Tribal Tobacco Education & Policy Findings from an advocacy initiative in Indian Country
ClearWay MinnesotaSM works to promote health and reduce the harm of commercial tobacco in Minnesota’s American Indian communities, in partnership with tribal Nations, the Minneso- ta Department of Health and Blue Cross and Blue Shield of Minnesota. In Minnesota, 59 per- cent of American Indian adults are current smokers (compared to 16 percent of all Minnesota adults).1,2 Further, 71 percent of American Indian adults in Minnesota are exposed to secondhand smoke at community locations on a regular basis (compared to 34 percent of all Minnesota adults).1,2 In 2008, ClearWay Minnesota launched the Tribal Tobacco Education and Policy (TTEP) initia- tive to provide resources and assistance to five tribal Nations to address commercial tobacco through policy and advocacy approaches. The goals of this initiative are to: Community 1. Educate American Indians about the health dangers of commercial tobacco use and Change Stories secondhand smoke. 2. Advance commercial tobacco-free tribal policies on tribal lands. White Earth Tribal Building Smoke-Free Buffer Zone Evaluation Background
White Earth Smoke-Free Given the innovative nature of the TTEP initiative, ClearWay Minnesota recognized the im- Policy at Casino portance of a culturally-relevant, collaborative evaluation approach. An external evaluator worked with TTEP coordinators in a team approach to develop indicators of success for tobac- White Earth Cessation co advocacy work in tribal communities, recognizing that context is critical for advocacy evalu- Systems Change ation. The evaluation focused on a “co-learning” approach with annual discussions as a partici- patory method to better understand how advocacy took shape (e.g., activity, strategy, focus) Bois Forte Tribal and what successes and obstacles TTEP coordinators encountered. To gather information Building Smoke-Free about TTEP, we used mixed methods with a strong qualitative component, including culturally Buffer Zone relevant methods of observation and storytelling.
Leech Lake Organizes Local Tobacco Advisory Findings Councils The TTEP initiative supported four sites to pass formal smoke-free policies and all sites to ex- Mille Lacs Smoke-Free pand informal smoke-free policies. The TTEP sites have also increased community awareness State of the Band of secondhand smoke through highly publicized community events and through working in partnership with key tribal agencies. All of the sites integrated cultural messages into their Upper Sioux Tribal programs, events and outreach activities with a focus on the core value of strengthening and Building Smoke-Free restoring cultural traditions. Buffer Zone In order to deepen our understanding of community inspired change, we used a systematic storytelling protocol. We reviewed activity data and chose validated changes to further ex- Bois Forte Smoke-Free plore key indicators developed by the team. Community interviews were then conducted with Foster Care key decision makers. These data were synthesized into a brief report called Community Change Stories or Aanji Aadizookaanag in Ojbwe and Woyake Hdutokça in Dakota. This pack- White Earth Asemaa et contains the ten stories that have been compiled to date. (Traditional Tobacco)
Fond du Lac Protects For further information contact: Members with Smoke- CoCo Villaluz, Senior Manager Free Powwows [email protected] 1. American Indian Community Tobacco Projects. Tribal Tobacco Use Project Jaime Martinez, Director Survey, Statewide American Indian Community Report. 2013. [email protected] 2. ClearWay MN and Minnesota Department of Health. Minnesota Adult 952-767-1400 02/01/2016 Tobacco Survey: Tobacco Use in Minnesota: 2010 Update. February 2011 Aanji Aadizookaanag - Change Stories Community-led Policy Successes in Native Nations
White Earth Tribal Building Adopts Smoke-Free Policy
Process of creating CHANGE management was a key reason the policy process In August 2008, worked as smoothly as it did. White Earth health educators However, the process was not all without setbacks. Gina Boudreau Initially, the policy stated that the entire grounds would and LaRaye be smoke-free. When people began to complain, the Anderson were Council backed off from this restriction and changed approached by the the policy to allow smoking in the back areas of the Executive parking lot. While the tobacco coalition was Director of the Tribe to create a smoke-free policy for disappointed with this change in the policy, they the newly built tribal council and government building created strong culturally-specific signage to make sure in White Earth, MN. In September, the health that the messages banning smoking anywhere near the educators sent the Executive Director a draft of the building and promoting the sacredness of tobacco are policy to review. With his approval, they presented a still loud and clear. slide show on secondhand smoke and data on community support to the Tribal Council and asked Strategies for the CHANGE them to adopt the policy. In October, the Council White Earth health educators used a variety of approved the policy, which specified that the entire strategies in their policy change work, including: grounds would be smoke-free. As part of the policy change, all employees were sent a letter that announced Taking Advantage of New Opportunities: The White the policy and detailed the cessation services available Earth coalition uses a strategy which has proven to be to help them quit smoking. successful: When new businesses or buildings open, jump on the opportunity to create a smoke-free policy How did the policy get passed in just a few months from the get-go. This was a strong component for time? Goundwork! getting the policy passed with “Leaders in the community know that we work the new tribal building, but it The White Earth health on tobacco issues constantly and the fact that we has also been successful with education department has are known tobacco advocates helped us to create three new convenience stores, a been building their tobacco part of the desired change in policy.” new building for elders, and education and policy new community centers that initiative since 1999, when Gina Boudreau, Tribal Health Educator have opened in White Earth. they produced a public service announcement to educate about differences Maintaining a Strong Community Coalition: The health between commercial and traditional tobacco. Gina education department has built a strong coalition of Boudreau and LaRaye Anderson have been staffing the community members who support and guide their effort from the beginning. Since their initial policy efforts. Ms. Boudreau and Ms. Anderson share their change successes in 2005 (creating smoke-free village thoughts: “We wrote the policy and did the parks), they have actively worked on 23 policy and presentation to the tribe, but the coalition wrote letters program changes, including enhancing IHS clinical of support. For the tobacco coalition, when we speak practice in cessation, formal/informal no smoking or take action we speak as a group.” policies, and getting media placements in radio, newspapers, and theatre ads with messages about Sharing Strength Based Messages with the Community: secondhand smoke and the sacredness of tobacco. The White Earth educators and coalition members worked hard to offer messages about norms that As Ms. Boudreau reflects “I would say that the leaders resonate with community values. For example, they in the community know that we work on tobacco issues emphasized the importance of role modeling, as constantly and the fact that we are known tobacco community leaders and as adults for tribal youth. They advocates helped us to create part of the desired change encouraged community leaders to create a professional, in policy. I believe that others are starting to get the healthy environment for tribal workers and community message that tobacco should be used in a sacred way.” visitors. When the White Earth tribal building decision The fact that the Executive Director approached them was made, the health educators created beautiful was an important indication of the health educators’ signage that didn’t just give a negative message about knowledge and respect in their community – and as no smoking, but also shared a positive message they point out, this support from upper leadership and reinforcing sacred use of tobacco. Page | 1
Aanji Aadizookaanag - Change Stories Community-led Policy Successes in Native Nations
White Earth Tribal Building Adopts Smoke-Free Policy
Strategies for CHANGE (continued) Lessons Learned about creating CHANGE Community ownership of change and Building Relationships. White participation in change is critical in Native Earth health educators spent time communities, where change has often been and effort building relationships forced from the outside at great cost. “We with administrators and upper learned the importance of framing policy in a management. Such good positive light and emphasizing cultural relationships contributed to policy values, such as respect, that are important to approval. building a healthier future for Indian people.”
Sharing Community Data Back to Encourage every coalition member to see the Community: White Earth themselves as change agents. Native people advocates took the opportunity to need to remind each other collect data on the level of support and encourage each other the community members had for that “we do not need to be smoke-free environments. But the afraid -- change that draws data didn’t just sit on the shelf; on community strengths is they reflected the community part of restoration of what opinions supporting smoke-free was lost.” environments back to the Tribal Council as part of their slide show discussion on the policy. Being patient and persistent in the work can help coalitions create a Importance of the CHANGE strong reputation with According to the US Preventive Task Force, creating community leaders, who 100% smoke-free environments is one the most will then see the coalition as an important partner effective strategies for reducing harm caused by in creating new policy and practice. commercial tobacco (www.thecommunityguide.org). Research shows that reducing secondhand smoke can Understand politics! Tribal officials are elected immediately decrease the number of heart and asthma leaders so they are very sensitive to feedback from attacks in a community. The Centers for Disease their constituents -- people who smoke can be Control and Prevention found that hospitalizations in quite vocal about losing their space. Anticipating Pueblo, Colorado dropped 41 percent during a three- this reaction can help you understand the setbacks year period when smoking was that might come with banned, but there was no such By specifically choosing one of the busiest and strict policy changes. drop in the other two areas most visible worksites on the reservation, the In White Earth, the studied that had no such ban. policy was able to protect many employees, coalition wanted a (CDC MMWR for January 2, tribal members and visitors from the harmful completely smoke- 2009 / 57(51&52);1373-1377). effects of secondhand smoke as well as free area, but smoking encourage a new community norm to once again was ultimately With American Indian people in respect tobacco as a sacred medicine. allowed in the back of Minnesota suffering very high the lot. Despite this, death rates from heart disease, cancer, diabetes and the coalition continued the pressure to have a lung disease, this is a critical step in protecting the strong smoke-free policy to encourage a norm of future of the people (data available from Great Lakes non-commercial use. As of 2009, people are Intertribal Council Epidemiology Center at respecting the new policy. Smoking is no longer www.glitc.org). seen anywhere near the tribal building or entrance.
