1. Priority Populations/New Users Isaiah Brokenleg M.P.H. Behavioral Health Epidemiologist

2. Prerequisites Acknowledge and pay respect to the Indigenous people whose land we use Indians are not all alike Unique and different from other Communities of Color But similar due to shared experiences Not “new users,” but “new abusers”

3. Traditional Tobacco Spiritual Commodity Physical Purposes Communicates Prayer Medicine

4. Traditional Tobacco (Nicotiana rustica) Given as gift to the people (various stories) Not to be bought or sold By itself (asema) or Mixed (kinnickinick)

5. Commercial Tobacco 2 nd Best Imagery Addiction Money Maker

6. Commercial Tobacco (Nicotiana tobaccum) Not traditional to this area, imported Addictive Harmful when abused Used as substitute Hiding in plain sight

7. American Indian Tobacco Epidemiology According to BRFSS about 35.5% of American Indians (AI) in MN, WI & MI Smoke (n=126) The American Indian Community Tobacco Project found that 62% of AI adults in urban MN were smokers and only 12% had never smoked (n=300) 4 of the 5 leading causes of AI death in MN, WI, & MI are tobacco related

8. Relationships with Research Past harms have created mistrust of research Standard research methods do not work in “Indian Country” – Selection bias – Not differentiating between spiritual and abusive tobacco use Research conducted does not benefit the Indian community

9. Relationships with Research Previous Harm/Trust Issues Need for Data Research Problems C.B.P.R.

10. Wisconsin Native Youth Tobacco Survey

11. What is the WNYTS? Culturally competent Self-administered School based Tobacco survey – Traditional/ceremonial use – Tobacco abuse – Thoughts/beliefs about tobacco – Environmental Tobacco Smoke exposure

12. Challenges Racial conflicts – Within/between communities – Off reservation schools – Perceptions of Indian capabilities Scheduling with schools and staff Communication $$ Thanks WI TPCP!!! (hugs and kisses)

13. Successes First ever comprehensive statewide Native youth tobacco survey Used census method Went about it in a “good way” Large # of participants (N > 1800) Built stronger relationships with tribes, schools, and state Demonstrated abilities of Indian work

14. Ceremonial Tobacco Use

15. Middle School Tobacco Abuse

16. High School Tobacco Abuse

17. Tobacco use = tobacco abuse? Ceremonial users (at 1 st glance) 40- 70% more likely to have abused or be current tobacco abusers Type of tobacco used in ceremony makes all the difference – Cigarettes for ceremony = 2 to 4 times more likely to have abused or be current tobacco abusers – Loose tobacco or traditional tobacco = 50-75% less likely to have abused or be be current tobacco abusers

18. Thanks! Great Lakes Inter-Tribal Epidemiology Center PO Box 9 Lac du Flambeau, WI 54548 715-588-3324 www.glitc.org/epicenter