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Unfair and Unjust Practices and Conditions Harm American Indian and Alaska Native People and Drive Health Disparities										Related Pages
										Some historical policies and practices have led to worse mental and physical health among American Indian and Alaska Native (AI/AN) people. For example:
The Indian Removal Act of 1830 and the Dawes Act of 1887 ordered AI/AN people from the lands they had been living on. This removal by force contributed to the loss of entire tribes, their culture, traditions, and languages. AI/AN people are faced with daily reminders of these losses, and many still experience grief from this historical trauma. This helps to explain why AI/AN people have some of the highest rates of poor mental health among U.S. population groups.
From the late 1880s until the passage of the Indian Religious Freedom Act of 1978, U.S. laws banned many AI/AN cultural practices, including some traditional uses of tobacco. To keep their cultural practices alive, some groups began to substitute commercial cigarettes for traditionally grown tobacco at ceremonies.
As outlined in certain U.S. legislative acts (e.g. Snyder Act, Transfer Act) the Indian Health Service is responsible for providing health services to AI/AN people. Resources needed to support health services have not kept up with rising prices, and more people now need to use these services.18  This makes AI/AN health disparities worse.18Aichillum Shell BasketTobacco prepared for traditional use. Photo courtesy Kathleen Jack, CRIHB.
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			The tobacco industry targets AI/AN communities with marketing and advertisingStress can increase commercial tobacco use and make health problems worseThere are also current reasons—like the ones explored below—that help explain why commercial tobacco* harms the health of AI/AN people.The tobacco industry targets AI/AN communities with marketing and advertisingTraditional dancer
Tobacco companies promote their products more heavily to people in racial/ethnic minority groups, including AI/AN people.19
In order to target AI/AN people, the tobacco industry uses many strategies to influence people and make it seem like they are doing good for the community. Some examples include:
Giving financial support to cultural events like pow wows and rodeos;19
Using images, symbols, and names that have special meaning in tribal culture (such as feathered war bonnets or illustrations of American Indians smoking pipes) to sell commercial tobacco products;20
Giving misleading statements about traditional tobacco to persuade AI/AN people to use commercial tobacco products instead of or alongside traditional tobacco;20
Cutting prices on commercial tobacco sold on tribal lands to attract and keep customers.19There are steps that can be taken to reduce the pressure to buy commercial tobacco that comes with heavy advertising and discounts, such as:
Making the difference between commercial and traditional tobacco clear.
Using money from state tobacco settlement funds—which are paid to states every year by tobacco companies—to collaborate with AI/AN people to develop strategies for commercial tobacco control and prevention.
Supporting counter-tobacco education and advocacy efforts developed by and for AI/AN communities, including:***Stop the Sale of our Image: Don’t Buy the Lie***
This community-based campaign from California raises awareness of how commercial tobacco ads promote stereotypes of American Indians.17
***Keep Tobacco Sacred***Minnesota tribes developed Keep Tobacco Sacred*,*an ad campaign and related documentary that reminds and educates about the differences between traditional and commercial tobacco.
***Community-based coalitions***The Cheyenne River Sioux Tribe Canli Coalition organized to prevent an e-cigarette company from implementing a targeted marketing campaign that included price promotions, coupons, giveaways, and charitable contributions and was presented to tribal leadership using false and misleading statements.21Top of PageStress can increase commercial tobacco use and make health problems worseStress, such as that caused by financial problems, discrimination, or violence, can make someone more likely to smoke.22,23,24,25 Some AI/AN people face many types of stress:Indigenous youthIndigenous youth report experiencing racism more often than white youth
They have the highest poverty rate of all racial/ethnic groups in the U.S.26,27 Chronic financial problems are a major source of stress.
AI/AN youth face multiple stressors, including poverty, racism, and traumatic life events.28
AI/AN youth (aged 11-15) are more likely to report that they have experienced discrimination due to their ethnicity than non-Hispanic white youth.29When people have severe or long-lasting stress, their bodies respond by raising stress hormones and keeping them raised.30,31 When this goes on for a long time, they may develop health problems like high blood pressure and type 2 diabetes.32,33,34 Smoking cigarettes also leads to disease and disability and harms nearly every organ of the body.14**“Commercial tobacco” means harmful products that are made and sold by tobacco companies. It does not include “traditional tobacco” used by Indigenous groups for religious or ceremonial purposes*.Next Section: American Indian and Alaska Native People Need More Protection from Exposure to Secondhand Smoke >Top of PageReferencesGovernment Printing Office. Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity, 1997 [accessed 2022 Mar 19].
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Odani S, Armour BS, Graffunder CM, Garrett BE, Agaku IT. Prevalence and Disparities in Tobacco Product Use Among American Indians/Alaska Natives — United States, 2010–2015. Morbidity and Mortality Weekly Report, 2017;66(50):1374-8 [accessed 2022 Mar 19].
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Johnson-Jennings MD, Belcourt A, Town M, Walls ML, Walters KL. Racial discrimination's influence on smoking rates among American Indian Alaska Native two-spirit individuals: does pain play a role? J Health Care Poor Underserved. 2014;25(4):1667-1678 [accessed 2022 Mar 19].