By specifically choosing one of the busiest and most visible worksites on the reservation, the policy was able to protect many employees, tribal members and Type of Change: Formal Tribal Policy visitors from the harmful effects of secondhand smoke Location of Change: White Earth Reservation Tribal Center as well as encourage a new community norm to once Reach of Change: 500 tribal building employees & visitors again respect tobacco as a sacred medicine. Contact: Jaime Martinez at [email protected]
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Aanji Aadizookaanag - Change Stories Community-led Policy Successes in Native Nations
White Earth Creates Smoke-free Policy at Casino The community CHANGE at the casino and tribe. Open communication with The White Earth Health Education Department upper management was facilitated throughout the collaborated with the White Earth tribal council, policy process by a tribal council member and three casino management, and employees to create representatives from the casino who were active on additional smoke-free space the tobacco coalition. The tribal council member and and policies at the Shooting casino representatives (from the safety, human Star Casino and Event Center. resources, and casino liaison departments) attended As a result, the smoke-free meetings with the space has increased and tribal council, casino includes: a 100% smoke-free management, and event center; 292 (of 390) smoke-free hotel gaming commission rooms in 2 hotels; 500 sq. feet of smoke-free to share information gaming area; smoke-free service windows; about the coalition’s increased smoke-free space in dining areas; a work. They provided smoke-free bar; and smoke-free offices, coalition meeting meeting rooms, and employee break rooms. minutes, informed leadership about goals, gained approval to move forward with plans, and shared progress updates. Process of creating CHANGE The White Earth Health Education Department has The White Earth gaming commission was a key player been building their tobacco program for nearly 10 because it monitors all activities at the Shooting Star years. They have a well established tobacco coalition Casino. It is a tribally operated board of that has actively worked on 23 policy and program commissioners designed to control and foster growth changes to increase smoke-free space, increase of the gaming activities of the White Earth traditional tobacco use, and create culturally-specific reservation. The five members are appointed by the messages about secondhand smoke. In 2001, they White Earth tribal council and can include tribal began to educate the community about smoke-free council members or commissioners who are not tribal policy work and share community survey results. council members.
By 2005, the coalition began discussing how they The relationships between the coalition, gaming could improve smoke-free policy at the Shooting Star commission, and upper management assisted with Casino Hotel and Event Center. Employees, especially efforts to identify areas of the casino and event center those working at services windows and in the event that could improve smoke free policy. After gaining center, were concerned about exposure to second hand support from the gaming commission, the coalition smoke. The tobacco coalition worked with managers to add knew it was up to them to ask “The tribe is a sovereign nation and this more questions about smoke- for more smoke-free space but means that it does not have to follow the free policies to customer they didn’t think it was state-wide Freedom to Breathe Act. This is satisfaction surveys. The possible to create a 100% a huge barrier to furthering our work on coalition used the casino smoke-free policy. Instead smoke-free policy within the casino. We specific information from the they decided to develop a have to continue to take baby steps toward surveys to work with human “chip away” strategy by healthier environments.” Gina Boudreau, resources to further clarify focusing on small changes White Earth Health Educator areas for improvement. over a longer period of time. In 2006, the casino management supported employee The coalition began to make a plan by listening to cessation by offering the Quit Plan at work program. what customers, employees, and community members The White Earth Health Education Department were saying about smoke-free policy. They gathered worked with Clearway Minnesota to arrange quarterly information on the complaints about secondhand cessation support sessions hosted at the casino and smoke. In addition, the coalition reviewed results event center. Advertisements about tobacco and about smoke-free support from statewide and cessation opportunities were placed in the in-house community surveys. According to the surveys, most newspaper and on the TV in break rooms. The success people preferred smoke-free areas. rate was 50% for participants in the first session.
The tobacco coalition shared the overwhelming support for smoke-free policy with upper management Page | 1
Aanji Aadizookaanag - Change Stories Community-led Policy Successes in Native Nations
White Earth Creates Smoke-free Policy at Casino Process of creating CHANGE (continued) lunch, and had the Ciggy Butts mascot provide smoke-free messages. The tobacco coalition will also In 2007, several informal policies, which consist of be advertising “The Great American Smokeout”, the unwritten agreements or behavior expectations for third Thursday in November, as a way to keep the norm changes, were recommended by the coalition smoking issue at the forefront of discussion. and implemented by casino management as a result of these efforts. The casino management created smoke- Strategies for the CHANGE free service windows by requesting that the safety The White Earth tobacco coalition used a variety of division rope off the area around service windows, strategies in their smoke-free casino policy work post no smoking signage, and provide ashtrays for including: customers to dispose of cigarettes before visiting windows. The alterations to the environment changed Building relationships. Staff built support early by the behavior expectations of customers. talking about program goals, speaking openly about issues, listening, and avoiding assumptions. They did Casino management also began to change smoke-free this by supporting other coalitions, going to events, policy at the event center by first adopting informal and attending tribal council meetings. polices. When large events were hosted at the event center, ashtrays were covered up and guests were Educating about policy change. Very early the asked to smoke outside. Casino management also tobacco coalition started educating the community supported a smoke-free rental option – if customers about smoke-free policy change and why it works. requested a smoke-free facility for their event it was They continue this education to encourage smoke free provided. homes, cars, and workplaces.
In 2008, when the results from the customer surveys Communicating with key leaders. Coalition members revealed that 76% of event center patrons preferred included tribal council members and casino non-smoking areas and customers supported more management representatives. They generated ideas, smoke-free area on the gaming floor, formal policies communicated goals and progress, and carried out the were written and posted. The upper management at coalition plan. These individuals were the “middle the casino directed the human resource management people” between the coalition and the casino to draft formal policies related to smoke-free areas management, gaming commission, and tribal council. within the Shooting Star Casino and Event Center. Change in these leadership positions is common but The new policies established a completely smoke-free the coalition viewed it as an opportunity to build event center and increased the amount of smoke-free relationships, educate about coalition efforts, and space. The casino continues to monitor customer gauge support. The coalition felt it was critical to satisfaction and evaluate the keep management well informed smoke-free policies by “You can’t sit at your desk and expect to of past accomplishments and conducting surveys. build support. You have to be future goals in commercial out…building relationships and social tobacco prevention and control. Currently (2009), health capital. Your presence is what the educators and the tobacco community remembers.”-Gina Boudreau, Creating awareness of policy coalition continue to White Earth Health Educator campaign. The health educators provide information about worked with casino staff to their smoke-free policy work as well as the difference incorporate messages about secondhand smoke, between commercial abuse and traditional use (which commercial tobacco abuse, traditional tobacco use, is only for prayer and healing). Advertisements and and cessation into advertisements in casino media. articles are still placed in the in-house newspaper and They also supported the creation of a traditional on the televisions in employee break rooms. The tobacco garden at the worksite. coalition planted a traditional tobacco garden behind the casino as an opportunity to teach about traditional Collecting and using data for planning and uses of tobacco. “Just for 2 hours” is another evaluation. Background information about existing campaign recently launched by the coalition. To work casino policies and survey data was collected, towards a future all day smoke-free event at Shooting analyzed, and shared throughout the policy making Star Casino and Event Center the coalition hosted a 2 process to create a plan, demonstrate need, and hour smoke-free activity with employees. At the evaluate smoke-free casino policy. event they encouraged quitting, provided a brown bag Page | 2
Aanji Aadizookaanag - Change Stories Community-led Policy Successes in Native Nations
White Earth Creates Smoke-free Policy at Casino
Strategies for the CHANGE (continued) Lessons learned about creating CHANGE Understand that casinos are a source of Providing support for quitting. The tobacco program revenue for the tribe and fears regarding the helped with the Quit Plan® at Work program to economy affect this work. support quitting. This was continued quarterly until Ongoing education that respects the Indian Health Service started a cessation program. sovereignty of the tribe and their right to make decisions about smoke-free policy is Acknowledge and show appreciation. People like to be likely most effective. recognized for their contributions. It makes them feel Recognize there are many steps to building valued and keeps them passionate about the work. support and creating 100% smoke-free Remember to celebrate accomplishments often policies. because there are more bumps than successes along Use a comprehensive approach that includes the way. the provision of quitting services for employees and encouragement to quit as part Importance of the CHANGE of the plan for creating more smoke-free There is no safe level of exposure to secondhand space. smoke – it causes illness and death. Regular exposure With a “chip away” strategy that builds on to secondhand smoke at work can cause a 91% incremental changes to move toward a increase in coronary heart disease (Kawachi, et.al, completely smoke-free environment, it is Circulation, May 1997; 95: 2374 - 2379). In addition important to collaborate with casino to health issues, secondhand smoke creates a serious management, tribal leaders, and gaming financial burden for individuals, communities, and commissioners as part of the change process. businesses. According to the Creating Healthier Policies in Indian Casinos study, most casino leaders perceive that a 100% smoke-free casino would save money (www.indigenouspeoplestf.org/tobacco.html). Workplace smoke-free policies have many benefits for employers, employees, and customers including: • Support for quitting smoking; • Lower employee absenteeism; • Increased employee productivity on-the-job; • Lower health care costs; • Lower health and life insurance costs; • Reduced maintenance and cleaning cost; • Less damage to furniture and equipment; and • Decreased risk for fire, explosions, and other accidents related to smoking.
