American Indian Adult Tobacco Survey: Development of the American Indian Adult Tobacco Survey and other Implementation Tools

Surveillance data suggest that AI/AN populations have the highest commercial tobacco use rates compared to all other populations within the US. Many American Indian tribes in the U.S. argued that such aggregate findings are misleading, do not provide tribal-specific rates, and that the tools and methods used to collect such data are not culturally appropriate. In 2000 CDC Office on Smoking and Health funded a project to develop a culturally competent adult commercial tobacco questionnaire, and interviewer training and implementation manuals for use within American Indian communities. In a collaborative effort, five Tribal Support Centers, the CDC, tribal members, and native researchers conducted formative research throughout Indian Country. Findings informed development of the American Indian Adult Tobacco Survey as well as corresponding manuals. Formative research findings were myriad and included examples such as: a need to differentiate sacred use of tobacco from abuse of commercial tobacco; the concept of health encompasses physical, spiritual, emotional, and mental health on both individual and community levels. All findings suggested that face-to-face surveys using tribal members as interviewers is the most culturally appropriate method of data gathering and would yield the most accurate data. This collaboration provided a forum for tribes to work on an equal footing with the federal government, gave voice to the concept of tribal self-determination, and respected tribal sovereignty. As a result, tribes have embraced these public health tools (survey and manuals) and are using them to accurately assess the burden of tobacco use within their own populations.