1. . Felicia Schanche Hodge, Dr.P.H. Professor and Director Center for American Indian Research and Education CAIRE

2. Smoking is Epidemic in Indian Country Smoking Policy Study. Funded by the Cancer Center at the University of Minnesota Conducted in 2001-2002 Sites = 3 states and 7 tribes

4. Reservation Participants Minnesota tribe = –White Earth –Leech Lake –Mille Lacs South Dakota tribes = –Pine Ridge –Rosebud –Yankton Nebraska tribe = –Winnebago

6. Tobacco Control What is the extent of the problem? – Who’s problem is it? – What are the dimension of the problem? – What are the precursors?

7. How do we approach the problem? How do you measure the problem? How is the problem going to be treated? Who are the decision makers? Is a partnership possible?

8. PROBLEM = Cigarette smoking Community identifies problem as cigarette smoking – not tobacco… Conducted focus groups Identified – Examined policies Conducted Key Interviews Developed Partnership

9. Tobacco Policies Indian Health Service has tobacco policies. - No Smoking Signs - Designated Smoking Areas - A Brief Statement

12. Tobacco Policies Use of Indian Health Service Policy Revision of Policy to allow smoking Recognition of Policy Adherence to Policy Importance of Policy

17. Tobacco Policies Indian Health Service Tobacco Policy Tribal Tobacco Policy Clear statement/policy Signs adherence Group socialization No clear statement/policy Ignores Signs Group socialization

18. Tobacco Sales In all reservation stores Above candy products In clear view to customers Media development Internet sales

20. c

24. Internet Sales of Tobacco Sale of tobacco on the Internet Less expensive Sold at tribal smokeshops Sold via internet Attractive packaging Selling “Indian” identity No sales tax

25. TOBACCO Is sacred in American Indian communities Is used in ceremonies Is used in prayers Is used in healing Is a traditional gift giving Is a sacred herb

26. CIGARETTE SMOKING Is an abusive habit Is habitual Is implicated in cancers of the lung, cervix, oral cavities, etc. Is the most preventable cancer causing risk factor

27. Remember…. Difficult to stop smoking Cultural sensitivity a must Stages of smoking cessation required Addictive behaviors Co-morbidity

28. What is the current smoking rate of the U.S. adult population? -- 10% -- 20% -- 30% -- 40%

29. What is the smoking rate for American Indians? -- 10% -- 20% -- 30% -- 40% -- 50%

30. Tobacco statistics

31. Diabetes Wellness – R01 – NINR 1998-2002 Sites: Oglala Sioux Rosebud Sioux Yankton Sioux Winnebago Findings:Traditional methods work 47%-80% smoking rates

38. Percent Women Smokers by Age Age Group

40. Percent Women with CES-D score  16 by Smoking Status

43. Smoking Cessation on Reservations Decision – to not smoke Recognition – of the problem Implementation – of policy Adherence – to policy Control – of tobacco products Concern – over the well-being of community

44. Tobacco Control Tribes need to recognize the problem Need to define the problem Develop partnerships Need to establish boundaries Need to enforce policies Allow future generations to grow up healthy

45. Lessons Learned = Traditional Methods Of education = storytelling Of communication = oral tradition Of support = group support Of identity = Tribal Of cues to action = threat Of behavior change = community action