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American Indians Hit Hardest By Tobacco Costs

Smoking costs American Indians in California $795 million a year in health care and lost productivity, according to a report released yesterday by researchers at UCLA.

By analyzing census figures, government health data and economic consequences of smoking cigarettes, the UCLA Center for Health Policy Research estimated that smoking cigarettes comes with an average annual price tag of $1,076 per American Indian in California.

More Native Americans – nearly 739,000 – live in California than in any other state. They make up just 2.1 percent of the state’s population, but they account for 4.4 percent of its $16.3 billion smoking cigarettes-related costs, researchers found. The disproportion reveals holes in access to health care and cultural complications in cessation campaigns.

Nearly 20 percent of the state’s American Indian adults currently smoke, and more than one in four used to smoke. The rates are among the highest of all racial and ethnic groups, but Native populations are less likely to have health insurance, the report found.

Forty-one percent in the state are covered by their employers, compared to 67 percent of whites with job-based insurance. The majority of Native Americans in California – 90 percent – cannot access Indian Health Service here because their tribes’ reservations are in other states.

Even for those whose reservation is in the state, California’s vast geography may mean the services are beyond their reach. About two-thirds of American Indians in the state live in urban areas.

As a result, many Native Americans do not have the resources or support to address tobacco-related illnesses – the single most preventable cause of premature death in the country, according to the U.S. Centers for Disease Control and Prevention. Nineteen percent of American Indians in California say they lack a regular health care provider.

In addition to the direct health costs of smoking cigarettes, researchers calculated productivity lost due to smoking cigarettes-related illnesses among California's Native population. Among the costliest conditions:

* Trachea, lung and bronchus cancer: $84.5 million
* Ischemic heart disease: $58.3 million
* Chronic airway obstruction: $60.8 million
* Stroke: $11.1 million

California American Indians ages 25 to 39 have the highest smoking cigarettes rate (23 percent). As these smokers age, their health and economic burden will increase, said Delight Satter, the report’s lead author and a member of the Confederated Tribes of Grand Ronde, Ore.

However, researchers noted that the cost of smoking cigarettes was not always financial.

"Older members of the family and community are called upon to pass on important traditions, knowledge and history to the younger members," the report said. "The loss of cultural capital due to death could be even higher than the human capital loss … or actual spending on health care."

In many American Indian tribes, tobacco is one such tradition. It has a medicinal and sacred use in prayer and other ceremonies.

"The tobacco industry is aware that Natives have a sacred value and a sacred relationship with tobacco, and they exploit that cultural value in marketing campaigns," Satter said.

Used moderately in Native tradition, smoking cigarettes tobacco did not always pose the health risks seen today. But with little or no access to natural tobacco plants, many American Indians have turned to commercial tobacco, she said.

“Commercial tobacco is not the same as the original plant. It’s got additives, carcinogens and toxins added to it,” she said.

Native communities must do more to separate these types of tobacco, Satter said. The report includes measures that could reduce commercial tobacco use, including implementing tribal policies that regulate tobacco advertisement, availability and taxes. Community education and social marketing interventions are also suggested.

“I’m quite sure Natives would readily choose a traditional plant over a commercial tobacco,” Satter said. “You can still promote sacred use and cultural identity at the same time you can say, ‘Be healthy and stop commercial tobacco use.’”




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