Type of Change: Worksite (casino) Policy Location of Change:White Earth Reservation Reach of Change: Employers, employees, & customers Contact: Jaime Martinez at [email protected]
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Aanji Aadizookaanag - Change Stories Community-led Policy Successes in Native Nations
White Earth Creates Health Systems Change
The community CHANGE to implement a policy to have a cessation program at The White Earth Reservation Community Health the clinic. The clinic based change did not require a Education Tobacco Program collaborated with the formal policy resolution. Instead the staff talked White Earth Indian Health Service (IHS) clinic to about their current system of care and ways to create a successful health systems change. Because of incorporate the guidelines for providing cessation in the tobacco program’s efforts the clinic setting. They created procedures for the IHS clinic has brief intervention, referral, implemented a cessation nicotine replacement program that encourages therapy, patient follow-up, providers to use evidence- and documentation. based practice to ask each patient about smoking and To get the program started, offer nicotine replacement therapy (NRT). tribal health educators Tribal health educators and clinic staff provide arranged for provider patient follow-up. training on best practice in treating tobacco dependence. In 2007, Mayo Medical Center – Rochester provided Process of creating CHANGE cessation training for 15 providers. Following The White Earth Health Education Department has training of the IHS health providers, the health been building their tobacco program for nearly 10 education department continued to support the years. They have actively worked on 23 policy and implementation of cessation efforts by conducting program changes to increase smoke-free space, follow-up calls to patients and collecting data and increase traditional tobacco use, and create culturally- information about cessation. specific messages about secondhand smoke. They also worked to create cessation services for their community because they recognized the importance Strategies for the CHANGE of supporting quitting in a comprehensive approach White Earth health educators used a variety of to tobacco control. strategies in their health systems change work, including: In 2005, White Earth health educators, who had received best practice cessation training from Mayo Meet with people to talk about the issue. Already Clinic, were providing part-time cessation and follow established quarterly meetings between IHS and the up support to community members by offering tribal health program staff were utilized by the White cessation classes at workplaces and NRT in the form Earth health educators to engage upper management of patches, gum, and lozenges. At that time, they also and providers to raise the issue of delivering better began working with a doctor on their tobacco tobacco cessation services to the community. They coalition and the Chief Executive Officer of the IHS used this forum to begin educating the tribe’s upper clinic to review and revise the organization’s smoke- management and IHS staff about the need for free policy. Within 4 months, a 100% smoke-free cessation services. policy was implemented at the clinic. The smoke-free policy created an environment where employees Use information and data effectively. At quarterly needed help and support to quit smoking. meetings, health educators included information about gaps in health insurance coverage for cessation, The need for quit services by employees was community survey data about help seeking behavior, combined with other information and presented to the program data about cessation success rates, and local upper management of the tribe and IHS leaders utilization of the statewide quit plan services. during quarterly managers meetings. The managers determined that the cessation services could be more Work with clinical and IT staff to modify current effective if there was collaboration between the tribal health system. The health educators used their health program and the Indian Health Service (IHS) knowledge of tobacco control to provide consultation providers – doctors, nurses, and pharmacy staff. to develop a clinic based cessation program for treating tobacco dependency. Information technology White Earth health educators used this opportunity to also worked with providers to modify the IHS make a request to the management of the IHS clinic Resource and Patient Management System (RPMS) to document cessation services.
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Aanji Aadizookaanag - Change Stories Community-led Policy Successes in Native Nations
White Earth Creates Health Systems Change
Strategies for the CHANGE (continued) www.PublicHealthReports.org, Volume 117, May- Collaborate to support clinic cessation efforts. June 2002, p.281-290). Tobacco use is addictive and Acknowledging the limited time clinical providers it usually takes more than one attempt for a smoker to have to address a large number of issues, White Earth quit. Assisting tobacco abusers with quitting smoking Health Education program staff took on the duty of is one part to the comprehensive approach to placing the two-week follow up phone calls to commercial tobacco control. Illness and premature patients and entering this data in the RPMS. death related to cigarette smoking decrease when quitting increases. Quitting can also reduce the Provide education and training for staff. The White tobacco related health care costs, for Native nations, Earth Health Education program arranged for the businesses, and communities (www.ctri.wisc.edu/). Mayo Clinic to deliver a cessation training session for 15 clinic providers. In addition, they provided Information about effective tobacco dependence information about best practice in tobacco control treatments is available. Reminder systems, patient and familiarized health providers with outside referral services, treatment with medication, and brief resources such as the “Helping Smokers Quit: A intervention have all increased successful cessation. Guide for Clinicians” (www.ahrq.gov/clinic/tobacco) Even brief advice from several different people in the and Quit Plan services (www.quitnow.net/quitplan/). clinic setting is more effective at increasing quit rates The IHS provided training to tribal health educators than minimal efforts, such as giving out free literature about the RPMS because they were placing follow-up (www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat2.cha calls to patients and entering data into the system. pter.28163).
Maintain relationships The Puyallup Tribal Health “Cessation could be more effective with with staff and continue to collaboration between the tribal health program Authority implemented the monitor progress. In and the IHS providers-doctors, nurses and Public Health Service Clinical addition to providing the pharmacy. Our tobacco program educated the Practice Guidelines to treat follow-up call to the tribe’s upper management and IHS staff…with nicotine dependence. Since patients, health educators information about cessation coverage gaps, help 2002, smoking rates have continue to keep the seeking behavior, cessation success rates, and decreased by 26% and clinic discussion open with the local community’s utilization of the statewide visits for upper respiratory providers about the quit plan.” Gina Boudreau, White Earth health infections, coughs and asthma cessation program. They educator have decreased by 60%. The work with pharmacy staff program has produced quit rates to collect data and return information about in their Native clinic that are similar to those found in performance to clinic providers and health managers. non-Native clinics. Highlighted on page 2 at: The health educators also share resources and provide www.doh.wa.gov/Tobacco/data_evaluation/SuccessS reminders to clinic staff about best practice. tories/PuyaTrSuccess.pdf
Make policy comprehensive. Clarifying and Lessons learned about creating CHANGE improving the smoke-free workplace policy for the Establish relationships with providers in IHS clinic helped to create a healthier environment your community to help communicate with and also provided additional motivation for a strong key decision makers. cessation component. Use information and data to support the need for cessation programs in your Importance of the CHANGE community. This health systems change will assist individuals IHS and tribal clinic providers are really with overcoming tobacco addiction which in turn, busy. There is lack of time for everybody to will reduce tobacco related illness in the community get everything done. Work together to and save the tribe and IHS money in the long-term. develop and deliver the cessation program. Most recent data (2009) from the IHS cessation Ask for guidance from people who have program showed that 45% of those who returned for done this before – look for models where it their second visit remained smoke-free at 12 weeks. is being done already. Not re-creating helps American Indian smokers have less success quitting move things more smoothly and quickly. smoking, even though more express a desire to quit. (Gohdes, et.al. 2002; available for download at: Type of Change: Health Systems Change Location of Change:White Earth Indian Health Service (IHS) Reach of Change: IHS employees and clients Contact: Jaime Martinez at [email protected] Page | 2
Aanji Aadizookaanag - Change Stories Community-led Tobacco Policy Successes in Native Nations
Smoke-Free Zone Adopted Around Bois Forte Buildings
The TTEP program built on these early accomplishments to protect tribal members and visitors from secondhand smoke exposure. During 2009, the TTEP coordinator began providing
education to community members and tribal leaders not only on the dangers of secondhand smoke, but also on the growing body of knowledge on the dangers of thirdhand smoke, the toxic residue from cigarettes that clings to materials. But front and center in all education was the critical need to restore non-recreational, cultural use of tobacco as a Tribal Government Center with 50-foot Buffer Zone healing force for change. The TTEP coordinator The Community CHANGE worked with local spiritual elders and the cultural In early June 2010, Tribal Tobacco Education and committee leader to learn about and experience the Policy (TTEP) Coordinator Daanis Chosa sat at her healing ceremonies, and collaborated on community desk and pulled together a packet of important events to share this knowledge with tribal members, documents: a copy of language for a resolution on a including a Manomin (Wild Rice) Walk and smoke 50-foot smoke-free buffer zone around tribal free indoor powwow using traditional tobacco. buildings, an approval email from the tribal attorney, and a formal agenda request form for A Tribal Council member, Cathy Chavers, met one- going before the Bois Forte Tribal Council. Ms. on-one with Ms. Chosa, participated in events, and Chosa had been working on this issue for many let her know the Council supported her efforts. months, and was now hopeful that the resolution would be reviewed favorably by the Council In February of 2010, the TTEP coordinator reached members. She sent the packet to the Executive out to the tribal attorney for advice on drafting a 50- Director of the Bois Forte tribe for placement on the foot buffer zone policy around all tribal buildings. Tribal Council agenda. She had researched other tribal policy initiatives, but wanted input from her own tribal legal team. On July 7th, 2010, Ms. Chosa was called into the The attorney worked closely with Ms. Chosa to Tribal Council chamber to read the resolution. The highlight key points to draft a resolution. She then Council added clarifying language to allow the asked members of the health department, cultural ceremonial use of tobacco and exempt the casino, committee, and law enforcement to meet with and the resolution then passed with no debate. technical assistance providers to discuss and finalize the resolution. The group added a Process of creating CHANGE provision that the policy would include no smoking This historic policy change was part of a larger arc during after-hours use. The last step before Tribal of action to protect Bois Forte tribal members from Council was sending it to the Commissioner of secondhand smoke that began in the early 90s, Judicial Services and the Health Commissioner. starting first with tribal buildings going smoke-free indoors, followed by policy designating that Strategies for creating CHANGE Community Health Representative (CHR) vehicles The Bois Forte TTEP program used a variety of be smoke free. This action was spearheaded by strategies to create change: community champions, such as Jeneal Goggleye, now Health Commissioner, who was a prime force Doing background research. The TTEP coordinator in getting the initial changes in smoke free policy to took time to learn about policy change in general happen. She recognized the threat of commercial and in Bois Forte in particular. The Coordinator tobacco, and advocated for patients’ health above also had supporters who helped her navigate the and beyond tribal buildings going smoke-free, such policy change process specific to Bois Forte. as the need to protect patients from exposure to secondhand smoke during transport by CHRs.
