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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 American Indian Cancer Foundation also offers an infographic that describes how a tribal community may choose to acknowledge the importance of traditional tobacco use while protecting the community from the harmful effects of 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 traditional and 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:

The Alaska 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 brochure 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 tribal communities.

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.

Multigenerational Considerations

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

The Alaska Native Community Evaluation Project: An Equity Lens Review of Tobacco Prevention & Control in Alaska
Document
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
Date: 2015

Alaska Native Tobacco Prevention Community Toolkit
Document
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
Date: 8/2016

Breathe Easy Casino Workers: Smoke-free Casino Model Policy & Implementation Toolkit
Document
This model policy and implementation toolkit includes considerations for tribal casinos.
Organization(s): American Nonsmokers' Rights Foundation
Date: 2013

Breathe Easy: Tobacco-Free Policies
Website
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
Document
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 Jernigan, V.
Citation: American Journal of Preventive Medicine, 47(3),290-9
Date: 2014

National Native Network TA Webinar: Smoking Cessation in the Clinical Setting
Video/Multimedia
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
Date: 9/2015

National Native Network Webinar Series: Tobacco Control and American Indian Cancer Policy
Video/Multimedia
This webinar provides suggestions for how healthcare professionals and tribal leadership can collaborate to develop tobacco control policies.
Organization(s): National Native Network
Date: 2/2016

Smoke Free Event Toolkit: Primary Event Planning and Communication and Advertising
Documents
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
Video/Multimedia
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
Date: 4/2015

Tobacco Prevention
Website
The Indian Health Service has compiled resources related to tobacco use among American Indian/Alaska Natives.
Organization(s): Indian Health Service, Division of Health Promotion/Disease Prevention

Tobacco-Free Tribal Resolutions
Document
This document provides talking points and a resolution that support tobacco-free workplace policies in Alaska.
Organization(s): Alaska Tobacco Control Alliance, Southeast Alaska Regional Health Consortium, and Alaska Native Tribal Health Consortium