Breathing Clean Air is Sa'ah Naaghai Bik'eh Hozhoo (SNBH): A Navajo-centered approach to commercial smoke-free policy

Smoking rates among American Indian populations are the highest of any ethnic group in the United States, and few tribes have established indoor smoke-free policies to protect against secondhand smoke. The NCI-funded “Networks Among Tribal Organizations for Clean Air Policies” aims to inform smoke-free policy on the Navajo Nation through a community-based participatory research approach in which Navajo people are central to every aspect of research. To identify factors relevant to smoke-free policies among the Navajo people, a bicultural team of researchers developed and tested evidence-based messages on the economics and health effects of smoke-free policy. Methods:  Teams conducted focus groups among Navajo tribal members (N=27) living in three distinct regions of the Navajo reservation. Through collaborative analysis, which weighs scientific and cultural ways of knowing equally, principals of Sa’ah Naaghai Bik’eh Hozhoo (SNBH), a Navajo traditional system that places human life in harmony with the natural world and provides principles for wellbeing emerged from the data. Patterns were categorized by the Dine Policy Institute SNBH framework on smoke free policy. Results: Qualitative themes included Navajo perspectives on the shift away from family and cultural teachings considered protective to a smoke-free life; and the ethical and economic struggle to balance and respect individual and collective rights to live and work in smoke free environments. Conclusions: The Navajo traditional system of SNBH emerged as a culturally salient framework for understanding the economic and health effects of smoke free policy and was considered fundamental to protecting the health of Navajo people.