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Smoke-Free Zone Adopted Around Bois Forte Buildings
Strategies (continued) Importance of the CHANGE Connecting the issues of restoring healthy tradition Evidence continues to mount on the dangers of with reducing danger. Woven together in all Bois exposure to commercial tobacco smoke. In a report Forte education was a message about sacred released in December 2009, the Surgeon General tradition versus commercial abuse. The coordinator found “Even occasional smoking or secondhand spent many months providing smoke causes immediate education at community Why did it pass easily? Education. I’d never damage to one's organs and events on dangers of heard about thirdhand smoke before! And poses risk of serious illness or secondhand and thirdhand Daanis did a wonderful job… I was really death.” (available at pleased. [Her] youth, plus she has the cultural smoke, plus the importance aspect to share. www.surgeongeneral.gov/) of smoke free policies. And American Indian people in while not all of the tribal Cathy Chavers, Tribal Council Member Minnesota suffer very high members are traditional, a growing movement to death rates from heart disease, cancer, diabetes and reaffirm and restore culture has taken root in Bois lung disease, and youth have high rates of asthma Forte. The TTEP coordinator drew on the and infections. Communities are beginning to rise knowledge of the cultural committee and spiritual to the challenge of addressing the fact that over leaders to enhance knowledge of a tobacco tradition 50% of tribal members are using commercial of cultural strength and healing. tobacco. According to the US Preventive Task Force, creating 100% smoke-free environments is one the most effective strategies for reducing harm from exposure, but also helping people to quit. Resources such as the Tribal Policy Toolkit (www.keepitsacred.org/toolkit) provide a roadmap for communities to use smoke free policy to improve the health of their people.
Lessons Learned about CHANGE Culture is Key – Daanis Chosa at tobacco garden, Cathy The personal touch. Try lots of ways to reach Chavers at Creation Story Mural in the Government Center people, such as emails and newsletters, but putting up flyers at homes brought more participation. Asking for help. Working with colleagues in key tribal roles helped the TTEP coordinator move Build a team and make use of their expertise. Ask forward on policy change. The tribal attorney for advice and feedback from multiple sectors – played a key champion role, crafting a draft legal, law enforcement, culture, tribal leaders, resolution, adding stores and vehicles to the policy, health, etc. – to build support and a stronger policy. and giving advice on how to present the issue. The culture committee and law enforcement participated Work your networks. Talk to people you know and in reviewing and advising on the policy before it get their feedback, better yet, get them involved. was sent up through the chain of approval at Bois Forte. The coordinator also took advantage of Choose a “Messenger” who will resonate with the technical assistance from experts in tribal policy, community. At Bois Forte, the policy request came available through the funding agency. from a young leader, with community connections, who learned tradition and integrated the message of Building on community connections. Bois Forte is a how tobacco should be used for healing not harm. small community, and the coordinator was able to connect with relatives and tribal members with Think ahead. Tribal leaders consider enforcement a cultural knowledge and in leadership positions. She major challenge. Have an enforcement plan and also collaborated on education with other groups. partners ready to help before policies pass! Type of Change: Formal Tribal Policy Location of Change: Bois Forte Tribal Buildings Reach of Change: 150 Tribal building employees (plus visitors) Page | 2 Contact: Jaime Martinez at [email protected] Aanji Aadizookaanag - Change Stories Community-led Tobacco Policy Successes in Native Nations
Leech Lake Organizes Local Tobacco Advisory Councils
The Community CHANGE winter. All of the elders understand that, they’ve People arrived at the Bena community center on the been through it. They told me several years ago, morning of March 7, 2011, from villages around the there’s no hurry, there’s a right time for everything. Leech Lake Nation. But the people weren’t And we’ll get there. So I think the non Native gathering for the usual powwow, not a sporting timetable placed on the Natives and then another event or a community feast. Instead, they came for Native tries to place it on another Native, I think a two-day training in diverse community based that’s part of that oppression because we don’t live tactics – tobacco policy, media, community that way.” organizing – tactics that would help them stop the harms to their people caused by commercial tobacco. Tribal Tobacco Education and Policy (TTEP) Coordinator Spencer Shotley welcomed them to an event that represented the fruits of two years of effort. Spencer had used knowledge of his own tribal community, and skills he had learned from training and technical assistance, to patiently and respectfully bring dozens of people from five villages into the work on tobacco issues at Leech Lake.
