Enhancing Tobacco Control Policies in Northwest Indian Tribes

Smoking-related diseases are a major cause of Native-American mortality. Smoking rates among American Indians, particularly women, do not reflect the decline in smoking prevalence observed over the past two decades in the United States. Reduction of exposure to tobacco smoke can be approached by educational or skill-building strategies directed at changing the behavior of individuals -- for example, smoking cessation interventions. An alternative approach is to modify the environment in ways that alter individual behavior and/or help protect people from known risk factors.

The aim of this program is to work with tribes to develop their own culturally appropriate tobacco use policies.

In the original project, two American-Indian staff members of the Northwest Portland Area Indian Health Board delivered the intervention. Tribal representatives were invited to one of four regional workshops that included an overview of the project, a presentation on the health risks of smoking and environmental tobacco smoke, and an introduction to the Tribal Tobacco Policy Workbook. The regional meetings were followed by a visit to each tribe, where project staff typically worked with members of the tribal health committee or people designated by the tribal council chair. A tobacco policy resolution approved by the tribal council was the goal for each tribe.

The consultation process took place over a 45-week period.

The population focus was federally-funded Indian tribes located in Washington and Oregon.

The program can be administered in a community setting.

The Tribal Tobacco Policy Workbook is required. This 36-page book includes sections on forming a tobacco policy committee, key decisions in developing policy, and how to publicize and implement a tribal policy.

The Northwest Portland Area Indian Health Board, in collaboration with investigators at two research settings, initiated the project. Researchers developed and evaluated a culturally appropriate tobacco consultation process for the 39 federally recognized tribes in Washington and Oregon.

The effectiveness of the intervention was demonstrated in a randomized trial wherein half the tribes received the consultation immediately and the other half served as a "wait-list" control group. The consultation was then provided to the control group or wait-list tribes and the same positive results were observed.

The consultation intervention took place over a 45-week period. The intervention began with a kick-off meeting. Project staff visited each tribe at least once, but no more than twice during the intervention. On average, between 6 to 9 intervention telephone calls per tribe were made (range: 3-15 telephone calls). Post-intervention measures were obtained over a 4-month period.

The consultation intervention led to significant changes in restricting smoking at tribal council meetings, at tribal work settings, and in private offices.