RAPID CITY, S.D. -- Smoking cigarettes in Indian country has become a
social norm, but the use of commercial tobacco products is not only
non-traditional, it is the greatest health risk in Indian country.
Most people know that smoking is unhealthy, but do they know it is a
leading cause of death among American Indians -- greater than cancer, heart
disease, diabetes and auto accidents combined?
Dr. Patricia Nez Henderson, vice president of the Black Hills Center for
Indian Health, is an expert on smoking and its related diseases. She is
working on developing a non-smoking policy and is instrumental in educating
young people about the hazards of smoking. She agreed to provide
information on smoking in conjunction with the Great American Smokeout, a
national day to quit smoking sponsored by the National Cancer Society. This
year's Smokeout will take place Nov. 17.
Most statistics focus on smokers ages 18 and up, but a growing number of
middle-school-aged youth has either tried smoking or smoke one or two
cigarettes a week.
An estimated 22.5 percent of adults in the United States smoke. In Indian
country that figure is elevated, Nez Henderson said. South Dakota tops the
list, with 27 percent of residents using tobacco products. American Indians
in South Dakota smoke at a rate just above 50 percent per capita. And there
are more young American Indians who smoke than any other ethnic group.
In most states it is illegal for anyone under the age of 18 to purchase
cigarettes, but Nez Henderson said those young people are getting
cigarettes and other tobacco products from friends or family or are buying
them. Enforcement of the law is lax.
In the Great Plains, rodeos and stock shows are among the top-attended
sporting events where smokeless tobacco is promoted. In fact, as Nez
Henderson pointed out, it is about the first thing people see when they
walk into the rodeo arena or stock show venue. Smokeless tobacco is on the
decline in most regions.
"Young people start experimenting at a very young age, and by the ninth
grade 91 percent of the students have tried cigarettes," Nez Henderson
Taxation is a means used to control the purchase of cigarettes by youth: a
dollar a pack can have a large effect on whether a young person starts
smoking. It has been proven that for every dollar of tax on a pack, youth
smoking reduces by 18 percent.
"It only takes three cigarettes to become addicted," Nez Henderson said.
In South Dakota alone, with an 8 percent American Indian population, 26
percent of the middle school students who are American Indian are
considered current smokers. That compares to the 2003 average of all ethnic
groups at 6 percent. High school students score statistically higher: 53
percent of American Indian high school students are considered current
One in five smokers will be diagnosed with a life-threatening illness in
adulthood. That means of the 53 percent of the high school students 10
percent are destined to suffer from cancer, heart disease, diabetes,
emphysema, asthma or other related diseases, Nez Henderson said.
Twenty-six percent of high school seniors admit to smoking at least one
cigarette per day. Three percent of eighth-graders smoke one cigarette per
Cigarettes are a gateway drug, opening the door to methamphetamine,
cocaine, marijuana and alcohol abuse, Nez Henderson said.
"Smoking is the most preventable cause of death," she said.
Secondhand smoke has been proven to be more deadly than or at least as
deadly as actually smoking. Many parents who smoke in their homes or
automobiles are subjecting their children to secondhand smoke. Nez
Henderson said that if they must smoke, parents should do so outdoors and
not in the presence of their children. Smoking elsewhere, out of sight of
the children, also helps to reduce the acceptance of smoking.
Nez Henderson said even though American Indians smoke fewer cigarettes per
day than the rest of society, they are more vulnerable to catastrophic
diseases -- which could be genetic. American Indians may metabolize
nicotine byproducts at a slower rate than other ethnic groups, she said.
With a slower metabolic rate, the carcinogenic byproducts stay in the body
States are making inroads to the cessation of smoking; California, after
its ban on smoking in public places, reduced the number of smokers
significantly. Montana will implement a no-smoking ban in public places
effective Jan. 1, 2006. South Dakota, with a very high rate of smokers per
capita, failed to approve no-smoking legislation in 2005.
The tribes of Montana are working with the state to help stop smoking in
public places. American Indian youth and adults in Montana smoke at much
the same rate as those in South Dakota. South Dakota is listed as the worst
state for the number of smokers in Indian country. Alaska Native tribes
also compare to South Dakota.
"If tribes have non-smoking policies in the workplace, they also need to
enforce them," Nez Henderson said.
Nez Henderson is now working with the Navajo Nation to implement a smoking
Outside Sioux San hospital, a large IHS facility in Rapid City, employees
can be seen smoking next to the hospital. Nez Henderson said the regulation
is that smokers have to be either 25 or 50 feet from the building.
"Tribes need to make non-smoking a priority: they need to take a stand,"
Nez Henderson said.
It may be hard for some tribes to justify non-smoking bans when their
economic enterprises partly consist of discount smoke shops. Through a
community effort with states, tribes and local communities, a compromise
can be reached to help the cessation of smoking.
Tobacco Free Kids, an organization made up of American Indian youth, has
contacted BHCAIH and Nez Henderson. It is interested in organizing
statewide and nationally to get South Dakota and the tribes behind them.
They said, however, that the tribes are not backing them up.
It makes no difference whether a person smokes or chews -- the adverse
health affects are the same. And the "light" cigarettes are just as deadly
as the others.
The tobacco industry spends $9.5 billion in marketing the product and most
of the advertising is directed at young people, Nez Henderson said.
Given the amount of advertising, young people do know the pitfalls of
smoking. It has been proven that students who know the risks of using
tobacco are less likely to use. Two-thirds of students, whether in middle
or high school, know that cigarettes are addictive; but 1 in 5 students
believe that addiction is just "probably true."
Most students said they would like to stop smoking; many have tried to
quit. Most of the students who have failed to quit did not participate in a
school or community program that could have helped them. Many schools have
a special group or class for students who want to quit.
Tobacco use goes back centuries in Indian country; it is used in ceremonies
by most tribes. But the tobacco used for ceremonies is not the same as that
found today in a pack of cigarettes or a tin of smokeless tobacco. Today's
commercial tobacco has been infused with some 4,000 chemicals, 40 or which
are known carcinogens.