International Indigenous Tobacco Control

How many smoke?

The First Nations and Inuit Regional Health Survey (FNIRHS) was conducted in 1997 by Health Canada. This survey collected data from First Nations people living on reserves and Labrador Inuit communities [47].

• 62% of First Nations and Inuit peoples are smokers.
• The smoking prevalence for First Nations and Inuit peoples is double that of the general Canadian population in many age groups.
  Smoking rates are highest among young adults aged 20-24 at 72%.
• Smoking rates decreased as education levels increased, but the smoking rate of 53% in the highest education group is still almost double the general Canadian population smoking rate.
• 57% of First Nations and Inuit indicated that smoking occurred in their homes.
• The Canadian Community Health Survey was conducted in 2001 by Health Canada. Aboriginal peoples were surveyed in the Territories or outside of First Nations and Inuit communities [48].
• 51.4% of Canada's off-reserve Aboriginal peoples are current smokers; almost double that of the general Canadian population.
• The smoking rates of off-reserve Aboriginal peoples is significantly higher than those of the non-Aboriginal population in both urban and rural areas.

What is being done?

The Canadian Government has announced that it will invest over $480m (including $58m in existing funding) in Health Canada's Tobacco Control Strategy over the next five years, almost five times the investment that was made in the previous initiative, which is now winding down.

The funding will be allocated to key areas of tobacco control that have been proven effective both in Canada and other jurisdictions. It will bolster existing Health Canada programs, while directing $210m to mass media campaigns implemented in partnership with health and advocacy non-government organisations.

The Canadian strategy involves a First Nations and Inuit initiative, which is intended to help build the capacity of communities to address the health issues around tobacco use, and improve retailer compliance on reserves [through increased education]. Consultations will begin immediately with representatives of First Nations and Inuit associations to determine how best to address the unique challenges tobacco use presents to their communities.

How many smoke?

Tobacco use is a significant contributing factor to poorer health outcomes in Maori compared to non-Maori [49].

• In 2001, 51 percent of Maori smoked daily, compared to 21 percent of Europeans and 31 percent of Pacific peoples [50].
• Tobacco kills nearly 600 Maori prematurely every year [51]. A third of Maori deaths each year are attributed to tobacco-related disease and illness.
• The life expectancy for Maori men is 69 years, compared to 73 years for non-Maori. For Maori women life expectancy is 74 years, compared to 77 years for non-Maori [52].
• Maori children can be expected to have twice the second-hand smoke exposure of non-Maori children [53].
• Maori were more likely than non-Maori to have had other people smoke around them indoors at work, 30% compared to 19% respectively [54].

What is being done?

The New Zealand Government has recently made a substantial investment in tobacco control, increasing expenditure on anti-smoking campaigns to over NZ$28m, equivalent to more than AUD$6 per capita per annum. For a population of around four million people, around $1m per annum is provided to the Quitline to provide a call-back counselling service based on the one developed in Victoria, Australia. An allocation of $5m has been set aside for Maori cessation.

In July 2003 the Prime Minister of New Zealand received the National Maori Tobacco Control Strategy 2003-2007, developed by ATAK - the Maori Smoke Free Coalition in conjunction with the wider auahi kore/ smokefree community. The development of this strategy is a first for Maori in the area of tobacco control.

Source: VicHealth Centre for Tobacco Control (2001) Tobacco control: a blue chip investment in public health. Melbourne: Cancer Council of Victoria

There has been some change in awareness among New Zealand Maori of the health effects of tobacco smoking and increasing acceptance of smoke free messages [55].

The impetus for change has come from Maori organisations, such as women's groups and early childhood centres. This impetus has been further supported by Maori health promotion initiatives promoting smoke free marae (tribal meeting places), homes and workplaces and Maori quit support programs [56].

How many smoke?

Approximately 2 million American Indians and Alaska Natives* live in the United States and have settled across the country; the largest percentage resides in Oklahoma (13%) [58]. Although many tribes consider tobacco a sacred gift and use it during religious ceremonies and as traditional medicine, the tobacco-related health problems they suffer are caused by chronic cigarette smoking and spit tobacco use. Because of the cultural and geographic diversity of American Indians and Alaska Natives, tobacco use often varies widely by region or subgroup [59].

• Data from the 1997 National Health Interview Survey show that among the five major racial and ethnic populations adult smoking prevalence was highest among American Indians and Alaska Natives (34.1%) followed by African Americans (26.7%), whites (25.3%), Latinos (20.4%), and Asian Americans and Pacific Islanders (16.9%) [60].
• In 1997, 37.9% of American Indian and Alaska Native men smoked compared with 27.4% of white men. The smoking rate among American Indian and Alaska Native women was 31.3% compared with 23.3% among white women [60].
• Cardiovascular disease is the leading cause of death among American Indians and Alaska Natives, and tobacco use is an important risk factor for this disease [59].
• In the United States, lung cancer is the leading cause of cancer death among American Indians and Alaska Natives [59].

Smoking related deaths from Cancers of the lung, trachea and bronchus per 100,000 people

Source: U.S. Department of Health and Human Services 1998, Tobacco use among U.S. racial/ethnic minority groups - African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: a report of the Surgeon General, U.S. Department of Health and Human Services, Centres for Disease Control and Prevention, Atlanta.

*American Indian and Alaska Natives are people who have origins in any of the original peoples of North America and who maintain that cultural identification through self-identification, tribal affiliation, or community recognition.