Lesson 03: Tobacco and Native Americans 

Tobacco, Health and the Law
Professor Vernellia R. Randall
The University of Dayton Law School



bullet Syllabus
bullet Introduction
bullet Cigarettes and Health
bullet Tobacco and Native Americans 
bullet Targeting of Children, Women and Minorities
bullet Laws, Regulations and Litigation
bullet Settlement Agreements
bullet Proposed Laws, Regulation and Litigation
bullet Tobacco and the Third World Countries
Professional Websites
bullet Race, Health Care and the Law
bullet Race and Racism in American Law
bullet Gender and the Law
Students, Learning and Legal Education

Reading Assignment
bullet Early Uses of Indian Tobacco in California
bullet American Indian Ethnobotany Database: Foods, Drugs, Dyes, and Fibers of Native NorthAmerican Peoples
bullet Commercial Tobacco Abuse In American Indian  Communities 
bullet Tobacco's but an Indian Weed
bullet American Indian Portraits Large Tobacco Silks
Sacred Use of Tobacco
bullet The Sacred Use of Tobacco
bullet The Sacred Origin of Tobacco
bullet We Pray with Tobacco (video on reserve)
bullet Tobacco, Culture, and Health among American Indians: a Historical Review
Marketing of Tobacco to Native Americans or by Native Americans
bullet By purchasing a product Sold by American Indians on Indian tribal land
bullet Native Americans Disagree over Manufacture of Cigarettes
Current Tobacco Use and Health Consequences
bullet Prevalence and predictors of tobacco use among Lumbee Indian women in Robeson County, North Carolina
bullet Correlates of tobacco use among Native American women in western North Carolina
bullet American Indians and Alaska Natives and Tobacco
bullet Tobacco Use or Abuse? 
bullet Comparison of Drug Use Rates for Reservation Indian, Non-Reservation Indian and Anglo Youth
bullet Non-ceremonial Tobacco Use among Southwestern Rural American Indians: the New Mexico American Indian
Tobacco Control
bullet Promoting tobacco control policies in Northwest Indian tribes
bullet Tobacco use policies and practices in diverse Indian settings
bullet Effectiveness of a Consultation Intervention to Promote Tobacco Control Policies in Northwest Indian Tribes: Integrating Experimental Evaluation and Service Delivery

bullet Traditional Tobacco Use In Northern California," in News From Native California, Spring 1996.
bullet The Elders Gathering
bullet Offering Smoke: The Sacred Pipe and Native American Religion., Jordan Paper, The University Of Idaho Press, Moscow Idaho, copyright 1988, ISBN 0-89
bullet American Indian Tobacco Education Network
bullet American Indian Religious Rights Foundation
bullet Ralph Linton, Use of Tobacco Among North American Indian (1924) (On Reserve)

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Spangler,-John-Given; Bell,-Ronny-Antonio; Dignan,-Mark-Boberg, Prevalence and predictors of tobacco use among Lumbee Indian women in Robeson County, North Carolina., 22  Journal o  Community Health 115-25 (Apr. 1997).

ABSTRACT:  Tobacco use among some Native American tribes is high compared to the overall US population.  Little is known, however, about tobacco use among Native Americans in North Carolina, a state with strong economic ties to tobacco.  To assess the epidemiology of tobacco use in this population, data from the North Carolina Native American Cervical Cancer Project was reviewed.  Nine hundred eighty-two Lumbee Indian women in Robeson County provided general demographic information as well as information on cancer risk knowledge, attitudes and behaviors during the 5-year study.  Women were selected from the community using a random sample of 5200 persons from the tribal roll of approximately 40,000 persons.  20.6% of women were current smokeless tobacco users, while 23.7% were current smokers.  Demographic and social support predictors were unique for the different types of tobacco use. Cigarette smoking was associated with younger age, higher education, excellent or good self-reported health, having a recent physical exam, separated or divorced marital status, low church participation, and alcohol consumption.  Conversely, use of smokeless tobacco was associated with older age, lower education level, fair or poor self-reported health, widowed marital status, and having a high number of friends.  These data show a high prevalence of smokeless tobacco use among women in this population, and a contrast in the predictors of tobacco use by source.  Intervention programs for tobacco use cessation should be sensitive to these differences. 

Spangler,-John-G; Dignan,-Mark-B; Michielutte,-Robert, Correlates of tobacco use among Native American women in western North Carolina, 87 American Journal of Public Health. 108-11 (Jan. 1997).

ABSTRACT:  Objectives. This study examined correlates of tobacco use among Cherokee women.  Methods. Prevalence rates were analyzed for 614 randomly selected Eastern Band Cherokee women.  Results. The prevalence rates for current smokeless tobacco use and smoking were 8% and 39%, respectively.  Smokeless tobacco use correlates included lower education and having consulted an Indian healer. Smoking correlates included younger age, alcohol use, no yearly physical exam, separated or divorced marital status, and lack of friends or church participation.  Conclusions. Smoking rates among these women were slightly above national rates.  The association of smokeless tobacco use with having consulted an Indian healer may help in understanding Cherokee women's smokeless tobacco use.

Edward Lichtenstein,Promoting tobacco control policies in Northwest Indian tribes,  85 American Journal of Public Health 991994 (July 1995)

ABSTRACT:  A culturally sensitive consultative process to facilitate adoption by tribal councils of more effective tobacco control policies was developed and evaluated.  Thirty-nine North-west Indian tribes were randomized to early intervention or late intervention conditions. Early intervention tribes received a policy workbook and consultation by means of meetings and telephone calls.  Late intervention tribes were assessed but received no assistance or encouragement regarding tobacco use policies.  The stringency of the policies was assessed via telephone at baseline and after intervention.  At postintervention there were consistent, and generally statistically significant, differences in adoption of more stringent and comprehensive smoking policies for early intervention tribes compared with late intervention tribes.  The intervention could be used in other Indian settings.

