Community Creates Unique American Indian Quit Smoking Program

The following is an excerpt from American Lung Association’s report, Cutting Tobacco’s Rural Roots: Tobacco Use in Rural Communities. Posted with permission.* You can find the full report here.

The Americans with the highest smoking rates among all ethnic groups have been the least
researched—and perhaps the least helped by smoking cessation efforts. It is a sobering situation—one that has challenged a team of tenacious experts to create a long-term public health strategy to help American Indians quit smoking, funded by the American Lung Association.

Christine Makosky Daley, Ph.D. and Won Choi, Ph.D. of the University of Kansas worked through a number of barriers to create an effective smoking cessation program for American Indians, whose culture includes ceremonial use of tobacco as a sacred plant. Their program, All Nations Breath of Life (, began with a request from patients at an Indian Health Service clinic who asked for a novel smoking cessation program that was culturally sensitive to American Indians.

American Indians, living throughout the United States in more than 500 tribes with unique customs, use traditional tobacco to welcome and honor guests, for blessings, as gifts, and as part of sacred ceremonies and powwows.

The distinction between misuse of commercial tobacco and ceremonial use of traditional tobacco is just one of the cultural elements researchers must understand.

“We realized right away that we couldn’t modify existing smoking cessation programs for the general population or other cultures,” explained Dr.Daley. “They all say ‘don’t use tobacco at all,’ and we were working among a culture of tobacco. There is very little we know from a research perspective about that culture of tobacco, so we really needed to start at the beginning, understanding traditional use of tobacco as well as the fact that it is an economic mainstay on some reservations. We had to dive in and start something new.”

Diving into that culture meant conducting community-based participatory research: including the community in all phases of research and program development, so that the program ultimately reflects the American Indians’ culture and is a product of the community who will use it.

After five years’ research and pilot testing, All Nations Breath of Life presents a comprehensive smoking cessation program of group sessions, one-on-one phone counseling and pharmacotherapy of the individual’s choice—all free of charge. The researchers are tracking the efficacy of the program and are learning about the personal impact on American Indians who have quit smoking.

“One elderly gentleman had smoked for 40 years and would go to powwows but couldn’t dance because he would get out of breath too quickly,” said Dr. Daley. “After completing the program he could get out with his grandson and dance a two-day powwow without getting winded. Being able to get out there with his grandson was a huge event for him!”

*Edited to add additional paragraph breaks.


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