Kristine Rhodes, M.P.H.Jean Forster, Ph.D.

University of MinnesotaSchool of Public Health

For the American Indian Community Tobacco Project Steering Council

September 7, 2007

Patterns of Tobacco Use Among American Indians in Minneapolis-St. Paul

AICTP Steering Council

Describe urban Indian history and current status as context

Describe difference between traditional, spiritual and addictive uses of tobacco

Define need for different research paradigm CBPR, Reality-Based Research

Illustrate their application in the AICTP Present AICTP results to date Describe how the research findings = action

Goals for This Presentation

Pre-colonization history Post-colonization history

Assimilation/eradicationTermination of federal responsibilityRelocationSelf-determination

Twin Cities Urban Indian Population

Twin Cities Urban Indian Population

Current situation:

33,000 American Indians in Twin Cities41% of Minnesota Indian population

35% households in povertyHigh unemployment rateLow high school graduation rateInadequate health care

Asema or Cansasa

Broadleaf Tobacco

Photo Source: Wikipedia.com

Nicotiana tabacum

Snuff

Pipe

Red willow“kinnickinick” Shell for Smudging

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Nicotiana rustica

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Traditional Tobacco UseAsema, Cansasa, Kinnickinick

High rates of addictive smoking Upwards of 50%

High rates of related health problems Cancer, especially lung cancer Cardiovascular disease Diabetes

Little useful information Actual rates of smoking Why American Indians smoke more American Indian-specific prevention

Recreational Tobacco Abuse

Methodological, conceptual flaws limit usefulness of existing research

Distrust between University and American Indian community

We need a different research paradigm…

Dominant research paradigm problematizes Indigenous culture takes research findings out of context generates knowledge for its own sake doesn’t reflect the knowledge of Indigenous

community

Decolonizing Methodologies: Research and Indigenous Peoples

Linda Tuhiwai Smith, Maori education specialist

University of Auckland

Recognizes the community as basic unit

Builds on community strengths, resources

Facilitates partnership in all phases of research

Integrates knowledge, action for mutual benefit

Community-Based Participatory Research

Incorporates aspects of Indian culture

Uses research methods culturally appropriate

Involves American Indians in all aspects of research

Reality-Based Research - John Poupart

Predominantly American Indian Final authority on all aspects of the research

Research questions Protocols and instruments Data collection Analysis and interpretation Dissemination and action

Opportunities to participate in all phases Financial resources shared Monthly working meetings

AICTP Steering Council

What are the cultural strengths of the Twin Cities American Indian community?

What are the tobacco-specific issues?

How could cultural strengths address these tobacco issues?

Research Questions

Elder talking circles In-person structured interviews of adults School-based surveys of youth

Community reaction/ interpretation

Dissemination Community Scientific

Research Plan

Four talking circles in Minnesota Snowball recruitment Led by American Indian elder Community locations (2 urban and 2

reservation) Incentives: Meal and cash

Opportunity to respond to summary findings before finalized & distributed

Elder Talking Circles

Encourage parents to lead by example Develop & offer better cessation

assistance Creative community-wide education More smoke-free areas & events Promote traditional tobacco teachings &

use Increase access to traditional tobacco

Elder Talking Circles - Summary

Flier, The Circle ad, referrals N=300 Ages 18-74, reflecting population age,

gender distribution Administered by Native SC members Community locations $25 gift card

Reaction talking circles

Adult Interviews

Tribal Affiliation Anishinabe/Ojibwe 70% Dakota/Lakota

19% Ho-chunk 2% Other 9%

Arapaho, Blackfeet, Chickasaw, Menomonie, Navajo, Northern Cheyenne, Omaha, Oneida, Ponca, Seneca, Southern Cheyenne, Three Affiliated Tribes

Age Distribution 18-24 years 21% 25-34 years 20% 35-44 years 26% 45-54 years 15% 55-64 years 12% 65+ years 7%

Gender Female 53% Male 47%

Participant Characteristics (N=300)

Overall 80.3%

Female 85.9%

Male 74.0%

Never smoker 90.3%

Former smoker 87.3%

Current smoker 75.5%

Traditional/Spiritual Tobacco Use

Smoking Status (N=300)

Current 62%

Former26%

Never 12%

51.7% among Native Americans in Minnesota (reported)

40.4% among Native Americans in U.S. 21.1% among general population in

Minnesota

Compared to…

Age0%

10%

20%

30%

40%

50%

60%

70%

80%

18-24 25-34 35-44 45-54 55+

Current

Former

Never

Smoking Status by Age (N=300)

Want to Quit 68%

No/ not sure 32%

Desire to Quit (N=186)

Tried to quit 6+ times (83%) Tried to quit 2 - 5 times (69% vs. 42%)

Smoke-free home (82% vs. 61%)

Someone close is upset about their smoking (64% vs. 47%)

Tried to quit in past year (64% vs. 28%)

Who REALLY want to quit?

