolescents Walter, & Dyer, 1996) and become set between ages four subscales: assertive masculinity, aggressive masculinity, 8–12; however, for members of minority cultures, affective femininity, and submissive femininity. In addition, EID remains important throughout their lives. the BIQ was designed for use with American Indian Acculturative stress results in depression, anxiety, and populations, and is consistent with a bidimensional model psychosomatic symptoms (Kvernmo & Heyerdahl, of acculturation (Berry, 2003). We modified the questions 2003), and females are at greater risk of acculturative of the BIQ to be more appropriate to First Nations problems than males (Kvernmo & Heyerdahl, 2003). populations in Canada by describing “First Nations” (First The acculturative style of youth may indicate a Nations ID) as opposed to “Indian,” or “White/Canadian” psychological orientation that affects whether they (White/Canadian ID) as opposed to “White” subscales. will engage in risk behaviours. The purpose of our study was to explore the Data analysis relationship between GID and EID with regard to Chi-square analysis and independent sample t-tests were smoking among