Tobacco use snuffing out dreams of Native communities

Lung cancer leaves a devastating imprint on the many communities and reservations that make up Indian country. It is the leading cause of cancer death for American Indians and Alaska Natives, claiming nearly one life every three or four days. It is also the second leading killer overall for Native Americans over the age of 45. However, we have good news to share: You can change all of this.

November was National Lung Cancer Awareness Month, and in the tradition of storytelling, this is a good time to pass along to young and old an important message about life and health, tobacco and cancer. The story is about lung cancer prevention, and keeping sacred traditions alive from one generation to the next through longer, healthier lives.

The story about lung cancer begins with the enemy – the poisonous substances that have been packaged as a means of enjoyment and relaxation in the form of a cigarette, cigar, snuff or smokeless tobacco. It begins innocently enough when the curious try it a few times and soon find that their bodies desire more of it. Unlike ceremonial tobacco use, cigarettes and similar products were designed to be habit-forming, leading to addiction.

Native Americans have the highest smoking rates in the United States. National surveys indicate that nearly 33 percent smoke cigarettes as compared to 22 percent of whites, 20 percent of African-Americans, 15 percent of Hispanics and 11 percent of Asian-Americans. The data for adolescents are even more alarming. Native youngsters are more likely to smoke than any other ethnic group in the country. They are also more likely to be exposed to and breathe toxic air poisoned by tobacco smoke, which leads to damage in their lungs at a younger age. The poisons in tobacco products are especially toxic to lungs, which receive the highest dose through inhalation, whether through personal use or secondhand smoke.

Data collected by the National Cancer Institute paint a bleak picture of the cancer burden in Native communities. For example, according to NCI, the states of Alaska, Washington and Iowa have twice the rate of new cancer cases as compared to other states. NCI data also indicate that Native people have experienced the greatest increase in death from lung cancer in those younger than age 54 during the five-year period from 1999 to 2003, taking the lives of the youngest elders in the community.

The message of the story is clear: A united effort must be undertaken in Indian country to eliminate recreational use and exposure to tobacco products. Those who do not smoke should not start this bad habit. Those who do smoke can take steps to stop use permanently. Resources are available to everyone through various programs that offer counseling steps to stop smoking permanently.

Resources include counseling and information on various ways to quit smoking, and they’re available at (800) 4 CANCER and www.smokefree.gov. Important cultural lessons are passed from one generation to the next, so I would like to urge all elders to share this information with the younger members of their families and communities when they share life lessons.

As you reach out to your communities with this important message, we will continue to do our part at NCI, where we are working every day to increase our efforts to research and eliminate the greater cancer burden in American Indian communities. The reasons for cancer excess burden, or cancer health disparities, are numerous. Under the leadership of our new director, Dr. John Niederhuber, NCI is committed to addressing these disparities and to bringing advances in cancer research to all Americans, in all communities.

Niederhuber recently proposed a new plan, called the NCI Community Cancer Centers Program, which would add a new level of cancer care beyond the existing 61 NCI-designated cancer centers. The pilot program would support a small number of facilities over a three-year period in an attempt to find the best ways to bring the most promising cancer treatments and clinical studies or trials to the community through local hospitals. About 40 percent of the project’s funding to those hospitals will be dedicated to cancer health disparities.

NCI is working closely with the Native community to control and prevent smoking and lung cancer through various methods. The NCI’s Cancer Information Service, Rocky Mountain Region, works closely with Native American Cancer Research in Pine, Colo. NACR has ongoing local, regional and national tobacco prevention projects in Indian country. Local and regional efforts have developed strategic tobacco plans, incorporating community-driven interventions for both the Denver urban Indian population and the Ute Mountain Ute population in southwestern Colorado.

NCI’s national program is in partnership with the Northwest Portland Indian Health Board and the National Tribal Tobacco Prevention Network. A Native-specific educational curriculum, titled “Get on the Path to Lung Health,” is now available as a free download on the NACR Web site, http://natamcancer.org.

Additionally, the Mayo’s Native Circle is a resource center that provides cancer-related materials to health care professionals and laypeople involved in the education, care and treatment of American Indians and Alaska Natives (http://cancer center.mayo.edu/native.cfm). In 2007, NACR and the Native Circle will add tobacco survey items that have been used successfully in Indian country. These partner organizations plan to increase assessment and awareness of existing Native-specific tobacco information in the coming months.

Today, lung cancer is a very sad story in Indian country. But it does not have to be. The story can take a different, healthy path to a happy ending.

Dr. Yvonne Vargas, MPH, is a medical officer with the National Cancer Institute’s Division of Cancer Prevention with the lung, head and neck cancer research group.