Unfair and Unjust Practices and Conditions Harm American Indian and Alaska Native People and Drive Health Disparities
Some historical policies and practices have led to worse mental and physical health among American Indian and Alaska Native (AI/AN) people. For example:
- The Indian Removal Act of 1830 and the Dawes Act of 1887 ordered AI/AN people from the lands they had been living on. This removal by force contributed to the loss of entire tribes, their culture, traditions, and languages. AI/AN people are faced with daily reminders of these losses, and many still experience grief from this historical trauma. This helps to explain why AI/AN people have some of the highest rates of poor mental health among U.S. population groups.
- From the late 1880s until the passage of the Indian Religious Freedom Act of 1978, U.S. laws banned many AI/AN cultural practices, including some traditional uses of tobacco. To keep their cultural practices alive, some groups began to substitute commercial cigarettes for traditionally grown tobacco at ceremonies.
- As outlined in certain U.S. legislative acts (e.g. Snyder Act, Transfer Act) the Indian Health Service is responsible for providing health services to AI/AN people. Resources needed to support health services have not kept up with rising prices, and more people now need to use these services.18 This makes AI/AN health disparities worse.18
There are also current reasons—like the ones explored below—that help explain why commercial tobacco* harms the health of AI/AN people.
Tobacco companies promote their products more heavily to people in racial/ethnic minority groups, including AI/AN people.19
In order to target AI/AN people, the tobacco industry uses many strategies to influence people and make it seem like they are doing good for the community. Some examples include:
- Giving financial support to cultural events like pow wows and rodeos;19
- Using images, symbols, and names that have special meaning in tribal culture (such as feathered war bonnets or illustrations of American Indians smoking pipes) to sell commercial tobacco products;20
- Giving misleading statements about traditional tobacco to persuade AI/AN people to use commercial tobacco products instead of or alongside traditional tobacco;20
- Cutting prices on commercial tobacco sold on tribal lands to attract and keep customers.19
There are steps that can be taken to reduce the pressure to buy commercial tobacco that comes with heavy advertising and discounts, such as:
- Making the difference between commercial and traditional tobacco clear.
- Using money from state tobacco settlement funds—which are paid to states every year by tobacco companies—to collaborate with AI/AN people to develop strategies for commercial tobacco control and prevention.
- Supporting counter-tobacco education and advocacy efforts developed by and for AI/AN communities, including:
Stop the Sale of our Image: Don’t Buy the Lie
This community-based campaign from California raises awareness of how commercial tobacco ads promote stereotypes of American Indians.17
Keep Tobacco Sacred
Minnesota tribes developed Keep Tobacco Sacred, an ad campaign and related documentary that reminds and educates about the differences between traditional and commercial tobacco.
The Cheyenne River Sioux Tribe Canli Coalition organized to prevent an e-cigarette company from implementing a targeted marketing campaign that included price promotions, coupons, giveaways, and charitable contributions and was presented to tribal leadership using false and misleading statements.21
- They have the highest poverty rate of all racial/ethnic groups in the U.S.26,27 Chronic financial problems are a major source of stress.
- AI/AN youth face multiple stressors, including poverty, racism, and traumatic life events.28
- AI/AN youth (aged 11-15) are more likely to report that they have experienced discrimination due to their ethnicity than non-Hispanic white youth.29
When people have severe or long-lasting stress, their bodies respond by raising stress hormones and keeping them raised.30,31 When this goes on for a long time, they may develop health problems like high blood pressure and type 2 diabetes.32,33,34 Smoking cigarettes also leads to disease and disability and harms nearly every organ of the body.14
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- U.S. Census Bureau. American Fact Finder, 2020. American Community Survey Demographic and Housing Estimates [accessed 2022 Mar 19].
- Odani S, Armour BS, Graffunder CM, Garrett BE, Agaku IT. Prevalence and Disparities in Tobacco Product Use Among American Indians/Alaska Natives — United States, 2010–2015 . Morbidity and Mortality Weekly Report, 2017;66(50):1374-8 [accessed 2022 Mar 19].
