While the reduction in the overall U.S. smoking prevalence has been declared one of the top 10 public health achievements of the past century, the growing disparity in smoking between American Indians and the general population is one of the biggest challenges of the 21st century. Minnesota in particular has very high smoking rates among American Indians (59%). Tribal Nations in Minnesota share a past of attempted cultural genocide and a present of restoring the strength of their cultural teachings, including the prominence of traditional tobacco as a sacred "first medicine." The Tribal Tobacco Education and Policy initiative works to address this complex and challenging context. This article describes results of a participatory evaluation from 2010 to 2013 in four Minnesota Tribal Nations-three Ojibwe and one Dakota. Tribal Tobacco Education and Policy coordinators used their cultural knowledge to develop community-level strategies, identifying appropriate strategies from best practices on tobacco advocacy, while drawing on the strengths of their own sovereignty and sacred tobacco traditions. Tribal coordinators generated support for policy change by conducting culturally relevant education, engaging tribal members, and nurturing relationships. This approach resulted in norm changes, practices toward restoring traditional tobacco, informal policies, and tribal resolutions to advance smoke-free policies.
Keywords: Native American/American Indian; advocacy; environmental and systems change; health disparities; health promotion; international/cross-cultural health; lay health advisors/community health workers; public health laws/policies; social determinants of health; tobacco prevention and control.