For American Indians wanting to quit smoking, the demonizing of tobacco can come at a cultural and spiritual cost.
Tobacco has been regarded as sacred by American Indians for thousands of years and, in most instances, it was rarely inhaled. But as of 2007, the Centers for Disease Control and Prevention reported that American Indians and Alaska Natives have the highest smoking rate in the United States at 36.4 percent compared to 19.8 percent for African Americans and 21.4 percent for whites.
With the importance of sacred tobacco to many American Indian nations and the high smoking rates, some smoking cessation clients at the Oklahoma area IHS office in 2003 requested a program that respected sacred tobacco.
Researchers at Kansas City Medical Center developed a program that would aid in smoking cessation while allowing clients to continue traditional tobacco practices.
This program, All Nations Breath of Life, a cooperative effort by the University of Kansas Medical Center and the American Lung Association, provides free smoking cessation assistance to American Indians while allowing them to learn, explain and appreciate the importance of tobacco to their respective nations.
By 2006, the medical center had developed a good version of the program, said Dr. Christine Daley, KUMC assistant professor of preventive medicine and American Indian Health & Research Alliance director.
“We work both in urban and reservation communities. We have over 220 tribes represented in the greater Kansas City area and Kansas. We’ve expanded and will run some groups in Oklahoma, California and Minnesota. We’re anxious to find additional places that would like to run the program.”
How the Program Works
While some clients come to the center for the program, ANBL also promotes the program at the AIHRA’s Nations Energies Powwow held every May 1 at the Johnson County Community College in Overland Park, Kansas, Daley said.
“No one is going to quit smoking until they make a personal decision that they’d like to quit. Nicotine is more addictive than heroin. A lot of times when we’re recruiting, we’re looking for people who have thought about quitting.”
Facilitators in the program are American Indians, some who kicked the smoking habit, but all facilitators are nonsmokers, said Stacy Braiuca, Citizen Potawatomi, head facilitator for ANBL and a clinical social worker.
The program involves eight weeks of group sessions with six to 10 participants in a group.
Sacred tobacco uses listed and more sought
Sacred tobacco usage among American Indian nations varies widely. All Nations Breath of Life, a smoking cessation program for American Indians in Kansas City, provides support to smokers interested in quitting by including education about and encouraging the traditional uses of tobacco.
The program created the following list of traditional American Indian uses of tobacco:
There’s a topic each week, and clients also get to talk about the things they are struggling with. The topics range from the client’s use of tobacco, facts about smoking, how to quit, dealing with withdrawal and cravings, traditional tobacco use, support from family and preventing relapse.
Clients have three weeks away from group therapy, and then come back for one group session at the 12-week mark. They then take three months off and return for a final group session.
During this program, each client receives telephone support. Each week from the beginning of the program, counselors like Braiuca make motivational phone calls to the clients during group sessions and during their break.
“You start where they are. ‘How are you doing with your smoking cessation? How confident are you with quitting?’” Braiuca said. “You try to guide them to help them see their strengths and how they’re coming with quitting and to identify the positive changes they’ve made.
“We’re helping them identify the barriers and helping them use their motivations and strengths. They’re the ones identifying these – you’re helping.”
The whole program, Daley said, is about providing options. “We try to tailor the program to the individual. Quitting smoking is a very individual process.”
One of the unique aspects of the program is building natural communication with others in the group, Braiuca said. Clients provide support to each other by saying what works for them.
“It’s culturally tailored. One of our sessions talks about traditional uses of tobacco. We encourage people to use their tobacco traditionally. We discuss how they use tobacco and the respect for tobacco.”
According to ANBL, tobacco for some American Indian tribes was traditionally “smoked in a pipe or corn husk (and rarely inhaled); the smoke carries people’s prayers to the Creator and the spirit world,” or “placed in the open fire of a sweat lodge, giving thanks to the Creator.”
Usage of sacred tobacco varies from one American Indian nation to the next; not all American Indians have a history with tobacco. ANBL includes other traditional uses on its Web site at www.anbl.org.
What about Relapse/Weight Gain?
“A lot of people start smoking again when a stressful event occurs in their lives,” Daley said. “Often they’ll relapse then. People try to quit multiple times.”
But Daley stresses that relapse is OK.
A significant portion of the discussions in their groups is about relapse, and the facilitators try to plan for that, Braiuca said.
Patients are given “quit kits” that have things like hard candy, toothpicks and other aids.
“We encourage people to try something else, such as exercise or crafts. Anything you can do to help them get away from that desire to smoke,” Daley said.
Some clients worry about gaining weight after they quit, and the average person gains about 15 pounds after quitting smoking.
“We encourage them to eat healthy,” she said.
The program also dedicates a session to maintaining their weight and encouraging healthy behavior.
“We encourage people to try new healthier foods, and this works well,” Daley said. “We also tell people that quitting smoking will improve their health. Quitting smoking is the healthiest thing you can do for yourself.”
With one patient, Braiuca said, four months after a gentleman had quit, he said he went dancing and realized “he didn’t get winded on the floor. He was then able to enjoy himself longer.
“There are several others who dance at pow wows who say they feel better now when they dance, and they can dance the two-step longer.”
ANBL’s Future Plans
The organization has funding that will last another four years, and Daley is currently waiting to hear about another grant.
The program provides help in person or via telemedicine, and Daley is working on developing an online version.
“We’re building infrastructure in community organizations that can continue to provide smoking cessation as a service after the research is over. We just want to keep improving it. Any project like this is a work in progress.”
Daley’s goal is for the program to provide research for individual needs. With telemedicine, they identify remote locations and place equipment there. The smokers meet in their area, but the facilitator and physician are at the University of Kansas Medical Center.
“The telemedicine is new that we’re starting, and we’re trying to use this in California and Minnesota. Some places in Oklahoma want to use the telemedicine program.”
If pharmacotherapy products can be purchased over the counter, KUMC can send them to distant clients, but if clients need pharmacotherapy requiring a prescription, KUMC works with the client’s physician. But the medicine is still free, Daley said.
People interested in the program can call (913) 588-0866 or e-mail email@example.com.