Abstract: Smoking rates among American Indian youth and adults are the highest in the nation. Funded by the University of Minnesota Cancer Center, the Tobacco Policies Among Plains Indians Project held focus groups on seven reservations during 2001-2002. Members of three Ojibwe reservations in Minnesota, three Sioux reservations in South Dakota, and one Winnebago reservation in Nebraska participated. Areas investigated included smoking knowledge, initiation, attitudes and behaviors, and perceptions of harm. Findings indicate that lenient attitudes toward smoking behaviors, low harm value, and partiality toward the smoking habit and the ritualistic behavior it invokes are long-standing and powerful to overcome. To initiate interventions for persistent smoking, tribes will need to target efforts toward the creation of healthy communities.
Key Words: American Indians, Native Americans, Northern Plains Indians, Smoking Attitudes, Tobacco
The prevalence of smoking among American Indians is the highest in the nation and has been for many years (Centers for Disease Control and Prevention [CDC], 1998). American Indian adults smoke at rates ranging from 34-79%, with higher smoking prevalence rates reported for northern and western states than other regions of the country (CDC, 2001; Hodge, 2002). These rates are two to four times the rates reported for the general population. In a 1999 study, 50% of Indian youth reported that they smoked, as compared to 34.8% of the general population of high school students (CDC, 2003). Despite targeted efforts to curb smoking among American Indian populations, smoking rates continue to soar.
Over the past 20 years, there has been a national effort to decrease the population's dependence on tobacco products. This campaign has been lead, in part, by various states in an attempt to reduce high smoking rates among current smokers. Efforts include funding of scientific research, educational programs targeting youth and adult smokers, secondhand smoke prevention programs, smoking cessation interventions, and policy changes. Although these efforts directed at reducing the prevalence of smoking have been somewhat successful, the rate of decline in tobacco use has varied among diverse groups, such as American Indians (Hodge, 1995). The smoking patterns of these groups are of special concern because of their poor health status, high smoking rates, and lower smoking quit rates. The Public Health Service has also reported that impoverished populations, particularly American Indians, have very high rates of tobacco product use due, in part, to the lack of information on the harmful effects of tobacco (CDC, 1998).
The American Indian population may not be fully aware of the health hazards associated with tobacco abuse. A strong proactive leadership is needed to confront and halt the targeted advertising by multimedia efforts. Efforts are also required to decrease the social acceptability of smoking. Prior studies have documented that adult Indian smokers and nonsmokers were shown to be statistically more lenient in their attitudes toward the acceptability of smoking (Glover & Hodge, 1999). They were reluctant to tell others to quit smoking, to move away from smokers, and even to establish a no-smoking policy in their homes. The American Indian cultural influence, which values noninterference, may be a significant factor in the social acceptability of smoking in some Indian communities.
As the rest of the nation makes steady progress toward the National Cancer Institute goal of a smokeless society, the American Indian population has benefited considerably less from targeted activities. The few published reports that have addressed smoking interventions among American Indians were focused on preventing smoking in school age children (Liechtenstein et al., 1995). There are only a few reports of cessation initiatives and interventions that target cues (i.e., activities, policies, messages) to smoking (Johnson, Lando, Schmid, & Solbert, 1997; Liechtenstein et al. …