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LETTER: SMOKING IN AMERICAN INDIAN AND ALASKA NATIVE PEOPLE WITH DIABETES REVISITED ($$) 

Morton et al's article on smoking and diabetes in American Indians and Alaska Natives raises important concerns.1 Because of the longstanding organized emphasis on smoking ascertainment and cessation for individuals with diabetes, the findings likely reflect a serious ascertainment bias.

The Indian Health Service (IHS) Division of Diabetes has measured smoking status in American Indians and Alaska Natives with diabetes since 1986 with the Annual Diabetes Care and Outcomes Audit.2 The IHS Standards of Care for Diabetes emphasize smoking assessment. In 2007, 91.8% of patients with diabetes, systemwide, were assessed for tobacco use. Less than a quarter (23.4%) reported current . . . [Full Text]

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