Patterns of Tobacco Use Among American
Indians in Minneapolis-St. Paul
Kristine Rhodes, M.P.H.
Jean Forster, Ph.D.
University of Minnesota
School of Public Health
For the American Indian Community
Tobacco Project Steering Council
September 7, 2007
AICTP Steering Council
Goals for This Presentation
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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
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CBPR, Reality-Based Research
Illustrate their application in the AICTP
Present AICTP results to date
Describe how the research findings = action
Twin Cities Urban Indian Population
Pre-colonization history
 Post-colonization history
 Assimilation/eradication
 Termination of federal responsibility
 Relocation
 Self-determination

Twin Cities Urban Indian Population
Current situation:
 33,000 American
Indians in Twin Cities
41% of Minnesota Indian population
 35%
households in poverty
 High unemployment rate
 Low high school graduation rate
 Inadequate health care
Traditional Tobacco Use
Asema
Cansasa
Asema,or
Cansasa,
Kinnickinick
QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
Pipe
Nicotiana tabacum
Broadleaf Tobacco
Nicotiana rustica
Snuff
Red willow
“kinnickinick”
Shell for Smudging
Photo Source: Wikipedia.com
Recreational Tobacco Abuse
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High rates of addictive smoking
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High rates of related health problems
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Upwards of 50%
Cancer, especially lung cancer
Cardiovascular disease
Diabetes
Little useful information
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Actual rates of smoking
Why American Indians smoke more
American Indian-specific prevention
We need a different research paradigm…
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Methodological, conceptual flaws limit
usefulness of existing research

Distrust between University and American
Indian community
Decolonizing Methodologies:
Research and Indigenous Peoples
Linda Tuhiwai Smith, Maori education specialist
University of Auckland
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

Community-Based Participatory Research
Recognizes the community as basic unit
Builds on community strengths, resources
Facilitates partnership in all phases of research
Integrates knowledge, action for mutual benefit
Reality-Based Research - John Poupart
Incorporates aspects of Indian culture
Uses research methods culturally appropriate
Involves American Indians in all aspects of research
AICTP Steering Council
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Predominantly American Indian
Final authority on all aspects of the research
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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
Research Questions
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 Plan
Elder talking circles
 In-person structured interviews of adults
 School-based surveys of youth
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Community reaction/ interpretation
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Dissemination
Community
 Scientific
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Elder Talking Circles
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Four talking circles in Minnesota
Snowball recruitment
 Led by American Indian elder
 Community locations (2 urban and 2
reservation)
 Incentives: Meal and cash
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Opportunity to respond to summary
findings before finalized & distributed
Elder Talking Circles - Summary
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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
Adult Interviews
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
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Reaction talking circles
Participant Characteristics (N=300)
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Tribal Affiliation
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Age Distribution
 18-24 years
Anishinabe/Ojibwe 70%
 25-34 years
Dakota/Lakota
19%
 35-44 years
Ho-chunk
2%
 45-54 years
Other
9%
 55-64 years
 Arapaho, Blackfeet,
 65+ years
Chickasaw, Menomonie,
Navajo, Northern
Cheyenne, Omaha,
 Gender
Oneida, Ponca, Seneca,
 Female
Southern Cheyenne,
 Male
Three Affiliated Tribes
21%
20%
26%
15%
12%
7%
53%
47%
Traditional/Spiritual Tobacco Use
Overall
80.3%
Female
Male
85.9%
74.0%
Never smoker
Former smoker
90.3%
87.3%
Current smoker
75.5%
Smoking Status (N=300)
Never
12%
Former
26%
Current 62%
Compared to…
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51.7% among Native Americans in
Minnesota (reported)
40.4% among Native Americans in U.S.
21.1% among general population in
Minnesota
Smoking Status by Age (N=300)
80%
70%
60%
50%
Current
40%
Former
Never
30%
20%
10%
Age
0%
18-24
25-34
35-44
45-54
55+
Desire to Quit (N=186)
No/ not sure
32%
Want to Quit
68%
Who REALLY want to quit?
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Tried to quit 6+ times (83%)
Tried to quit 2 - 5 times (69% vs. 42%)
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Smoke-free home (82% vs. 61%)

Someone close is upset about their
smoking (64% vs. 47%)
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Tried to quit in past year (64% vs. 28%)
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Length of Most Recent Quit Attempt
Among Current Smokers (n=186)
60%
52%
50%
40%
43%
Less than 1 week
32%
30%
20%
29%
29%
More than 6
months
16%
10%
0%
Female
1 week - 6 months
Male
Time Since Last Cigarette,
Former Smokers
Less than 1 month
Total
N=77
10.4%
Between 1 month and 1 year
18.2%
More than 1 year
71.4%
Main Reason for Quitting
Former
Smoker
N=77
48.0%
Current
Smoker*
N=126
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%
Health reasons
*Among those who want to quit
Knowledge of Cessation Resources
in the Indian Community (n=300)
53%
No
47%
Yes
Desired Cessation Assistance
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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
Ways to quit…differences by gender
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Men more willing to:
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just quit on their own - 85% vs. 71%
Women more willing to:
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call a quit line - 32% vs. 13%
visit a website - 20% vs. 11%
try acupuncture - 50% vs. 26%
Ways to quit…differences by age
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%
Adult Recommendations
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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
Youth Survey
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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
D/L/N akota
Ho-Chunk
Diné
Other:
58%
40%
5%
1%
5%
Age Distribution
11 or younger
12
13
14
15
16
17
18 or older
Gender
Female: 50.3% Male: 49.7%
9.5%
9%
13%
17%
21%
15%
10%
5%
Youth: Traditional Tobacco Use
How often do you use tobacco for ceremony,
prayer or traditional reasons? N=213 (64%)
Daily
Weekly
Monthly
A few time per year or less
5%
13%
15%
66%
What type of tobacco do you usually use for
ceremony, prayer or traditional reasons?
Native tobacco
Pouch/packaged
Cigarettes
Other
38%
36%
14%
12%
Youth Smoking Status by Age
60%
Never
Experimental
Past Month
50%
40%
30%
20%
10%
0%
Š13
14 -15
Age
16-18
Overall
Youth Smoking Status by
Type of Tobacco Used for Spiritual Use
60%
Never
Experimental
Past month
50%
40%
30%
20%
10%
0%
Comme rcial
Native only
Youth Smoking Status by
Perceived Parental Attitude
90%
80%
70%
60%
Never
50%
Experimental
40%
Past month
30%
20%
10%
0%
OK/Don't Care
Not OK
Youth Recommendations
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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
Next Steps for the AICTP Partnership
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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
Cultural Strengths of
Urban American Indian Community
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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