Second Hand Smoking in Indian Country: Unique Policy Considerations for American Indians and Alaskan Natives

Purpose: Public health interventions to control tobacco have had great success in cities where public venues and bars prohibit in-door smoking. Yet, reservation casinos have not benefited from such policy decisions placing workers and “clients” at risk for diseases linked to second hand smoke. Study Design: Second hand smoke policies for workplaces and academic and news articles on second hand smoke issues for casinos and American Indian reservations were reviewed to identify common and unique concerns and case studies. Results: Tribal government structures vary across the US making it difficult to apply “templates” for second hand smoke ordinances and regulations that have been successful for other groups. Public support for and awareness of second hand smoking issues is limited to public or home environments. Casinos have unique relationships with tribes making it difficult to apply best practices from other workplaces. Conclusions: Native American communities may bear a larger burden of health consequences of addictive tobacco use if public health measures such as best practices in tobacco control are not disseminated. Such increases in cancer, respiratory and cardiovascular disease could cripple already limited health care facilities. In order to quickly tailor second hand smoke initiatives for AIAN communities may, a community based participatory approaches may be needed. Such projects promise to both provide community leadership in developing and implementing effective workplace policies and garner community support for policies and implementation. Public health professionals and policy analysts need to develop processes and language that is sensitive to diverse tribes involved in gaming.