Perceptions of ceremonial and nonceremonial uses of tobacco by American-Indian adolescents in California.

BACKGROUND: American-Indian adolescents have the highest tobacco use prevalence of all ethnic groups in the United States. Although much has been written about the role of tobacco in traditional Native-American cultures, little is known about modern-day perceptions of tobacco among American-Indian adolescents.
METHODS: This study conducted focus groups of 40 American-Indian adolescents in urban and rural areas of Southern California. Participants discussed the role of traditional ceremonial tobacco use in their lives, the use of commercial tobacco as a substitute for sacred tobacco, the perceived safety of traditional versus commercial tobacco, and the perceptions of American-Indian imagery in tobacco advertising.
RESULTS: Many American-Indian adolescents may be introduced to traditional tobacco use at early ages. Smoking is viewed as a sign of respect for the elders, but there are acceptable ways for adolescents to participate in ceremonies without inhaling smoke. Commercial cigarettes often are substituted for homegrown tobacco at ceremonies and events. Traditional tobacco was perceived as less dangerous than commercial tobacco because it does not contain chemical additives. However, respondents still perceived that smoking traditional tobacco and breathing tobacco smoke conferred health hazards. Participants found the use of American-Indian imagery in tobacco advertising offensive and stereotypical. Indian casinos were mentioned frequently as places where smoking occurred.
CONCLUSIONS: Continued health education efforts are needed to decrease habitual use of commercial tobacco products and secondhand smoke exposure among American-Indian youth. Further research is needed to identify ways for American-Indian youth to participate in their cultural traditions while minimizing their risk for tobacco-related diseases.