Roberta Hall, et. al.,   Tobacco use policies and practices in diverse Indian settings,  19(3) American Indian Culture and Research Journal 165- 180 (1995)

ABSTRACT: A description of the 1990-92 tobacco policies of four geographically and culturally diverse American Indian settings.  Data were obtained from 39 Indian tribes in Washington, Idaho, and Oregon; 18 California Indian health clinics; 8 Southwest schools attended by American Indians; and 6 Northeast urban Indian centers.  Modest relationships were found between observed indoor use of tobacco and leniency or absence of smoking policies, and between the presence of no-smoking signs and stringency of indoor smoking policies.  This indicates a statistically significant link between policies and practices and suggests that more stringent policies could lead to healthier environments inside tribal buildings.  One of the most important findings is that Indian agencies are controlling personal use of tobacco products within their sites.

Christina, Pegp, et. al., Tobacco, culture, and health among American Indians: a historical review, 19(2) American Indian Culture and Research Journal 143-164 (1995)

ABSTRACT:  An investigation of possible historical and cultural reasons for the high prevalence of contemporary tobacco use among North American Indians.  A literature review of tobacco use by American Indians in precontact and colonial times shows that it was used extensively for ceremonial, spiritual, social, political, and medicinal purposes. Centuries of aboriginal sacred use, combined with increasing commercial use of tobacco since the fur trade, may have formed a residual base of susceptibility for later secular use.  The high prevalence of tobacco use among most American Indian social groups renders it probably the greatest current threat to the health of American Indians.  Tobacco's addictive qualities place it on the same level as alcohol as a source of physical and psychological dependency, a fact not always recognized in American Indian social contexts.

Edward  Lichtenstein, et.al., Effectiveness of a Consultation Intervention to Promote Tobacco Control Policies in Northwest Indian Tribes: Integrating Experimental Evaluation and Service Delivery, 24 American Journal of Community Psychology 639-55 (Oct. 1996)

ABSTRACT:  A quasi-experimental replication of an intervention for promoting tobacco control policies in Northwest Indian tribes is described and the process of intervention including issues of collaboration among research institutions and Indian organizations is discussed.  The policy intervention was evaluated using a pretest-posttest design wherein 20 tribes that had served as wait-list controls now received the intervention.  The intervention comprised a tribal representative attending a kickoff orientation; follow-up visits to the tribes; distribution of tobacco policy workbooks; and phone call consultations.  Policy status and stringency were assessed by means of telephone interviews with two key contacts per tribe, and by a count of enacted policies.  There were significant pre-post changes in the primary outcome measure, a composite summary score of tobacco policy stringency, and changes were also reflected in enacted policies.  The intervention effects observed were similar to those found in the prior randomized trial and suggest a robust, disseminable intervention. Much of the success achieved was attributed to the role of an Indian organization in planning the project and implementing the intervention and evaluation protocols.

Fred Beauvais, Comparison of Drug Use Rates for Reservation Indian, Non-Reservation Indian and Anglo Youth, 5(1) American Indian and Alaska Native Mental Health Research 13-31 (1992) 

ABSTRACT: Data from the 1988-1990 American Drug & Alcohol Survey (N = 150,000+ high school students each year) are used to compare rates of drug use & involvement for 3 groups: American Indian (AI) youth living on reservations, AI youth living off reservations, & Anglo youth. A consistent pattern emerged, showing the lowest rates of use among Anglo youth, higher rates among nonreservation AI youth, & the highest rates among AI youth on reservations. Rates of tobacco & marijuana use also are especially high for AI youth, & these youth show a pattern of earlier initiation to drug use. Gender differences reveal slightly higher rates of use for males. 8 Tables, 4 Figures, 14 References.

F.D., Gilliland, et. al, Non-ceremonial Tobacco Use among Southwestern Rural American Indians: the New Mexico American Indian, 7(2)  TOBACCO CONTROL 156-160 (SUM 1998).

Objectives-To ascertain non-ceremonial tobacco use among rural American Indians in New Mexico (United States).  Design-A geographically targeted telephone survey. Setting-Rural New Mexico.
Participants-American Indian residents aged 18 years and older.  Main outcome measures-Prevalence of ever-smokers and current smokers of cigarettes and ever-users and current users of  smokeless tobacco, number of cigarettes smoked, and prevalence of cigarette smoking quitting behaviour. Results-Of the 1266 respondents, 38.5% (95% confidence interval (CI) = 34.5% to 42.1%) reported ever smoking, and  16.3% (95% CI = 13.5% to 19.0%) reported being current smokers. Current smokers averaged 7.6 (95% CI= 6.0 to 9.3)  cigarettes per day. Current smoking prevalence was highest among men and lowest among college graduates. Prevalence of  smokeless tobacco use was 24.1% for ever-use and 7.2% for current use and showed a strong male predominance of use.  Conclusions-The prevalence of current smokers among rural American Indians in New Mexico was lower than among  American Indians of other regions in the United States, all New Mexicans, and the national population as a whole. Although  smoking prevalence was lower among American Indians in New Mexico, variation by sex and education followed the same  patterns as reported among American Indians of other regions.