Process of creating CHANGE Leech Lake is a Nation of Ojibwe living around the 3rd largest lake in Minnesota. A majority of Leech Youth Director Gary Charwood, and TTEP Coordinator Spencer Shotley at the tobacco booth at a local powwow. Lake members smoke cigarettes, and this level of addiction is fueled by the availability and heavy marketing for cheap Seneca cigarettes. The people The TTEP coordinator started out by going to of Leech Lake reservation live in 14 villages, monthly LIC meetings, and introducing himself and separated by distances of 20 to 80 miles. Each the project. An important element was to “read” the village elects members of their community to serve tone of the meeting. If frustration or tension was in on Local Indian Councils (LICs) that work locally the air, Spencer would respectfully ask to return at a but also advise the Reservation Tribal Council. future date. Targeting seven communities, widely spread apart geographically, was also a major To create coalitions to address the challenging task challenge. Other factors took extra time and of tobacco, the TTEP coordinator built on the patience: understanding the negative effects of existing LIC infrastructure, as intergenerational trauma and well as the foundation laid by Be real respectful to your people and allow addiction on peoples’ ability to them time or whatever it takes to move Marcy Ardito, the previous communicate and work together, things forward to work with you . . . when and canceled or rescheduled tobacco staff, who’d worked you use that approach you’re not out of for a decade on community place, not trying to tell the community to meetings in tight-knit communities education. The idea was to go pick blueberries in the winter. due to the sickness or death of a create Tobacco Advisory Spencer Shotley, TTEP Coordinator community member. Councils (TACs) from each village to empower for policy and system change. Drawing on the assets of the youth division was another key first step. Each Leech Lake community But the process did not happen quickly. As Spencer has a paid youth coordinator, who does prevention notes, “Be real respectful to your people and allow education including some on tobacco. The TTEP them time or whatever it takes to move things coordinator tapped this knowledgeable community forward to work with you . . . and when you use resource to be a member on the TAC and also for that approach you’re not out of place, not trying to ideas on who to recruit. This helped to get the right tell the community to go pick blueberries in the people involved. Page | 1
Aanji Aadizookaanag - Change Stories Community-led Tobacco Policy Successes in Native Nations
Leech Lake Organizes Local Tobacco Advisory Councils
The TTEP coordinator then focused on bringing there, they are interesting, sad, moving, things like education to each community at the LIC meetings that, everyone has their own story.” and booths at powwows. TTEP also supported a smoke-free “Drum and Dance” mini-powwow in Build relationships and empower others. The TTEP each community with messaging on traditional coordinator built on LIC structure and relationships. tobacco and smoke-free living from a respected He placed himself by sharing his Leech Lake clan community leader. TTEP brought in Native experts and hometown. He also emphasized education so in tobacco for training to provide information and that people would be on the same level in terms of skills directly to community members. In the early knowledge about commercial tobacco – sharing phase of TTEP, the coordinator took on most of the what he learned through trainings on the tobacco work, but by the end of 2010, five of seven TACS industry tactic of targeting communities. In turn, attended trainings or were organizing events. some communities took the lead on organizing their own mini-powwows, and learning more about their Strategies for creating CHANGE traditions. TACs have begun to gather stories about The Leech Lake TTEP program used a variety of ceremonial tobacco. The use of kinnikinnick, from strategies to create change: the red willow, was taught to TAC members, and for the first time ever, used in place of pipe tobacco Hold deep respect for the people’s past and present at the opening ceremony of a statewide intertribal struggles. So many things have happened, and still smoke-free powwow in April 2011 at Leech Lake. happen today, that are out of Native people’s control even when they live on their ancestral lands Importance of the CHANGE and retain sovereign power. The TTEP coordinator Minnesota Native people suffer very high rates of asked the LIC for permission to do this work. He tobacco related diseases (glitc.org/ epicenter). The shared an example of a village where a resort owner National Cancer Institute and International Tobacco had built a dock on a swimming beach that had Control Movement recognize the centrality of been used by Ojibwe for generations, yet the resort community-based coalitions for tobacco control owner was adamant that the people could do (cancercontrol.cancer.gov/tcrb). Enacting clean nothing to stop him. Understanding this context is indoor air policies and system changes to reduce critical, especially when wanting to work on policy, tobacco access and increase cessation access are where communities will resist change unless they best practices that require community mobilization. can make their own decisions in an empowering environment where ideas and action are on their Lessons Learned about CHANGE schedule and from within. Build on the local structure. Leech Lake TACs that have LIC members involved are the most active. See the people as community Time and respect are needed to build community assets with an capacity for the long haul. Think carefully about important story your community and take time to do things in the to tell. Theresa right way. Activity will wax and wane but keep Jordan, long- coming back when individuals or communities time activist stumble. Creating a space that allows painful and member of dialogue without being destructive will help in the the Onigum larger healing process for the people. Theresa Jordan, Onigum LIC and TAC LIC and member with kinnikinnick for the powwow TAC, shares Train and Empower. Bring in Native experts to her strategy: “Get the people together, gather them, train and educate the people directly for this work. feed them, let them know what you are planning on This will motivate and inspire them to see doing. Actually ask them for help, to do this or do themselves as leaders to create healthy change. that. [Learn from them], there are a lot of stories out
Type of Change: Community Capacity Page | 2 Location of Change: 5 Leech Lake reservation communities Reach of Change: Leech Lake villages with ~4,000 population Contact: Jaime Martinez at [email protected]
Aanji Aadizookaanag - Change Stories Community-led Tobacco Policy Successes in Native Nations
Mille Lacs Designates Smoke-free State of the Band
The Community Aanji (Change) Traditional tobacco, or kinnikinnick, is made of red In late January, 2012, about 1,000 Mille Lacs tribal willow bark and its preparation and use is guided by members arrived at the Grand Casino Mille Lacs spiritual tradition. The TTEP program, called Gego from all over the reservation’s three Districts and Zaagaswaaken (Don’t smoke), works to restore this urban communities. The People of the Mille Lacs strong and healthy tradition and at the same time to Band were gathering for one of reduce the harm caused by the most important events of the commercial tobacco use. year -- the annual address from their elected leader, called the Mille Lacs still has a social State of the Band, where the norm of smoky environments. tribal Chief Executive goes over Gloria Songetay, TTEP the accomplishments of and coordinator from 2010-2011, challenges facing their Nation. conducted surveys with Band members at community Tribal Tobacco Education and events and WIC clinics. She Policy (TTEP) Coordinator found that 66% were exposed Carol Hernandez arrived at the to secondhand smoke in the event and was surprised– home and 75% in cars. Of happily so—by the sign 100 attendees at a popular welcoming tribal members to health fair in March 2011, 67 the convention center, which is reported currently smoking usually a smoking area within cigarettes. During the first the casino. The sign announced several years of the TTEP that “The State of the Band is a initiative in Mille Lacs, TTEP non-smoking event.” This change was surprising Coordinators Marlene Poukka and Ms. Songetay because it didn’t come about through the usual worked alongside the Minnesota Department of process of TTEP policy requests up the chain of the Health (MDH) Cessation Coordinator to provide Band government decision-making structure. educational presentations through the Mille Lacs districts and the urban community. They worked Process of creating Aanji with a spiritual leader and diligently integrated Mille Lacs is a Nation of more than 4,300 Ojibwe messages about cultural tradition and how it is at living in the region around Mille Lacs Lake in what odds with commercial use. Ms. Songetay decided to is today East Central Minnesota. The Mille Lacs create an educational video that would encapsulate Reservation is divided into three Districts, spanning this message with a focus on having the message be a large geographic area. The Band previously produced by, for and with Mille Lacs Band operated under a single agency form of government members. The resulting DVD was widely known as the Reservation Business Committee but disseminated, and its success led to a second video. determined that a separation of power, similar to the United States federal government, would be a more Drawing on this foundation, Carol Hernandez, the effective and responsible way to govern. Today, the TTEP Coordinator who took over when Ms. Mille Lacs Band tribal government consists of Songetay retired, took up the charge to work on executive, judicial and legislative branches. The developing policies to protect Band members. She Chief Executive leads the executive branch under a began inviting key community leaders for a 4-year term. The casino and events center are coalition, including the Corporate Commissioner in operated under a special Corporate Commission, charge of tribal businesses and casinos. While the which works very closely with the Band Executive request was turned down, the Commissioner did Branch, but is a separate entity. express her support for health and air quality. Other leaders, including the air quality specialist and Mille Lacs has a strong cultural tradition, including elders, accepted the position and began meeting. the use of tobacco for prayer and ceremony. Page | 1
Aanji Aadizookaanag - Change Stories Community-led Tobacco Policy Successes in Native Nations
Mille Lacs Designates Smoke-free State of the Band
As a Band member with considerable experience, Strategies for creating Aanji Ms. Hernandez was aware of the steps to introduce While we don’t know for certain how much TTEP a policy for consideration by the Mille Lacs tribe, contributed, the coordinators used several strategies beginning with approval from the Public Health that supported, if not directly created, the change: Supervisor, Lisa Blahosky, followed by the Health and Human Service Commissioner, then up to the Culturally-relevant education. The smoking rates Chief Executive’s office. After obtaining support at and exposure to secondhand smoke are exceedingly the first two levels, she visited the Executive office high in the Mille Lacs community. Partnering with to make her case for a smoke-free State of the spiritual elders and the cessation program brought important messages and resources to community members that resonate with the community context.
