Workplace Smoke-free Policy: Unintended Consequences Encountered at Northern Plains Reservations

Despite years of smoking cessation and control policies, American Indian populations continue to exhibit high smoking rates. In the context of inexpensive and Native-branded cigarette promotions, this paper examines a tobacco control measure (smokefree workplace) on Northern Plains reservations. We report on the unintended consequences of a workplace smoking ban policy. Eight focus groups were held on seven Northern Plains reservation sites. Data analysis of the participants followed Krueger’s focus group analysis methodology consisting of constant comparisons of themes and patterns elicited from the focus groups. The effects of the workplace smoking ban were examined. Poor implementation of the workplace smoking ban resulted in unintended consequences. Acts of resistance were reported with unrelenting smoking behaviors. Resistance took the form of ignoring the policy and public displays of smoking cigarettes at posted no-smoking signs. An atmosphere of resistance may be due to past experiences with “dry” policies and restrictions on certain traditional practices, which created an environment of defiance to certain governmental policies. Two additional policies supported by the communities provided a milieu of conflicting messages. Low-priced cigarettes at grocery stores, casinos and on the internet provided for increased purchasing power thus facilitating higher smoking rates. Also, local policy decisions to sell Native-brand cigarettes resulted in reinforced brand loyalty and unabated smoking