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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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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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Tehee M, Buchwald D, Booth-LaForce C, Omidpanah A, Manson SM, Goins RT. Traumatic Stress, Social Support, and Health Among Older American Indians: The Native Elder Care Study. *J Gerontol B Psychol Sci Soc Sci*. 2019;74(5):908-91 [accessed 2022 Mar 19].
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