- Substance Abuse and Mental Health Services Administration. Results from the 2018 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2019 [accessed 2022 Mar 19].
- Espey DK, Jim MA, Cobb N, et al. Leading Causes of Death and All-Cause Mortality in American Indians and Alaska Natives. American Journal of Public Health, 2014;104(Suppl 3):S303–S311 [accessed 2022 Mar 19].
- Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco Product Use Among Adults — United States, 2020. MMWR Morb Mortal Wkly Rep. 2022; 71:397–405 [accessed 2022 Mar 19].
- U.S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020. Pg. 57 [accessed 2022 Mar 19].
- O'Donald ER, Miller CP, O'Leary R, Ong J, Pacheco B, et al. Active smoking, secondhand smoke exposure and serum cotinine levels among Cheyenne River Sioux communities in context of a Tribal Public Health Policy. Tobacco control, 2020;29(5): 570-576 [accessed 2022 Mar 19].
- Public Health Law Center. Smoke-free Tribal Housing Policies [PDF-446 KB]. June 2020 [accessed 2022 March 19].
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- Mowery PD, Dube SR, Thorne SL, et al. Disparities in Smoking-Related Mortality Among American Indians/Alaska Natives. American Journal of Preventive Medicine, 2015 [accessed 2022 March 19].
- Heron, M. Deaths: Leading Causes for 2017. National Vital Statistics Reports, 2019;68(6) [accessed 2022 Mar 19].
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- U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2022 Mar 19].
- Hartmann WE & Gone JP. Psychological-mindedness and American Indian historical trauma: Interviews with service providers from a Great Plains reservation. American Journal of Community Psychology, 2016;57(1-2): 229 –242 [accessed 2022 Mar 19].
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- Warne D & Bane Frizzell L. American Indian health policy: historical trends and contemporary issues. American Journal of Public Health, 2014;104(S3): S263-S267 [accessed 2022 Mar 19].
- Lempert LK, & Glantz SA. Tobacco industry promotional strategies targeting American Indians/Alaska Natives and exploiting tribal sovereignty. Nicotine and Tobacco Research, 2019;21(7): 940-948 [accessed 2022 Mar 19].
- D’Silva J, O’Gara E, & Villaluz NT. Tobacco industry misappropriation of American Indian culture and traditional tobacco. Tobacco control, 2018;27(e1): e57-e64 [accessed 2022 Mar 19].
- O’Leary R. Examining the Youth E-Cigarette Epidemic [PDF-4.1 MB]. Testimony Before the Subcommittee on Economic and Consumer Policy. House Committee on Oversight and Reform, U.S. House of Representatives, July 24, 2019 [accessed 2022 Mar 19].
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- Hodge F, Nandy K. Factors associated with American Indian cigarette smoking in rural settings. Int J Environ Res Public Health. 2011;8(4):944-954 [accessed 2022 Mar 19].
- Johnson-Jennings MD, Belcourt A, Town M, Walls ML, Walters KL. Racial discrimination's influence on smoking rates among American Indian Alaska Native two-spirit individuals: does pain play a role? J Health Care Poor Underserved. 2014;25(4):1667-1678 [accessed 2022 Mar 19].
- Soto C, Baezconde-Garbanati L, Schwartz SJ, Unger JB. Stressful life events, ethnic identity, historical trauma, and participation in cultural activities: Associations with smoking behaviors among American Indian adolescents in California. Addict Behav. 2015;50:64-69 [accessed 2022 Mar 19].
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- Serfaini K, Donovan DM, Wendt DC, Matsumiya B, & McCarty CA. A Comparison of Early Adolescent Behavioral Health Risks Among Urban American Indians/Alaska Natives and their Peers. American Indian and Alaska native mental health research, 2017;24(2), 1–17 [accessed 2022 Mar 19].
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