Anti-tobacco supporters cite health, teen use

WINDOW ROCK, June 26, 2008

After the sweeping anti-tobacco campaigns of the '90s, is tobacco use still a big problem?

According to the Navajo Nation's Division of Health and a number of local organizations, it is. And they are pushing the Navajo Nation Council to pass a tobacco-free act during its summer session later this month.

It should be noted from the outset that the advocates, and the legislation sponsored by Delegate Thomas Walker Jr. (Birdsprings/Leupp/Tolani Lake), make a distinction between the native plant used in traditional ceremonies of many tribes and the smokes, chew and snuff peddled by tobacco companies.

The act would prohibit the use of commercial tobacco in public places, places of employment - including casinos - and private vehicles when children are in the vehicle. It will not affect the use of traditional tobacco used in Navajo ceremonies.

Laws to prohibit tobacco use in public places are primarily aimed at reducing exposure to secondhand smoke, now recognized as a serious public health threat. But the debate inevitably focuses attention on the users.

And on the Navajo Nation, the highest percentage of users are young - many too young to buy tobacco legally.

In 2005, 36 percent of Navajo high school students reported current use of cigarettes, according to survey data collected by the Division of Health. Compare that figure to the national average of 19.7 percent and there is a problem, said Dr. Patricia Nez Henderson, an adviser to the coalition of public and private entities seeking passage of the tobacco-free act.

"These rates are very startling," Nez Henderson said in a phone interview from Rapid City, S.D., where she is vice president of the Black Hills Center for American Indian Health.

"If we're talking about a third of the youth population smoking - that's outrageous! Fourteen to 20 years down the road they'll develop cancers that we're not familiar with: lung, bladder, cervical, and stomach cancer," she said.

Their children and family members, meanwhile, are being exposed to secondhand smoke and face increased risks for a host of health problems, as well.

The new norm

Historically, the Navajo Nation had far lower than average rates for tobacco-related disease because smoking, in particular, was rare. Among Navajos who identified themselves as smokers, the rate of use was far lower than in the U.S. as a whole, according to federal surveys dating back to the 1970s.

But as Navajo teens are increasingly exposed to mainstream culture, tobacco use is seen by many as cool.

Nez Henderson, who is originally from Teesto, Ariz., urged Navajos not to be passive about teen tobacco use.

"(Teen smoking) has become acceptable to the community, we accept it as normal," she said. "When Navajo youth are either chewing or smoking we don't take a second look anymore. It's become normal for us.

"As a physician this is not the norm," Nez Henderson said.

As far back as 1994, National Institute on Drug Abuse studies began ranking tobacco as more addictive than heroin. While its ranking among addictive substances is debated, Nez Henderson said, "When addiction has become part of the norm, then we have a problem."

Peter Nez (no relation to Nez Henderson), program manager of Southwest Navajo Tobacco Education Prevention Project, agreed that the Navajo Nation must see the issue of tobacco use on the reservation as a priority in health.

"Until we realize the damage to the kids (resulting from tobacco use) we won't address the issue," Nez said, pointing to other problems for teen smokers.

"Smoking is associated with alcohol use, domestic abuse, teen pregnancy, and poverty," he said. "It's going to take everyone working together to solve this problem. Policy is one way of doing that."

Tobacco reaching teens

How is smoking such a presence in the underage Navajo population?

Through a mix of exposure to cigarettes in media and use by family members, said Philene Herrera, Navajo Health Education program manager and organizer behind the tobacco use surveys.

"Media has a lot to do with it," Herrera said. "Movies, actors, there is a definite link with the media. They bait youth by making it look attractive and fun. It's like, if you do this you're going to have a lot of friends, or your going to be pretty and have fun."

At least two of the original Marlboro men - real cowboys who were featured in Philip Morris advertisements - died from lung cancer, but that's not what you see in ads like the one recently shot in Monument Valley, Utah, and Navajo, N.M.

In 1994, Mississippi became the first state to sue tobacco firms to recover Medicare costs associated with treating smokers. The other 49 states soon followed, ending in 1998 with a $246 billion settlement agreement under which the major U.S. tobacco companies agreed to curtail their advertising, reimburse states and fund public education campaigns to discourage tobacco use.

It might seem that allowing Marlboro maker Philip Morris to photograph on the Navajo Nation for new cigarette advertisements runs counter to those and other efforts by public health advocates. But that is just what happened recently.

After a moratorium on such projects as a result of the lawsuits against Big Tobacco, the tribe has resumed doing business with tobacco companies, said Lorie Lee, Navajo film office media production specialist.

"We were given an opinion from the (Navajo) Department of Justice to go ahead and allow that venture of commercial filming on the Navajo Nation because all of the (tobacco company) sponsorship of events (on the reservation) such as rodeos, and the selling of such products on the Navajo Nation," Lee said.

Tobacco advertising campaigns and exposure can have a powerful impact on youth, said Nez Henderson.

"Tobacco companies have a huge impact on this normalization of smoking," Nez Henderson said. "There is exposure to commercial tobacco through sponsoring of certain events, their donating money to certain causes.

"It's normal to see cowboys chewing Skoal," she said, 'and my little brother is smoking now because he came back from (military service in) Iraq. Twenty years down the line we're going to feel the effects of that.

"I have four brothers and a father, and all of them have experimented with either smoking or chewing," Nez Henderson added. "For some of them it's been very difficult to quit."

Since 1997 when the Navajo Nation's Division of Health began collecting survey data on tobacco use among youth, the percentage of regular cigarette users has fallen gradually every year.

The decline is generally attributed to education about the harmful effects of smoking, but Nez Henderson believes that change is too slow.

"School programs have limitations," she said. "As a tribe we have the opportunity to do much more. Policy can have a huge impact, and not just on our community but other tribes. We can serve as examples."

Nez Henderson currently lives and works in South Dakota, home to a number of reservations for Plains tribes. On those reservations the smoking problem is even more pronounced, she said.

"On Oglala they have high (tobacco use) rates, and elders are dying from smoking," Nez Henderson said. "I see it every day here on the Northern Plains. We have the power to change that on the Navajo Nation.

"The tribes here have been exposed to cigarettes a lot longer; it was part of the fur trade, people would trade fur for cigarettes," she added.

When a pregnant woman smokes, it gets passed to the next generation, she noted. "It gets passed in utero to the child and certain changes take place there making it more likely for the child to start smoking because now it's part of their blood, their genes."

On Navajo the smoking trend has developed differently but has arrived at the same problem, she said.

"Yes, historically we didn't have high rates, but now we're more integrated into the outside world," Nez Henderson said. "Our population is very young, so when we look at the Navajo Nation as a whole, it's very important to address this issue."

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