OREGON STATE UNIVERSITY

Northwest tribes working to cut tobacco use

11/26/1997

CORVALLIS - Many Pacific Northwest Indian tribes are changing their policies on tobacco use in buildings in an effort to prevent cancer and other diseases 10 years after a pioneering study demonstrated that such intervention was wanted, and needed.

The effort began in 1987 when Oregon State University professor Roberta Hall, working with the Northwest Portland Area Indian Health Board and the OSU Survey Research Center, did a pilot study on smokeless tobacco use among Indian youth.

The studies have continued, bolstered in 1990 by a five-year grant from the National Cancer Institute to see if tribes could be persuaded to make policies regarding personal use of tobacco more strict. The Northwest Indian Health Board, which included representatives from all federally recognized tribes in Oregon, Washington and Idaho, was in charge of the intervention. The Oregon Research Institute in Eugene helped organize the intervention and analyze results. Hall headed field observations.

Ten years after the initial study, the results suggest that the intervention was effective.

"It was really an experiment to see if culturally sensitive consultation could lead to a change in policies," said Hall, an OSU professor of anthropology. "Today you are much more likely to see smoking banned at tribal meetings and inside tribal buildings, there is more of an effort to education Indian children about the dangers of non-ceremonial tobacco use, and some casinos even have smoke-free areas.

"Our emphasis wasn't to get every individual to quit using tobacco," she added. "It was to work with the tribes to change their policies, which unintentionally condoned smoking and chewing."

The 10-year effort is being featured in a chapter of a new book edited by Robert Hahn, an epidemiologist with the Centers for Disease Control. The book will be published next year by the Oxford University Press.

Hall said that before the study began, reducing tobacco use wasn't a high priority with most Northwest Indian tribes. Efforts at addressing problems such as alcohol use took precedence, she said, because the negative effects of alcohol were more immediate and obvious. With a few exceptions, tobacco-related problems often take years to become evident.

There also was resistance from some tribal members who feared their ceremonial use of tobacco would be threatened. However, the project was concerned only with personal use, Hall pointed out.

"We worked with tribal leaders, who really have taken the initiative to change their tribal policies and begin educating the youth," Hall said. "At the time, they had a lot of other things on their plates to worry about, from economics to basic health care. Now that things are improving for many tribes, they are able to address other concerns, including tobacco use."

During the five-year study, the researchers worked with 39 tribes in Oregon and Washington, evaluating their policies and developing a "scale of stringency" to measure how strict those policies were. They worked with half of the tribes initially, using the other half as a control to measure their effectiveness. The researchers spent 18 months consulting with tribal leaders and providing information on tobacco use and addiction.

By the time the study was done, their "stringency" composite had risen from an average value of 3.7 to 5.2, with zero representing virtually no tobacco policy, and 6.0 representing strict regulation.

Even more telling was the anecdotal evidence.

"You could tell we were archaeologists," Hall said with a laugh. "We literally would scour the parking lots looking for cigarette butts. We would look for ashtrays as well as health-related posters in conference halls and meeting rooms. We would look to see if cigarette companies were advertising in the local grocery stores.

"Now, 10 years later, you're more likely to see posters urging kids not to smoke than you are to see tobacco advertising," she added.

Hall said Native Americans historically have had a high incidence of personal tobacco use. Though most of the tobacco in the U.S. is grown in the southeast, it has been grown for many centuries in the Pacific Northwest, she said, and archaeologists have recovered clay pipes from sites dating back 2,000 years.