Native American smoking: between trauma and traditional approach

In Canada, smoking and vaping are significantly more prevalent among Native Americans than in the general population. A Native American doctor points out the role of psychological suffering in this addiction, linked to multiple traumas, and suggests combining conventional treatments with specific support for this population.

Among Canadian Native Americans, with an overall prevalence of 53 % in 2018, smoking is on average 2 to 5 times higher than among non-Native individuals (15 %). Native Americans living on reserves have slightly higher prevalences than those not living on these reserves. Among young Native Americans, this smoking prevalence is steadily declining, but remains more than three times higher than that of young people in the general population (33 % versus 8 %, in 2018, for daily and occasional use).[1]. However, data is rare and mostly collected at the provincial level.

A CBC Canada report looked at Native American smoking and its specificities. It notably gives the floor to Dr. James Makokis, himself a member of the Saddle Lake Cree Nation in Alberta.

From traditional use to post-traumatic use

Dr. Makokis said tobacco use among indigenous populations must be treated with respect, something Health Canada also recognizes. In these communities, tobacco is a sacred plant, traditionally considered medicinal and used in prayers and for certain rites.[2]. In these circumstances, tobacco is inhaled only minimally, this use being considered very distinct from that of "commercial tobacco", which is discredited because it responds more to addictive behavior.

“When you look at the enormous amount of trauma that indigenous people have experienced through colonial violence, we know that they are even more predisposed to regulating their emotions… through substance misuse, whether it’s alcohol or drugs.”, analyzes Dr. Makokis. Traumas that, like other psychological fragilities, also lead to chronic tobacco use. These traumas can be historical, ranging from the extermination of these peoples to their confinement to reserves, but also more recent, as shown by two vast scandals of forced placement of Amerindian children, from the 1960s until very recently[3].

Tailored support for smoking cessation

The specificities of Native American populations therefore require more adapted approaches to the treatment of smoking. Dr. Makokis indicates that conventional medical treatments are combined with elements of traditional culture. Identity parameters, such as traditional language, ceremonies and spirituality are mobilized as "protective factors". Dr. Makokis draws attention to smoking among adults and young seniors, who are more affected by smoking, which risks depriving the community of a whole generation of elderly people, traditionally the custodians of cultural transmission.

As with other indigenous Inuit and Métis populations, these precepts and the need to develop adapted therapeutic approaches are one of the axes of Canada's Tobacco Strategy 2020-2025.[4]This includes the co-development, with representatives of indigenous groups, of specific strategies for these populations in terms of smoking.[5].

While young Native Americans tend to smoke less than their elders, they are now more likely to vape than non-native youth (31 % versus 20 %, for use in the last 30 days). This would similarly require specific intervention programs, to be adapted according to generations and their consumption patterns.

Keywords: Native Americans, Canada

M.F.

Schwientek S, Improve health of Indigenous people and culture by decolonizing tobacco, says Cree doctor, CBC Canada, published March 18, 2023, accessed March 21, 2023.

[1] Alberta Health Service, Indigenous People in Canada and Tobacco, Tobacco, Vaping and Cannabis Information Series, November 2022, 6 p.

[2] First Nations Health Authority, Respecting Tobacco, accessed March 21, 2023.

[3] Sixties Scoop Millennium Scoop: Overview, Indigenous Studies, KPU, accessed March 21, 2023.

[4] Government of Canada, Canada's Tobacco Strategy, updated December 19, 2022, accessed March 21, 2023.

[5] Canadian Partnership Against Cancer, Leading practices in first nations, inuit, and Métis smoking cessation, April 2019, 31 p.