Tribal Communities Learn How to Quit Commercial Tobacco Use

Man breaking a cigarette in half.

State and tribal partners trained community health workers and health care professionals on the health risks associated with commercial tobacco use and the availability of cessation resources.

by: Richard Mousseau


American Indians and Alaska Natives are at increased risk of cancer from commercial tobacco. The Great Plains Tribal Chairmen’s Health Board’s (GPTCHB) North Plains Comprehensive Cancer Control Program (NPCCCP) collaborated with the Great Plains Area Indian Health Service (IHS) to deliver a training program to improve tobacco intervention skills among health care professionals. From 2014 to 2016, state and tribal partners trained 110 community health workers and health care professionals on the health risks associated with commercial tobacco use and the availability of cessation resources in North and South Dakota.


In 2014, the GPTCHB and NPCCCP surveyed 10 of 18 Great Plains area tribes and found that more than 60% of tribal members were current smokers, compared to 44% of American Indian/Alaska Natives adults overall and 14% of adults nationally. For tribal members in the Great Plains area, high smoking rates contribute to tobacco-related cancer diagnoses and deaths.

During 2010 to 2014, more than 20,000 new tobacco-related cancers were reported among American Indian and Alaska Native adults. Age-adjusted incidence rates ranged from 2.1 laryngeal cancer cases to 44.7 lung cancer cases per 100,000 adults. In 2015, an estimated 2,100 adults died from a tobacco-related cancer.


About 122,000 tribal members receive health care services in 19 IHS units and tribal-managed service units of the Great Plains Area IHS. The NPCCCP collaborated with the IHS to host seven Basic Tobacco Intervention Skills Certification for Native Communities trainings in North and South Dakota. This certification opportunity was part of an eight-hour continuing education certification program offering culturally responsive treatment plans for tribal members who smoke commercial tobacco.

Trainees learned about the differences between the use of commercial and traditional tobacco. Traditional tobacco is tobacco and/or other plant mixtures grown or harvested and used by American Indians and Alaska Natives for ceremonial or medicinal purposes. Commercial tobacco is used recreationally and poses the risk for addiction. Trainees learned tobacco intervention skills needed to help tribal members distinguish between the two types of tobacco use. They also promoted community-clinical links that helped health care professionals and community health workers identify and connect tribal members who smoke with tobacco cessation resources.


During 2014 to 2016, IHS facilities in North and South Dakota hosted seven eight-hour trainings. NPCCCP certified 110 trainers, including community health workers, tobacco prevention specialists, physicians, nurses, pharmacists, and other experienced health care workers. Because of these trainings, referrals to tobacco cessation sessions increased from 29.4% of patients who smoked in 2011 to 49.5% in 2016 at 17 IHS facilities. Workers who completed the training gained the skills and knowledge to organize ongoing interventions to change behaviors that lead to quitting commercial tobacco use.

“The trainings provided information on culturally responsive ways to work with our people dependent on commercial tobacco. We were very happy with the broad group of health care professionals who attended from Sisseton IHS, as well as our Youth Tribal Health staff.”

Audrey German
Program Manager
Sisseton-Wahpeton Oyate

Future Directions

NPCCCP provides ongoing training opportunities to health care professionals in North and South Dakota that offer continuing education credits and tobacco cessation trainer certification. These trainings will help health care professionals and community health workers continue to promote tobacco cessation in tribal communities. The North and South Dakota Quitline representatives will also continue to share state resources and other information with anyone who is committed to quitting commercial tobacco use.

Your Involvement Is Key

Tribal leaders and members, as well as health care professionals, need ongoing education and training about the health risks associated with commercial tobacco use and how smoking cessation can help prevent cancer and improve overall health. By using culturally appropriate tobacco cessation resources that are sensitive to the tribal use of ceremonial tobacco, community health workers provide the cessation interventions and resources that North and South Dakota tribal members need to quit the use of commercial tobacco.

The findings and conclusions in this success story are those of the author(s) and do not necessarily represent the official position of the funding agencies of the Centers for Disease Control and Prevention (CDC).
View Page In:pdf icon PDF [739K]