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Networks Among Tribal Organizations for Clean Air Policies (NATO CAP)

Country: United States

Team: Scott Leischow, PhD, Mayo Clinic; Patricia Nez Henderson, MD, MPH, Black Hills Center for American Indian Health; Samantha Sabo, PhD, University of Arizona; Janet Okamoto, PhD, Mayo Clinic; Nicolette Teufel-Shone, PhD, University of Arizona

Focus: Smoke-free policies in Native American tribal lands, with particular emphasis on the role of tribal coalitions on those policies.

Problem: Smoking is prohibited in most work places and indoor public spaces because of the danger to human health. However, because Native American tribes are self-governing, state smoke-free laws are generally not implemented on tribal lands, the largest of which is the Navajo Nation (an area covering more than 27,000 square miles in portions of northeastern Arizona, southeastern Utah, and northwestern New Mexico).

Solution: This study uses surveys and interviews with Navajo elected officials, members of a Navajo clean air coalition (TEAM Navajo), and other Navajo people to describe attitudes and behaviors relevant to potential commercial (non-ceremonial) smoke-free policies in the Navajo Nation. The findings will inform members of the Navajo Nation about the beliefs and attitudes of their people toward commercial smoke-free policies and provide evidence-based information, which may enable them to decide what commercial smoke-free policies will be best for the nation (if any). Findings may also help other tribal nations and communities establish effective policies.

Findings: Survey and interview data are still being analyzed are still being analyzed. Because the Navajo Nation Human Research Review Board requires approval for the dissemination of all findings from research conducted on Navajo Nation, the survey and interview findings will be disseminated as approvals are granted by the Board.

The researchers also partnered with Americans for Nonsmokers’ Rights to pilot test how a national database of tribal smoke-free policies might be created. They are compiling a national database of tribal casinos with smoke-free policies and hope to learn about the processes—what did and did not work—that led tribes to establish these policies in their casinos.

Findings from the Tribal Policies Database Project
A total of 82 policies were collected in the tribal policies database pilot project showing that:

  • Many tribes have unwritten policies restricting or prohibiting smoking indoors, but they do not have any documented policy or rule.
  • Compared to larger tribes, smaller tribes do not have the infrastructure and capacity for providing information about the existence of policies and policy development. Smaller tribes also have limited resources for staff to answer questions and for Web site development and maintenance.
  • Information collection about tribal policies took much longer than anticipated by the researchers.

Findings from the Smoke-Free Tribal Casinos Mapping Project
A total of 389 tribal casinos were contacted as part of the smoke-free tribal casino mapping project. As of September 2013, preliminary results suggest that:

  • 12 are completely smoke-free,
  • 176 are partially smoke-free, and
  • 201 are not smoke-free at all.

Implications for Practice
From the tribal policies database project

  • Tribal governments can benefit from learning about options for commercial smoke-free policies that might be appropriate and effective in their communities.
  • A national database of tribal smoke-free policies would help achieve this objective but will take substantial resources to fully develop.

From the smoke-free tribal casinos mapping project

  • Tribal elected officials and casino management need more information and education about the health and financial costs related to smoking commercial tobacco and exposure to secondhand smoke in casinos.


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