Go through the tribal decision making process. So many things have happened, and still happen today, that are out of Native people’s control even when they live on their ancestral lands and retain sovereign power. The TTEP coordinator respected the chain of command and went through the policy making process. While this did not directly lead to the policy change, it showed tribal leaders that there was formal support for this request from the health Carol Hernandez, Band member & TTEP Coordinator care community and coalition members. Band. When the request was turned down because the event center is a “common area” allowing Importance of the Aanji smoking, the coordinator used the opportunity to A social norm is defined as shared expectations of ask for the Gego Zaagaswaaken DVD to be shown culturally appropriate and desirable behavior. The to educate Band members. The request was highly successful California tobacco control accepted. program used a social norm change approach “by creating a social milieu and legal climate in which So how did the smoke-free State of the Band come tobacco becomes less desirable, less acceptable and about? In an interview with the Kate Anderson, less accessible.” The success of the effort for a Grand Casino Banquet Manager and member of the smoke-free State of the Band is creating a healthy event planning committee, the casino staff brought social norm for Mille Lacs band members. As Lisa up the smoke-free issue during the planning Blahosky noted “This change is huge, one of the meetings with the Executive office staff. She most significant we could make. It’s one of our summarized, “[making the event smoke-free] is biggest community events. I’ve been going for another step in the process. Perspectives on seven years and it has always been really smoky.” smoking are changing -- it just keeps going in that “[Making the event smoke-free] is another step in the Lessons Learned about Aanji process. Perspectives on smoking are changing -- it Remember that the broader picture is in your favor. just keeps going in that smoke-free direction” Tribal and business leaders are aware that most Kate Anderson, Banquet Manager at Grand Casino Mille Lacs people do not smoke, and the trend is very much toward smoke-free areas. The TTEP program shows smoke-free direction.” She noted that it was that Mille Lacs is a part of and supports that trend. essential to check in with tribal leaders, who had made the request to show the DVD. They all Keep talking, even if no one seems to be listening decided to move ahead to make it smoke-free, and Don’t get discouraged by a “no”. It may take many to play the DVD at the event. Because of the requests to get what you want, but then again, you success of the event, the Casino General Manager may be surprised by others taking action. decided to make the convention area smoke-free beginning in June, 2012. Type of Change: Social Norm Page | 2 Location of Change: Mille Lacs Grand Casino convention center Reach of Change: ~1,000 Band Members, as of June, all visitors Contact: Jaime Martinez at [email protected]
Woyake Hdutokça –Their Story-To Change for Yourself Community-led Tobacco Policy Successes in Native Nations
Smoke-Free Zones Adopted in Upper Sioux Community
The Community CHANGE Against this backdrop of previous secondhand In the early summer of 2012, Tribal Tobacco smoke policy advances, USC leaders approved SM Education and Policy (TTEP) Coordinator funding from ClearWay Minnesota and hired a Dominick Knutson received final approval from the community member, Mr. Knutson, to serve as Board of Trustees (BOT) -- the elected tribal TTEP coordinator for tobacco education and policy leaders of the Upper Sioux Community-- on several issues. With the support of his supervisor, the TTEP resolutions which expanded smoke-free spaces in coordinator went to bat for enforcement of the his community. Mr. Knutson had been working on existing smoke-free buffer zone for the this issue for many months - talking to colleagues, administrative building. He moved the smoking can presenting important information, gathering and picnic table away from the door, and though feedback from community some grumbling ensued, members and pulling together employees were now aware of documents to present to the the policy. Mr. Knutson provided policy makers of the Upper a strong case to the BOT to Sioux Community. Because of formalize the policy and they these efforts, the elected leaders agreed – it was added to the passed strong policies that employee handbook in November designated all offices to be 2011. smoke-free, and established a 25-foot buffer zone around tribal The TTEP Coordinator used this buildings and a 50-foot buffer success as a springboard to ask zone around playground facilities. Dominick Knutson, TTEP and Coco for a broader policy of buffer Villaluz, ClearWay MinnesotaSM zones around USC buildings and no Process of creating CHANGE smoking in all USC offices. He laid the The Upper Sioux Community (USC), or People of groundwork by partnering with the cessation the Yellow Medicine, returned to their ancestral coordinator to provide education to community homeland in the 1930’s after removal and attempts members, employees and leaders on the dangers of at extermination during the U.S/Dakota Conflict of secondhand smoke and the importance of restoring 1862. They received only 746 acres of their original traditional use. The TTEP coordinator also lands and the people struggled with poverty, hunger collected feedback and surveys from USC members and a lack of housing. USC members fought for a at several community meetings. Mr. Knutson better life and conditions have improved. The USC included the community input in the policy request now provides services to its members and employs preamble that he presented to the BOT in late numerous community members. November 2011.
USC has also made important strides toward The BOT gave initial approval but asked for creating healthier environments for its members: in additional information such as a map of the buffer the mid-1990s all buildings became commercial zone. The TTEP coordinator continued talking with smoke-free indoors in compliance with federal leaders, who decided to look closely at all policies. policy. More recently, the USC built an addition to Because of their concern for children, they not only their casino hotel, and designated the lobby and 76 formally approved a 27 foot buffer around buildings new hotel rooms smoke-free. and no smoking in casino offices, but also decided to expand the buffer to 50 feet around playground facilities. The policies took effect in July 2012.
Page | 1 Woyake Hdutokça –Their Story-To Change for Yourself Community-led Tobacco Policy Successes in Native Nations
Smoke-Free Zones Adopted in Upper Sioux Community
Strategies for creating CHANGE Importance of the CHANGE The Upper Sioux TTEP program used a variety of Evidence continues to mount on the dangers of strategies to create change: exposure to cigarette smoke. States with smoke-free laws have documented decreases in heart attacks Educating on why. Kevin Jensvold, BOT Chair, and emergency room visits; a 2013 study showed a noted that “this happened because of Dominick’s 19 percent reduction in emergency calls to smoke- efforts regarding continued education around the free casinos. With smoking rates harmful effects of not only over 50 percent, American smoking; but of second and Indians in Minnesota suffer high third hand smoke.” He noted rates of heart disease, cancer, how important it was because lung disease, asthma and SIDS. “one concern was for people The US Preventive Task Force who choose to smoke; putting states that creating smoke-free limitations on someone for environments is one the most their own choices. As Indian effective strategies for reducing people it is our way to respect harm from exposure and helping others’ choices. Efforts were people to quit. Resources made to educate community (www.keepitsacred.org) provide members as the data indicated “The strength for our tribe is to guidance for communities to use bigger pollutants were a greater provide an environment that is policy to improve the health of concern for everyone.” conducive to better health and also to their people. support our culture and traditions about using tobacco in a good way. A Beginning with an “easy” win weakness is the limitation on people’s Lessons Learned on CHANGE where you have support. Mr. choices. We have to understand and Tribal leaders care about Knutson worked with his commit to non-use.” community health. Leaders supervisor at the administrative Kevin Jensvold, BOT Chair welcome positive opportunities to building where he knew he had improve community health. support to begin policy work. Working on this level allowed him to learn about policy making process Educate before you legislate. With smoking rates but also about opposition that he would encounter over 50 percent, preparing the ground for the “why” when moving toward more smoke-free spaces. of policies is essential to address concerns.
Building on community connections. Upper Sioux Choose a “Messenger” who will resonate with the is a small community, and the coordinator was able community. At Upper Sioux, the policy request to connect with his fellow USC members with came from a community member who had a cultural knowledge and in leadership positions. He personal passion for how tobacco should be used also collaborated on educational events with other for healing not harm. staff working in substance abuse and tobacco.
Be persistent. As the BOT Chair stated “It was Getting community feedback. Upper Sioux leaders good that [Dominick] was persistent because he want to know their community member opinions. kept it moving.” While patience is a virtue, because Collecting input through community discussions there will be delays, persistence is a necessity. and surveys provided useful information and results were actually included in the policy language itself. Type of Change: Formal Tribal Policy Location of Change: Upper Sioux Tribal Buildings & Offices Reach of Change: 60 employees (plus building visitors) Page | 2 Contact: Jaime Martinez at [email protected]
Aanji Aadizookaanag - Change Stories Community-led Tobacco Policy Successes in Native Nations
Bois Forte Protects Children with Smoke-Free Foster Care
