Association between iq'mik smokeless tobacco use and cardiometabolic risk profile among Yup'ik Alaska Native people

Ethn Health. 2018 Jul;23(5):488-502. doi: 10.1080/13557858.2017.1280136. Epub 2017 Jan 24.


Objective: The traditional lifestyle of Yup'ik Alaska Native people, including a diet abundant in marine-based foods and physical activity, may be cardio-protective. However, iq'mik, a traditional form of smokeless tobacco used by >50% of Yup'ik adults, could increase cardiometabolic (CM) risk. Our objective was to characterize the associations between iq'mik use and biomarkers of CM status (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], systolic blood pressure [SBP] and diastolic blood pressure [DBP], glycated hemoglobin [HbA1c], fasting blood glucose [FBG], waist circumference [WC], and body mass index [BMI]).

Design: We assessed these associations using data from a cross-sectional sample of Yup'ik adults (n = 874). Current iq'mik use, demographic, and lifestyle data were collected through interviews. Fasting blood samples were collected to measure LDL-C, HDL-C, TG, HbA1c, and FBG. SBP, DBP, WC, and BMI were obtained by physical examination. We characterized the association between current iq'mik use and continuous biomarkers of CM status using multiple approaches, including adjustment for measures of Yup'ik lifestyle and a propensity score.

Results: Based on either adjustment method, current iq'mik use was significantly and positively associated with at least 5% higher HDL-C, and significantly associated but in an inverse direction with multiple biomarkers of CM status including 7% lower TG, 0.05% lower HbA1c, 2% lower FBG, 4% lower WC, and 4% lower BMI. Observed associations for LDL-C, SBP, and DBP varied by adjustment method.

Conclusions: This inverse association between iq'mik use and cardiometabolic risk status has not been previously reported. Additional research is needed to replicate these findings and explore physiological mechanisms and/or confounding factors.

Keywords: Alaska Native; Iq’mik; Yup’ik cardiometabolic; smokeless tobacco.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Alaska Natives / statistics & numerical data*
  • Biomarkers
  • Blood Pressure
  • Body Mass Index
  • Cardiovascular Diseases / ethnology*
  • Cigarette Smoking / ethnology
  • Cross-Sectional Studies
  • Diet
  • Exercise
  • Female
  • Health Behavior
  • Humans
  • Life Style
  • Lipids / blood
  • Male
  • Middle Aged
  • Risk Factors
  • Sex Factors
  • Socioeconomic Factors
  • Tobacco, Smokeless / statistics & numerical data*
  • Young Adult


  • Biomarkers
  • Lipids