Considerations for Tobacco Programs for Tribal Populations
In some tribal communities, tobacco has sacred or traditional connotations and is used for ceremonial
or medicinal purposes. Rural program planners that serve American Indian/Alaska Native populations should be
aware of the distinction between traditional and commercial tobacco use.
The National Native Network (NNN), jointly funded by the Centers
for Disease Control and Prevention (CDC)'s Office on Smoking
and Health and Division of Cancer Prevention and
Control, is a key source of information about decreasing commercial tobacco use and related illnesses
among American Indian/Alaska Native populations. NNN offers information about differences between
commercial uses of
tobacco, success stories of tribal
communities that are implementing commercial tobacco prevention and cessation activities, and a
toolkit that includes
examples of commercial tobacco-free policies.
All tribes are different and no single approach to commercial tobacco prevention and cessation will
fully meet the needs of all American Indian/Alaska Native populations. Conducting a community tobacco
needs assessment or policy scan can help program planners understand the unique context of the
population they serve. NNN offers sample tobacco policy readiness assessments for:
Native Tobacco Prevention Community Toolkit—prepared by the State of Alaska Tobacco
Prevention and Control Program and the Alaska Native Tribal Health Consortium tobacco technical
assistance team—offers resources for a tribe, tribal organization, or tribal business interested in
implementing an evidence-based tobacco prevention policy or strategy.
Culturally Tailored Smoking Cessation for Tribal Populations
Rural healthcare providers that serve American Indian/Alaska Native populations may consider tailoring their
tobacco cessation materials to address cultural considerations about tobacco use. The University of Arizona
HealthCare Partnership developed several tobacco cessation resources for Native communities, including a
for providers that is based on the 5As
and the Basic Tobacco
Intervention Skills Certification for Native Communities. Red Star Innovations, in collaboration
the Inter-Tribal Council of Michigan, also developed a workbook
that provides suggestions for tailoring the 5As for tribal communities. As described in the Quitline
Model, providers in some states can also refer eligible patients to the American
Indian Commercial Tobacco Program.
Tribal Smoke-Free Policies
As sovereign government entities, tribal governments are exempt from state- and local-level tobacco-free laws.
However, several tribal governments have enacted their own policies in order to protect community members from
the harmful effects of commercial tobacco. NNN's Commercial
Tobacco Smoke-Free Tribal Policy Toolkit is an important resource for tribal communities seeking to
implement a smoke-free policy. Americans for Nonsmokers' Rights has also compiled resources
related to smoke-free policies in
The Alaska Department of Public Health and Social Services Tobacco-Free
Alaska offers resources and information about tribal resolutions to support
tobacco-free policies. These include resources
focused on tobacco-free colleges, schools, multi-unit housing, workplaces, and behavioral health.
Program planners may need to consider addressing or involving multiple generations of tribal communities in
tobacco cessation and prevention efforts. For example, tobacco cessation and prevention programs that are
tailored for multiple generations in the community can help emphasize the importance of living a commercial
tobacco-free life at every age. In addition, elders and older community members may help emphasize the sacred
role of tobacco in their Tribe, while educating youths about the dangers of commercial tobacco use. The American
Indian Cancer Foundation developed a report
that describes how elders may be able to engage youth in tobacco control efforts.
Resources to Learn More
Alaska Native Community Evaluation Project: An Equity Lens Review of Tobacco Prevention & Control in
This report describes disparities in tobacco use and cessation among Alaska Natives and provides
recommendations for decreasing tobacco use in this population.
Organization(s): State of Alaska Tobacco Prevention & Control Program
Native Tobacco Prevention Community Toolkit
This toolkit offers resources for a tribe, tribal organization, or tribal business interested in
implementing an evidence-based tobacco prevention policy or strategy. It includes information about
relationship building, how to conduct an assessment with community members, and policy resources.
Also included are model policies, policy analysis worksheets, and strategy charts.
Organization(s): State of Alaska Tobacco Prevention and Control Program and the Alaska
Native Tribal Health Consortium
Breathe Easy Casino
Workers: Smoke-free Casino Model Policy & Implementation Toolkit
This model policy and implementation toolkit includes considerations for tribal casinos.
Organization(s): American Nonsmokers' Rights Foundation
Easy: Tobacco-Free Policies
The Alaska Department of Public Health and Social Services offers smoke-free and tobacco-free
policies and information. Resources are available for implementing policies for tobacco-free
colleges, schools, multi-unit housing, workplaces, and behavioral health
Organization(s): The Alaska Department of Public Health and Social Services
Gambling with Our Health: Smoke-Free
Policy Would Not Reduce Tribal Casino Patronage
This study describes the results of a survey that indicate that casino patronage would not be
adversely affected by a smoke-free policy.
Authors: Brokenleg, I.S., Barber, T.K., Bennett, N.L., Peart Boyce, S., & Blue Bird
Citation: American Journal of Preventive Medicine, 47(3),290-9
National Native Network TA Webinar: Smoking
Cessation in the Clinical Setting
This webinar presents information about developing smoke-free policies, tailoring smoking cessation curricula
with cultural considerations, and implementing clinical tools and resources for smoking cessation.
Organization(s): National Native Network
National Native Network Webinar Series: Tobacco
Control and American Indian Cancer Policy
This webinar provides suggestions for how healthcare professionals and tribal leadership can collaborate to
develop tobacco control policies.
Organization(s): National Native Network
Event Toolkit: Primary Event Planning and Communication
The Native American Rehabilitation Association of the Northwest funded the development of the
Smoke-Free Event Toolkit, which provides planning recommendations and sample communications materials
for smoke-free tribal events.
Organization(s): The Native American Rehabilitation Association of the Northwest
Tobacco in Native American Communities | A
Smoke Free Powwow
This short video describes how the Confederated Tribes of Warm Springs made the Simnasho Pow Wow a
commercial tobacco-free event.
Organization(s): Smoke Free Oregon and the Confederated Tribes of Warm Springs
The Indian Health Service has compiled resources related to tobacco use among American Indian/Alaska
Organization(s): Indian Health Service, Division of Health Promotion/Disease Prevention
This document provides talking points and a resolution that support tobacco-free workplace policies
Organization(s): Alaska Tobacco Control Alliance, Southeast Alaska Regional Health
Consortium, and Alaska Native Tribal Health Consortium