The Community CHANGE a forum on tobacco sponsored by TTEP. As a foster On a cold winter’s day in early January, 2011, elder parent, she had learned that a neighboring county Marybelle Isham approached Daanis Chosa, then no longer allowed smoking in foster homes. She serving as Tribal Tobacco Education and Policy suggested that TTEP investigate this policy to see if (TTEP) Coordinator, at a community fundraiser. it could fit for Bois Forte. During 2012, Ms. Chosa Marybelle cares deeply about the children of the followed up on investigating policy options, and tribe, and worried that those in foster care were continued to provide education to tribal members, being exposed to toxic secondhand cigarette smoke. including growing concerns about the dangers of She was hoping that the TTEP program could do thirdhand smoke, the toxic residue from cigarettes something about it. Indeed, the TTEP program did that clings to materials in homes and cars. do something about it, and although it took more than two years, it was something She worked with Bois Forte very big. In July 2013, Bois Indian Child Welfare (ICWA) Forte passed a resolution making staff to hear their concerns and all foster homes smoke-free, discuss ideas for potential becoming the first tribe in policies. While they expressed Minnesota to have foster care concern about the shortage of protection in place. The Native homes available, health resolution also put them ahead of concerns took precedence. Ms. the state of Minnesota, whose Chosa gave a special presentation legislators were just beginning to to ICWA staff on effects of consider regulations on smoke-free secondhand smoke on children, Supporters: ICWA homes in April 2014. Supervisor Angela Wright (l) including SIDS and other and Tribal Councilwoman conditions. ICWA staff supported This momentous policy change was part Karlene Chosa (r) the effort, and provided a list of of a larger arc of action that began in the early contacts for other agencies to query about policy. 1990s to protect Bois Forte tribal members from No other tribe in Minnesota, and few counties in the secondhand smoke, starting with tribal buildings area, had yet created such a policy, so Ms. Chosa going smoke-free indoors. The groundwork for this expanded her search and asked for help from and subsequent community change has been ClearWay Minnesota technical assistance providers. spearheaded by champions including Marybelle Isham (mentioned earlier), Lester Drift, an elder After Ms. Chosa left TTEP in summer 2012, the who vocally supports restoring traditional tobacco program had a time of transition. But activity came and reducing secondhand smoke, Jeneal Goggleye, back strong in spring 2013 with the hiring of a new Health Commissioner, who was a prime force in TTEP coordinator, Donna Hoffer, who was passing initial secondhand smoke policies for the seasoned in tribal human services and policy work. tribe and elected leaders such as Cathy Chavers and She began by meeting with the ICWA staff to Karlene Chosa, who attended forums and supported introduce herself and ask for their support and policy change on restoring traditional tobacco and partnership. She wanted to find out about the issues, reducing harmful secondhand smoke. asking “how is this going to affect ICWA in the bigger picture?” To this end, she attended a regional Process of creating CHANGE ICWA workshop and spoke with other tribal staff, who were encouraging and gave her confidence to The TTEP program expanded upon earlier continue. Ms. Hoffer contacted Bois Forte ICWA accomplishments to protect tribal members from secondhand smoke exposure. After achieving their staff about moving ahead, and together they discussed how to handle the issue of smokers. To first priority to pass a smoke-free buffer zone in give smokers time to adjust to the change, they summer 2011, Ms. Chosa placed the smoke-free foster care policy on her annual workplan. In decided standards would apply at the next renewal date. ICWA staff offered to discuss the policy with December of that year, Marybelle Isham brought families to prepare them for such a change. the issue to the attention of the larger community in
Page | 1 Aanji Aadizookaanag - Change Stories Community-led Tobacco Policy Successes in Native Nations
Bois Forte Protects Children with Smoke-Free Foster Care
Ms. Hoffer prepared a tribal resolution by first Strategies (continued) getting copies of current standards and codes from Asking for Help. TTEP looked to internal and her ICWA colleagues. To insure that she would be external resources for help, including tribal well prepared, she reached out to two resources: the attorney, a policy institute, technical assistance Public Health Law Center and tribal attorney Mark providers, regional ICWA and foster care agencies. Anderson. Mr. Anderson helped her answer important questions on developing a complete and Communicating. TTEP kept up strong accurate resolution to present to the Council. After communication with ICWA. They asked for their review by ICWA staff and approval from the Health input on implementation and worked together to Commissioner, Ms. Hoffer sent the resolution to be review policy. As a strong partner, ICWA agreed to placed on the Tribal Council agenda. At the notify and work with families to eliminate smoking. hearing, she was prepared with background research. ICWA staff came as backup, but the Importance of the CHANGE resolution passed unanimously after only one Evidence continues to mount on the dangers of question on how many would be affected. exposure to commercial tobacco smoke, especially for children. Children are particularly vulnerable to Strategies for creating CHANGE the effects of secondhand smoke because they are The Bois Forte TTEP program used a variety of still developing physically, have higher breathing strategies to create change: rates than adults, and have little control over their Acting on community concern. TTEP built on the indoor environments (www.epa.gov/smokefree). concern expressed by a community elder. Children exposed to high doses of secondhand smoke are much more likely to experience serious Doing homework. The TTEP coordinators took time health conditions or consequences such as weak to find out about the ICWA lungs, asthma, infections, SIDS and program, research policy options “Don’t be afraid to make diabetes. Bois Forte continues to have and consult with tribal attorney. changes – these are our kids, very high smoking rates (57 percent) we don’t want them to have among its tribal membership. Smoke- They also came prepared with asthma and other health facts for the tribal council meeting free foster homes not only protect problems.” children from harmful smoke, but also when the policy was reviewed. Donna Hoffer, TTEP Coordinator role model not smoking as a social Building Strong Partnerships. TTEP coordinators norm in a community with high smoking rates. worked with the program directly affected by the potential policy change to learn more about their Lessons Learned about CHANGE work and concerns. ICWA Supervisor Angela Change from within. The issue of smoke-free foster Wright noted that they struggle to find American homes came from a concerned elder. Community Indian families and have many other policies to ownership of change and participation in change is implement, so having a strong partnership where critical in Native communities, where change has TTEP assists with follow-up and implementation often been forced from the outside at great cost. makes the policy change more “doable” for ICWA. Create a strong community presence. Tribal Educating. The TTEP program took advantage of members, elected officials and departments listen opportunities to teach community members about when it comes from credible, tribally-based sources. the health dangers, attending health fairs, diabetes TTEP provided a local educator using multiple event and powwows, and organizing community- venues to build a case for community change. wide events. Karlene Chosa, tribal council member, praised the role of education, saying TTEP does Be well prepared for policy “ask”. Tribal council leaders are impressed when advocates come “an outstanding job, dedicated to getting information to prepared and have completed the necessary steps to the people…which makes it easier on leaders. They pave the way with facts to back up policy change”. bring a solid resolution for consideration. Type of Change: Formal Tribal Policy Location of Change: Bois Forte Foster Homes Page | 2 Reach of Change: Average 7-8 families annually with 11 children Contact: Coco Villaluz, ClearWay MN 952-767-1409 Aanji Aadizookaanag-Change Stories Community-led Tobacco Policy Successes in Native Nations
White Earth Plants Sacred Gift of Asemaa (Traditional Tobacco)
The Community Change of the spiritual leaders of the White Earth Nation. On a warm and blustery day in the summer of 2014, “We will always have a great respect for the many Gina Boudreau pulls up to the White Earth different blends we use as long as it is used with the Government Center and walks over to the raised best intentions.” bed garden box at the entrance. She takes a few moments to say hello to the asemaa plants (known Ms. Boudreau recognizes that not everyone abuses as tobacco to non-Indians) which she had planted in tobacco—some simply carry what they have access early summer, pulling a few weeds that had come to for spiritual use. “Asemaa was used daily by our up beside them. Gina worked ancestors in thanks for this sacred gift given to us. with tribal maintenance to build We understand that the use of the asemaa garden at the request commercial tobacco is harmful and of Chairwoman Erma Vizenor, has caused great damage to the who supports Gina’s vision to health of our people,” says Ms. share the gift of asemaa with her Boudreau. She knows that her role community as a significant part can be to help people reverence and of her work as the Tribal use asemaa in the way of the Tobacco Education and Policy ancestors. “The community needs to (TTEP) Coordinator at the be reminded that we still carry that White Earth Health Department. knowledge on how we use this The raised bed accompanies medicine in a good way.” Her first beautiful signs announcing “no step was to talk to spiritual leaders smoking—keep tobacco sacred” and elders and remember herself for employees and visitors to that “even though we may feel the Government Center. TTEP Coordinator Gina Boudreau at the asemaa unsure about the offering or use of garden at the White Earth Government Center. this sacred medicine we have to Process of creating Change start somewhere and that is to White Earth is the largest Nation of Anishinaabe approach with the best of intentions.” She spent (Ojibwe) in Minnesota, with over 19,000 members. time learning from Frank Stech, a good friend, co- The reservation is located in the woodlands and worker and spiritual leader from White Earth open prairies of northwestern Minnesota, spreading Nation, and Sharon Day of Indigenous Peoples out over three counties. In 2010, the total Task Force, who gifted her with asemaa seeds that population of the reservation was 9,188 people, of had been saved for generations by sister tribes from which 44% (4,029) were American Indian. The the East. Ms. Boudreau asked tribal leaders and majority of the American Indian population resides members for space and equipment for gardens, in five tribal villages—several of these villages are since TTEP funding does not cover these costs. 50 to 60 miles apart. Jean Dakota, a member of the White Earth Tobacco Tobacco was pure long ago when our ancestors Coalition led by Ms. Boudreau, notes “It was a used it. Over time big tobacco companies started learning experience for both of us to plant the seeds. altering it, causing users to become highly addicted. Over the next couple of years, we began to learn For the White Earth Ojibwa, asemaa is the gift better how to grow them, and what the process is. received from creator, considered the most We’ve gone from novice to pros now!” During this powerful gift next to life and used to communicate time, Ms. Boudreau also reached out to the with the creator, to give thanks for everything in community and shared what she was taught about creation, for prayer and ceremonies. During traditional asemaa. She networked with everyone colonization, the U.S. government outlawed from the police to youth groups. “She taught a lot of ceremonies—and the use of asemaa—as part of us about the difference between traditional versus their campaign to “kill the Indian, save the man.” commercial tobacco” Ms. Dakota explained “Gina However, the Native American people “never lost works in a very respectful way, not harming anyone their asemaa traditions, we always had it,” says one or being negative about others in the process.”
