Networks Among Tribal Organizations for Clean Air Policies (NATO CAP): A place based approach to understanding commercial smoke-free policy and reducing tobacco related health disparities on the Navajo Nation

Smoking rates among American Indian/Alaska Native 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 (NATO CAP)” 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. Methods: To identify Navajo leadership perspectives about smoke-free policy, a mixed quantitative, and qualitative research approach was used to survey (n=75) and interview (n=15) Navajo elected officials throughout all five jurisdictions of the Navajo Nation. Through collaborative analysis, which weighs scientific and indigenous ways of knowing equally, bicultural teams triangulated survey and interview data. Results: Navajo elected official’s opinions about the health and economic benefits of smoke –free policy significantly differed by elected official's gender, age and region. Qualitative narratives provided a nuanced understanding of elected officials’ approach to balance cultural, health and economic issues of smoke free environments, inlcuding local and national levels of government.  Navajo leadership identified several place based and culturally relevant approaches that could be leveraged to raise awareness about the issue of second hand smoke and the benefits of smoke-free policy within family, community and policy domains.  Conclusions:  Smoke-free policy perspectives are culturally bound and place-based and require full participation of Navajo people, including elected officals to understand the effects of smoke-free policy and reduce tobacco related health disparities among Navajo people.