52%

29%32%

43%

16%

29%

0%

10%

20%

30%

40%

50%

60%

Female Male

Less than 1 week

1 week - 6 months

More than 6months

Length of Most Recent Quit Attempt Among Current Smokers (n=186)

Total

N=77

Less than 1 month 10.4%

Between 1 month and 1 year 18.2%

More than 1 year 71.4%

Time Since Last Cigarette, Former Smokers

Former Smoker

N=77

Current Smoker*

N=126

Health reasons 48.0% 78.6%

Pregnancy (women) 12.8% 1.6%

Dislike smoking 15.6% 6.3%

Family 6.5% 3.2%

Practice traditional ways 3.9% 0

Too expensive 1.3% 5.6%

*Among those who want to quit

Main Reason for Quitting

47%Yes53%

No

Knowledge of Cessation Resources in the Indian Community (n=300)

78% Quit on my own 61% Talk to a doctor or nurse 59% Try medications 57% Read a book or pamphlet 56% Talk to a spiritual advisor 42% Ask friends/ family for help 38% Try acupuncture 32% Attend a stop smoking program 23% Call a quit smoking hotline 16% Go to a quit smoking website

Desired Cessation Assistance

Men more willing to: just quit on their own - 85% vs. 71%

Women more willing to: call a quit line - 32% vs. 13% visit a website - 20% vs. 11% try acupuncture - 50% vs. 26%

Ways to quit…differences by gender

18 - 24 year-old smokers less willing to: talk to a doctor or nurse - 35% vs. 61%

Ages 55+ more willing to : attend a smoking cessation program/group -

52% vs. 32%

Ages 55+ less willing to: ask friends/ family for help - 20% vs. 42% just quit on own - 56% vs. 77%

Ways to quit…differences by age

Talk to kids about the dangers of smoking Lead by example, be a good role model and

don’t smoke around children Teach kids about traditional tobacco Get kids involved in positive activities Parents set no smoking rules for their kids Parents quit smoking first Offer more school programs about tobacco

Adult Recommendations

Youth Survey

N=388 American Indian youth 11-18 year-olds Paper and pencil Surveys administered by AICTP staff Recruitment

St. Paul Schools Minneapolis A.I. youth programs

Participant and school/program incentive

Participant Characteristics

Tribal Affiliation

Anishinabe/Ojibwe 58%D/L/N akota 40%Ho-Chunk 5%Diné 1%Other: 5%

Age Distribution11 or younger 9.5%12

9%13

13%14

17%15

21%16

15%17

10%18 or older

5%

GenderFemale: 50.3% Male: 49.7%

Youth: Traditional Tobacco Use

How often do you use tobacco for ceremony, prayer or traditional reasons? N=213 (64%)

Daily 5%Weekly 13%Monthly 15%A few time per year or less 66%

What type of tobacco do you usually use for ceremony, prayer or traditional reasons?

Native tobacco 38%Pouch/packaged 36%Cigarettes 14%Other 12%

Youth Smoking Status by Age

0%

10%

20%

30%

40%

50%

60%

≤13 14 -15 16-18 OverallAge

Never

Experimental

Past Month

Youth Smoking Status by Type of Tobacco Used for Spiritual Use

0%

10%

20%

30%

40%

50%

60%

Commercial Native only

Never

Experimental

Past month

Youth Smoking Status by Perceived Parental Attitude

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

OK/Don't Care Not OK

Never

Experimental

Past month

Parents talk to kids about the dangers of smoking

Parents set no smoking rules for their kids Get youth involved in other activities Offer more education on the dangers of

smoking Teach kids about traditional tobacco Stop selling cigarettes

Youth Recommendations

Website: www.AICTP.umn.edu Share results with community

Community events Presentations to community groups Data reports for community Newspaper reports, paid ads

Co-author scientific papers Intervention development

Next Steps for the AICTP Partnership

High spiritual use of tobacco Widespread acknowledgement of problem Strong belief in community’s role to solve Importance of children to community Change in social norms around alcohol use

Cultural Strengths of Urban American Indian Community