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Aanji Aadizookaanag-Change Stories Community-led Tobacco Policy Successes in Native Nations
White Earth Plants Sacred Gift of Asemaa (Traditional Tobacco)
After learning themselves, the coalition encouraged Vizenor noted about others to grow asemaa to widen the circle—White the tobacco garden, Earth now has around 20 growers! Darla Kier, a “Sometimes when we community member who received seeds from Ms are in a place and want Boudreau, has been growing for about 4 years. “I to offer tobacco, we pass what I have on hand so other people can then will run around and ask share.” She gives extra seeds to family and friends for a cigarette. But we and uses social media to offer seeds to other want to go back and interested brothers and sisters to grow for practice our traditional ceremonies and offerings. way—not just talking about it but doing it.” Erma Vizenor, Tribal Chair, supports asemaa tradition All this has increased use of asemaa. Jean Dakota Change social norms. explains “We’ve had people request help planting Ms. Boudreau and her coalition gently but the seeds to use in prayers. People will bring it up in determinedly work to create a new social norm. conversation – they were surprised to learn that we This means being a presence in the community could grow our own tobacco. They are more in while educating about and sharing their asemaa. touch with the sacred side of tradition… being Key leaders recognize the central role of social aware of how the seeds came to us, almost makes norms, including Chairwoman Vizenor, who says, them scared to plant them, because they are so “We set the example.” This includes special, and so beautiful.” Her not only gardens, but also policies to substance abuse program is reduce secondhand smoke. considering gardens as part of addressing tobacco addiction. The TTEP project has enough Importance of the Change tobacco now to offer birch Mainstream prevention efforts have bark baskets of asemaa to not been effective – witness the families for their funerals or alarmingly high smoking rate of 57% feasts. Someday, they would Jean Dakota and Gina Boudreau care among Minnesota American Indians. like to have enough available for their tobacco plants As noted by the World Health to replace the pouch tobacco currently used at their Organization and the Centers for powwows. Coalition members hope that the tribal Disease Control, the community context council will provide land and resources for gardens, (www.cdc.gov/socialdeterminants) must be considering them as part of the tribal landscaping. addressed to reach equity. This means drawing on cultural strengths, in this case asemaa tradition. Tribes in Minnesota will build on their traditional Strategies for creating Change use of asemaa to reduce tobacco abuse. White Earth used three strategies to create change:
Increase awareness. A resurgence of cultural Lessons Learned about Change knowledge is revitalizing tribal communities. Many Bring others into the work. Getting coalition community members are hungry for the teachings; members involved not only helps build skills for curiosity is brewing now and we do our best to gardening but also expands the circle of tradition. share the teachings. Our tobacco coalition members continually outreach and educate. Patience and persistence. Just like growing asemaa, Increase availability. Talking about asemaa is creating a shift in social norms takes many steps— important, but having the plant itself, rather than the nurturing tiny seeds that take time to grow—they commercial tobacco substitute, is priceless. When must be watched over, watered and fed with care. people receive asemaa, it is a powerful experience. Ms. Boudreau is making small strides toward Just get started! Knowledge of asemaa has been increasing the amount of asemaa available by building but more needs to be regained. Don’t be mentoring community members who agree to take afraid to ask questions and share knowledge—you on the responsibility of growing asemaa. As Chair will mistakes but from them comes great learning. Page | 2 Type of Change: Environmental Change Location of Change: White Earth Nation Reach of Change: Families and event participants Contact: Coco Villaluz, ClearWay MN 952-767-1409 Aanji Aadizookaanag - Change Stories Community-led Tobacco Policy Successes in Native Nations
Fond du Lac Protects Members with Smoke-Free Powwows
The Community The smoke-free powwow work CHANGE expanded upon this earlier A beautiful sunny day was accomplishment. Roberta dawning on the Mash- Ka-Wisen focused on being a visible Powwow grounds in Fond du presence at community events Lac. Greetings of boozhoo and providing one-on-one (hello!) filled the air as old education to key informal and friends and family found each formal (elected) tribal leaders. other as the gathering of relatives She conducted outreach at swelled to over 1,000. Roberta smaller indoor powwows Marie, Tribal Tobacco Education sponsored by the FDL and Policy (TTEP) coordinator, Department of Natural stood at the entrance to the Resources (DNR) in January and powwow and smiled a big smile. The day she had the tribal school in May. The TTEP program worked so hard for had finally arrived – the sign let supported these important community events powwow dancers and spectators know that the time through financial sponsorships and material had come to put away cigarettes and use tobacco in donations, which helped to create stronger the traditional way. The 22nd annual Veteran’s partnerships. For example, Roberta was invited to Powwow in July 2015 had been designated smoke- speak at the opening of the DNR powwow and used free, signs had been well-placed by the hard the moment to share her personal story and concern working maintenance crew and the MC was ready about the danger of commercial tobacco and the to make announcements about the new policy importance of traditional use. throughout the powwow weekend. Roberta was proud that the TTEP program had donated the TTEP also paved the way for smoke-free signage in Ojibwe as well as two blankets being community powwows by visiting the FDL veteran’s gifted at the powwow to honor the family members group, sponsor of the main summer powwow. As a of a WWII Ojibwe Code talker. veteran herself, Roberta was a great messenger to share information on the Process of creating newly passed smoke-free policy and promote the ideal of traditional tobacco CHANGE use. She found opportunities to connect This remarkable social norm one-on-one with Veterans’ officers at change was the next big step in a community events to introduce the idea series of community changes that of a smoke-free powwow arena. Roberta began nearly fifteen years ago also organized community education by when Nate Sandman, Fond du Lac Jarvis Paro and Roberta Marie spiritual leaders on traditional tobacco. (FDL) health educator, started “People may oppose it, but in In June, she sponsored a traditional work to address high rates of the end, you care about your tobacco harvesting workshop and sat commercial tobacco use (60%). people and want to help them – a smoke-free powwow is a beside Jarvis Paro, her former student, After a decade of laying a strong small, yet huge way to do it” staff for the tribal cultural program and foundation through promoting Jarvis Paro coordinator of the Veterans’ powwow. culturally-relevant cessation, Mr. He was supportive of a smoke-free Sandman felt the tribe was ready to address policy. powwow and took the idea to his committee. He received funding for the TTEP project funded Roberta followed up a few days later, bringing her by ClearWay Minnesota and hired Roberta Marie, a famous cupcakes as a thank you. She soon received respected tribal member who had previously the good news that the powwow would be smoke- worked as a cessation outreach specialist. She was free for the first time ever. Roberta didn’t rest on well equipped to step up the relationship building this good news however, and worked diligently required to address norm change for the tribe. In with powwow staff to ensure that signs would be up February, Nate and Roberta had achieved their first and the MC was ready to make announcements. priority to pass a smoke-free tribal building policy.
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Fond du Lac Protects Members with Smoke-Free Powwows
Jarvis was a true champion for this change. As he Visibility and Persistence. The TTEP program traveled around the rez, he saw the signs continued to be a presence at community events. announcing his tribe’s decision to create smoke-free They reached tribal members and leadership with areas. He noted on his visit to the Bois Forte messaging on the importance of creating smoke- powwow that they had gone smoke-free and free policies and restoring traditional tobacco. promoted traditional use. He shared his thoughts: Communicate, Follow-up and Provide Support. Why should I have to sit with my babies and they Roberta followed up after conversations with breathe other people’s smoke? In our culture, decision-makers and could be counted on for tobacco is huge – at cultural events, within ceremonies and funerals – tobacco is always logistical support, including signs and ashtrays. there, but people aren’t separating cultural vs. Prepare for the Change. Jarvis noted how important commercial use. But we can teach people that we it was to communicate well and work to prepare have a spiritual connection to tobacco, so we staff and visitors for the change in smoking rules. have to separate commercial from traditional tobacco. With Roberta’s help, I felt we could do it. Importance of the CHANGE After the powwow, Jarvis was pleased that people Evidence continues to mount on the benefits of had respected the new rules, and even let him know creating smoke-free policies to reduce the harms that they smoked less. He had helped people caused by commercial tobacco smoke. understand the difference of traditional use as an (www.thecommunityguide.org/tobacco) Reducing offer of prayer to the Great Spirit. exposure, especially for children and elders has
many benefits, including reducing acute heart and As a savvy strategist, Roberta asthma attacks. In addition, creating decided to jump on the momentum more smoke-free spaces helps people and ask Jim Mallery, director of the quit. This is particularly important in chemical dependency center and FDL, where over 50 percent of tribal sponsor of a major powwow, if he members still use cigarettes. Making would follow suit. Unsure if this popular community events smoke- could work, he took a “wait and see” free, such as powwows, not only approach and brought his mother to protects children from harmful the Veterans’ powwow to check it smoke, but also role models not out. After seeing how well it worked smoking as a social norm in this and how they no longer had to community with such high smoking breathe toxic smoke, he declared his Roberta Marie with Jim Mallery rates. powwow would also go smoke-free.
Lessons Learned about CHANGE Strategies for creating CHANGE Reach the heart of tribal leaders. Children and The Fond du Lac TTEP program used a variety of elders are the heartbeat of tribal life, and protecting strategies to create change: them resonates with tribal and community leaders. Relationship Building. Roberta Marie played a key Build trust and a “will do” reputation. Tribal and role by identifying leaders and decision makers in community leaders knew Roberta and had seen her the community. She took time to personally share positive and effective work. They trusted that if she the message of TTEP and encourage them to take was on board, things would get done in a good way. action. (Plus she brought custom-made cupcakes!) Sponsorships to Build Strong Partnerships. TTEP Jump on the momentum. When one leader steps up, leveraged their resources to provide financial look for other opportunities – at FDL, Roberta was support to important community programs and able to get two powwows for one! events, which often struggle for funds to provide Use the tribal approach. Support everyone’s efforts meals for tribal participants. Sharing resources to improve health and wellness, engaging the tribal helps show that TTEP is serious about cultural value of the circle that everything is related. restoration and supporting community well-being. Type of Change: Formal Powwow Policy Location of Change: Fond du Lac Veterans and CD powwows Reach of Change: 1000-5000 participants per weekend day Page | 2 Contact: Coco Villaluz, ClearWay MN 952 -767-1409