Circles of Tobacco Wisdom: learning about traditional and commercial tobacco with Native elders

Am J Prev Med. 2012 Nov;43(5 Suppl 3):S222-8. doi: 10.1016/j.amepre.2012.08.003.


Background: Circles of Tobacco Wisdom (CTW) was an elder-led, community-based project that aimed to enhance tobacco control in the American Indian community. Its goal was to provide elders with the knowledge, opportunities, and support to enable them to assume leadership of a tobacco control movement that was grounded in the ceremonial traditions of tobacco use.

Purpose: The purpose of this study was to test the effects of the pilot intervention on participants.

Design: The design of this pilot study intervention was a single group, pre-post comparison, with a pre-post survey, monthly check-ins, and a post-1-year focus group.

Participants: Twelve elders were included in the pre- and post-analyses. All twelve elders were women who self-identified as American Indian (mean age = 64).

Intervention: The CTW elders participated in monthly talking circles, quarterly learning sessions, and a post-1-year focus group, and took part in other learning, support, and community action opportunities. Data were collected from December 2008 through November 2009 and analyzed throughout the process.

Main outcome measures: American Indian Elders' tobacco-related knowledge, perceptions, beliefs, and behaviors were measured while participating in the CTW project.

Results: Knowledge, perceptions, beliefs, and behavior changes were seen with cigarette smoking, secondhand smoke, and ceremonial tobacco use and risk perception. After 6 months, the number of people the elders had talked with about tobacco increased, elders were more likely to have a discussion on tobacco at a community event, and their comfort level talking about commercial and traditional tobacco also increased. A number of themes also were identified in the focus group: feeling more comfortable talking about tobacco issues, learning a lot about traditional and commercial tobacco, and realizing the dangers of smoking.

Conclusions: Elders increased their knowledge about commercial and traditional tobacco and changed related attitudes as a result of CTW. Further, American Indian Elders perceived that CTW was effective.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Ceremonial Behavior*
  • Data Collection
  • Female
  • Focus Groups
  • Follow-Up Studies
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Indians, North American*
  • Leadership
  • Middle Aged
  • Pilot Projects
  • Smoking / epidemiology
  • Smoking / ethnology*
  • Smoking Prevention
  • Tobacco Smoke Pollution / prevention & control
  • Tobacco*
  • Young Adult


  • Tobacco Smoke Pollution