title: The Tribal Tobacco Education and Policy Initiative: Findings From a Collaborative, Participatory Evaluation.
abstract: While the reduction in the overall U.S. smoking prevalence has been declared one of the top 10 public health achievements of the past century, the growing disparity in smoking between American Indians and the general population is one of the biggest challenges of the 21st century. Minnesota in particular has very high smoking rates among American Indians (59%). Tribal Nations in Minnesota share a past of attempted cultural genocide and a present of restoring the strength of their cultural teachings, including the prominence of traditional tobacco as a sacred "first medicine." The Tribal Tobacco Education and Policy initiative works to address this complex and challenging context. This article describes results of a participatory evaluation from 2010 to 2013 in four Minnesota Tribal Nations-three Ojibwe and one Dakota. Tribal Tobacco Education and Policy coordinators used their cultural knowledge to develop community-level strategies, identifying appropriate strategies from best practices on tobacco advocacy, while drawing on the strengths of their own sovereignty and sacred tobacco traditions. Tribal coordinators generated support for policy change by conducting culturally relevant education, engaging tribal members, and nurturing relationships. This approach resulted in norm changes, practices toward restoring traditional tobacco, informal policies, and tribal resolutions to advance smoke-free policies.
authors.affiliation: 1 Scott Consulting Partners LLC, Richland Center, WI, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Scott
authors.affiliation: 2 ClearWay Minnesota, Minneapolis, MN, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: D'Silva
authors.affiliation: 3 Mille Lacs Band of Ojibwe in Minnesota, Onamia, MN, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Hernandez
authors.affiliation: 2 ClearWay Minnesota, Minneapolis, MN, USA.
authors.forename: Nicole Toves
authors.initials: NT
authors.lastname: Villaluz
authors.affiliation: 2 ClearWay Minnesota, Minneapolis, MN, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Martinez
authors.affiliation: 4 Blue Cross and Blue Shield of Minnesota, Eagan, MN, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Matter
mesh_terms: D003299:Cooperative Behavior; D054521:Cultural Competency; D006266:Health Education / Q000458:organization & administration*; D006801:Humans; D007198:Indians, North American; D008910:Minnesota / Q000453:epidemiology; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence*; D012907:Smoking / Q000208:ethnology*; D000074606:Smoking Prevention / Q000458:organization & administration; D062789:Tobacco Products / Q000331:legislation & jurisprudence
keywords: Native American/American Indian; advocacy; environmental and systems change; health disparities; health promotion; international/cross-cultural health; lay health advisors/community health workers; public health laws/policies; social determinants of health; tobacco prevention and control