Resolutions and experiments for a new year - help to quit smoking in Indian country

Op-ed by Mark Trahant

This  New Year I am experimenting, instead of resoluting. (I know, it’s  not a real word. But it just sounded right.) I’m interested in how  technology can play a role in behavior change, how to eat less, drink  enough water, exercise more, and sleep better.

The  tool I’m playing with is called a Fitbit. I’ll write more about that later, but  it’s already interesting because it measures steps, your sleep pattern  (although I am quite ready to argue about falling asleep in the chair  while watching TV. The device (and my family) says “yes,” but I  know better.

I  see how this technology could be helpful to wellness programs. Sunday  I walked 11,289 steps (not quite 3 miles), consumed more than 2,000  calories and slept 8 hours, waking up 7 times during the night.

We  change what we measure – and that includes our own behavior. Just  by watching my personal data, I am inclined to walk more and eat less.

But  that’s only part of what could make Fitbit important to a wellness  routine. Part two will come when others I know are on the system and  add their stats through social networks. Think of a community of folks  who are rooting for your success, for your better health, as you urge  them forward.

This  is more experiment, than a resolution. But this is the season for resolutions  – and for many that means it’s time to quit smoking.

A story in Indian Country  Today reported about  the Tulalip Tribe’s tobacco cessation effort. “Here at Tulalip and  throughout Indian country we face an uphill battle in addressing use  of tobacco. Some tobacco companies use Native American images and cultural  symbols in their advertising, such as warriors, feathers, and regalia.  They also slip in words like ‘natural’ in the brand names to build  image, credibility and sales within the Native American community,”  Mel Sheldon, chairman of the Tulalip  Tribes, told the newspaper.

I  also like the innovative program run by the California  Rural Indian Health Board–  Keep Tobacco Sacred – because it reminds people about the traditional  protocol for tobacco (instead of its recreational and commercial uses).

Smoking  is a significant health concern for Indian Country. About a third of  all American Indian and Alaskan Natives are smokers, according to the National Tribal Tobacco  Prevention Network. It  represents the highest use rate for commercial tobacco in every  age, ethnic and gender category in the U.S. We die in greater numbers  because of tobacco use.

And  it’s not just the act of smoking itself. Smoking complicates the management  of chronic diseases, including diabetes.

But  this is a complex problem for tribal leaders because some tribal enterprises  depend on the sales or use of tobacco. Smoke shops are a source of reservation  capital and jobs and tribal casinos market to smokers in states where  other casinos, bars and just about any facility open to the public is  smoke-free.

Unfortunately  it’s better for the casino business when there’s smoking. Even the  casinos with separate non-smoking facilities find that people gamble  significantly more per hour on the smoking side than in the non-smoking  areas.

But  what if the incentive framework was changed? What if the entire country  – tribal casinos and their competitors alike – went non-smoking?  That sounds far-fetched because the economics of a casino make this  problem seem intractable.

But  then again Indian Country has another history.

It  turns out the Indian Health Service was one of the first hospital systems  to go entirely non-smoking in 1985. “In late 1983, the PHS Indian  Hospital on the Hopi Reservation at Kearns Canyon, Arizona, became the  first to reach this goal,” the Centers  for Disease Control said in a 1985 report. “Now, virtually all IHS facilities have become smoke-free.  In addition, this initiative led to a smoke-free policy in the American  Indian schools on the Navajo Reservation at Zuni, New Mexico.”

We  don’t think of smoking at a clinic any longer. Could that be how we  think of casinos one of these days? Some resoluting might be ahead.

Mark  Trahant is an advisory board member of InvestigateWest and a Kaiser Media Fellow examining the Indian Health Service  and its relevance to the national health care reform debate. He is a  member of Idaho’s Shoshone-Bannock Tribes.