The Tribal Tobacco Policy Project: Working with Northwest Indian Tribes on Smoking Policies

Background. This article reports on the objectives, study design, intervention methods, baseline results, and process data from a trial involving 39 Northwest Indian tribes. Methods. Tribes were stratified and then randomized to either early or late intervention conditions. Intervention consisted of a consultation process to assist tribes to review and modify existing tobacco policies or to develop new policies relevant for their tribe and that protect tribal members from environmental tobacco smoke. Outcome measures consist of: (a) phone interviews to assess the comprehensiveness of tribal tobacco policy, (b) surveys of tribal leaders to assess norms and attitudes regarding tobacco use, and (c) observations of tribal settings to assess policy implementation and indicants of tobacco use. Results. Early and later intervention tribes were well matched on baseline measures and tribal characteristics potentially related to policy outcomes. There was considerable variability across tribes on all measures though, in general, tribal leaders expressed support for more stringent tobacco use policies. Process data indicated that early intervention tribes strengthened their tobacco policies, but generally did not do so through tobacco policy committees as originally envisioned. Conclusions. There is good potential for tobacco policy interventions with Indian tribes. Consultation processes and products, such as policy guidebooks, that are sensitive to traditional uses of tobacco and 60 differences among tribes can help to modify policies to reduce exposure of tribal members to environmental tobacco smoke.