The American Lung Association of the Northeast Tribal Success Story

Waponahki Tribes in Maine:

• Aroostook Band of Micmac Indians
• Houlton Band of Maliseet Indians
• Passamaquoddy Tribe of Indian Township
• Passamaquoddy Tribe of Pleasant Point
• Penobscot Nation

The American Lung Association of the Northeast:

• Patricia Knox-Nicola, Program Manager
• Lee Gilman, ALANE Senior Director, Health Education

The Maine Tribal Public Health District:

• Clarissa Sabattis, Director
• Kristi Ricker

The State of Maine CDC Office of Minority Health:

• Lisa Sockabasin, Director

Summary:

The five Maine Tribal communities, Aroostook Band of Micmac Indians, Houlton Band of Maliseet Indians, Passamaquoddy Tribe of Indian Township and Pleasant Point and the Penobscot Nation,  are experiencing a smoking rate in the adult population 18 years and older of 51.5 percent. The Tribal Leaders of all four Tribes have determined that this extremely high smoking rate is a primary health concern. The communities each have health programs that have provided smoking cessation and prevention education in various accepted methods for many years yet the smoking rates have not decreased. To address this high smoking rate a decision was made that a different approach was needed as cessation and prevention education had not been effective in decreasing the smoking rates. The Leadership Committee, composed of the Health Director from each Tribal community, the Project Co-Coaches, the Director of the Maine Tribal Public Health District and the Director of the Maine CDC Office of Minority Health, completed a community action plan and a decision was made to involve the youth as they are the future Tribal Leaders. The youth were given the challenge to create a video that would be presented to Tribal Leaders that would demonstrate that smoking was a concern to youth and that they prefer to see changes in the way that smoking is controlled in each community.

Challenge:

The five Maine Tribal communities are located in Aroostook County, Washington County and Penobscot County. These counties are located in northern and northeastern Maine and are very rural counties with high unemployment rates. Due to the lack of accurate health data on the Tribal populations, the five Tribal Health Programs completed a comprehensive health needs assessment, Waponahki Health Needs Assessment 2010. The survey documented a smoking rate of 51.5 percent in adults 18 years and older and that Tribal adults are 2.8 times more likely to smoke than adults in the State of Maine. This finding was significant due to the fact that the Tribal Health Programs have been focusing on smoking prevention and cessation for the past 15 to 30 years.

The Maine Tribal Leaders determined that commercial tobacco abuse was a priority in all Tribal communities. The challenge for the Tribal Health Programs was to initiate a prevention, cessation, education activity that would be effective in the Tribal communities. Many different cessation and prevention programs had been offered previously but had been unsuccessful in reducing the smoking rate long term. These interventions included developing guidelines for no smoking areas around public buildings and on the grounds of the community schools. However, due to the lack of enforcement and the lack of Tribal leadership support there was smoking immediately in front of the signs, cigarette butts were actually left on the no smoking signs and the ground surrounding the signs was littered with butts and empty cigarette packages.

Solution:

The Leadership Committee determined that the focus of the new commercial tobacco abuse initiative would be based on increasing the number of outside venues and events that are smokefree. The focus would be trying to set limits on the number of areas where smoking is currently occurred. It was determined that the Tribal Leaders would better hear the concerns of tribal youth, the future Tribal Leaders, then to continue to hear the voice of the health programs.  Youth, ages 8 to 18 years, were asked to make a video of smoking in their respective communities and how they viewed smoking.

As one of our youth said, "We can't tell someone not to smoke but we can tell them that they can't smoke here."

Results:

The youth teams were provided with equipment to enable them to develop a video that included how they felt about smoking in their community. The results were five very different approaches to how these youth saw smoking in their community.

During the time the videos were being made, the Health Directors and other project leaders hosted education sessions with the Tribal Leaders. These education sessions were centered on the need for Tribal Leadership to become involved in changing the "community environment" in regards to health disparities. The Tribal Leaders were provided education on the social determinants of health and that it takes more than available health care to impact the overall health of a community.

The five videos were presented to the Tribal Leaders with the youth who made the videos present. The youth were given the opportunity to speak with the Tribal Leaders directly and the Tribal Leaders had the opportunity to ask questions. During this conversation period, the Tribal Leaders spoke to the issue of developing enforceable guidelines to increase the number of smokefree venues and events in the tribal communities.

Future Directions:

The next steps will be to have the videos made into a 5 minute public service announcement (PSA) that may be used on closed circuit television and Tribally-owned television stations for education purposes. The PSA will be distributed to the CDC and the American Lung Association for use by other Tribal programs as an education tool. The Maine Tribal Public Health District, as part of its program, will continue to work with the Health program to provide smoking cessation and prevention education as well as with the Tribal Leadership to develop a vision for a healthy community.