Soto C, Baezconde-Garbanati L, Schwartz SJ, Unger JB. Stressful life events, ethnic identity, historical trauma, and participation in cultural activities: Associations with smoking behaviors among American Indian adolescents in California. Addict Behav. 2015;50:64-69 [accessed 2022 Mar 19].
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Serfaini K, Donovan DM, Wendt DC, Matsumiya B, & McCarty CA. A Comparison of Early Adolescent Behavioral Health Risks Among Urban American Indians/Alaska Natives and their Peers.American Indian and Alaska native mental health research, 2017;24(2), 1–17 [accessed 2022 Mar 19].
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						Page last reviewed:  June 27, 2022					Content source: 	Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion homeHomeOffice on Smoking and Health (OSH)plus iconOSH Partners with StatesFunding Opportunity AnnouncementsInteragency Committee on Smoking and Healthplus iconMembership RosterNewsroomStay ConnectedOrganizationSmoking & Tobacco Use FeaturesQuit Smokingplus iconHow to Quitplus iconBenefits of QuittingBasic Informationplus iconHealth Effectsplus iconCancerHeart Disease and StrokeChronic Obstructive Pulmonary Disease (COPD)Smoking During PregnancyEquality in Smoking & Disease: Nobody Wins!Electronic Cigarettesplus iconAbout Electronic Cigarettes (E-Cigarettes)Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young AdultsEmpower Vape-Free Youth CampaignMenthol Tobacco Productsplus iconState Menthol Fact SheetsMenthol Tobacco Products are a Public Health ProblemMenthol Smoking and Related Health DisparitiesAddressing Menthol Tobacco ProductsHeated Tobacco ProductsYouth Tobacco PreventionCommercial Tobacco and Health Equityplus iconBlack and African American Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoAmerican Indian and Alaska Native Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoAsian, Native Hawaiian, and Pacific Islander Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsQuitting TobaccoHispanic and Latino Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoLGBTQ+ Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsQuitting TobaccoPeople Across Geographic Regionsplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoPeople with Behavioral Health Conditionsplus iconHealth BurdenUnfair and Unjust Practices and ConditionsCommercial Tobacco Product Use and Behavioral Health Conditions can Affect Each OtherQuitting TobaccoPeople with Low Socioeconomic Statusplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoSecondhand Smokeplus iconGeneral InformationTrends and DisparitiesHealth ProblemsSecondhand Smoke in the CommunitySecondhand Smoke in the HomeSmokefree PoliciesResourcesGoing Smokefree Mattersplus iconBars and RestaurantsCasinosIn Your HomeMultiunit HousingSurgeon General's Reports on Smoking and Tobacco Useplus icon2020 SGR—Smoking Cessation2016 SGR—E-Cigarette Use Among Youth and Young AdultsHistorical ReportsA Brief HistoryArchiveData and Statisticsplus iconFast Facts and Fact Sheetsplus icon**Smoking and Cigarettes**Diseases and DeathHealth Effects of Cigarette SmokingTobacco-Related MortalityCigarette Smoking in the U.S.Adult DataCessationCost and ExpendituresEconomics**Smokeless Tobacco**Health EffectsProducts and MarketingSmokeless Tobacco Product Use in the United States**Other Tobacco Products**CigarsHookahsLow Yield Cigarettes**Secondhand Smoke****Youth Tobacco Use**Youth DataSmoking in the MoviesTrends in Tobacco Use Among Youth**Tobacco Industry**Tobacco Brand PreferencesIndustry MarketingSurveysplus iconNational Youth Tobacco Survey (NYTS)Alaska Native Adult Tobacco Survey Guidance ManualAmerican Indian Adult Tobacco SurveyScientific Evidence BriefsSTATE SystemMorbidity and Mortality Weekly Reports (MMWR)Vital SignsPatient Careplus iconPatient Care Settings and Smoking Cessationplus iconCardiovascular Care SettingsRespiratory Care SettingsCancer Care SettingsMaternal and Infant Care SettingsClinical Interventions to Treat Tobacco Use and Dependence Among AdultsClinical Cessation ToolsPatient Cessation MaterialsQuitlines and Other Cessation Support ResourcesClinical Education and TrainingE-Cigarettes and Patient CareState and Community Workplus iconTobacco Control Programsplus iconCessation Materials for Tobacco Control ProgramsNetworking2Save: Co-op AgreementGuidelines and ResourcesProgram FundingEvidence Based Guides for StatesState Fact SheetsTobacco Ingredient and Nicotine ReportingTobacco Counter-Marketing CampaignGlobal Tobacco Controlplus iconAbout Global Tobacco Surveillance System (GTSS)GTSSDataThe Global Adult Tobacco Survey (GATS) AtlasHelp & Glossaryplus iconGlossaryData and DocumentationUsing the GTSSData HomepageUsing the GTSSData Explorer PageContact UsMultimedia & Toolsplus iconMedia Campaign Resource Center (MCRC)Publication Catalog To receive email updates about Smoking & Tobacco Use, enter your email address: Email Address			What's this				Submit
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