Understanding Tobacco Use Amongst Youth in Four First

Nations

Funded by the CIHR and CTCRI (a partnership of the CCS, CIHR and Health Canada)

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Abstract This community research partnership explored the question of how traditional knowledge of tobacco could be used in prevention and intervention of tobacco misuse amongst First Nations Youth. In our presentation, we will review findings of our Indigenous-led five year project that involved 4 First Nations communities from across Canada. Our methodology used a decolonizing and OCAP™ compliant approach whereby each participating First Nations were involved in all aspects of research. Preliminary findings reinforce the importance of understanding tobacco as a sacred medicine in addressing disproportionate rates of smoking among First Nations Youth. As well, our findings speak to the active part that Indigenous Youth play in their own wellness, seeking cessation strategies where and when needed.

Outline Introduction Background Purpose Objectives Partnership Framework Model Project and Community Research Teams Methodology Key Preliminary Findings Community Action Plans

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Introduction Traditionally tobacco has been used by many First Nations for

ceremonial and medicinal purposes. However, it is well documented that the misuse of tobacco is of

concern to the general Canadian population as well as to First Nations.

Health effects linked to smoking include cancer, heart disease,

cerebrovascular diseases and chronic lung diseases (Physicians for a Smoke-Free Canada, 2007).

The RHS (2008/10) reported smoking rates of 33.1% amongst First

Nations youth aged 12 – 17 years and 56.9% (daily and occasional smokers) amongst First Nations adults aged 18+ while smoking rates remain at 8% amongst the general Canadian population.

Smoking decreased from 2002/03 from 25.6% to 20.4% and those

who quit did so in order to improve health.

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Background The lines between traditional tobacco use & commercial

tobacco use have become blurred. Tobacco misuse has become a widely defended cultural norm. There is a lack of research on tobacco cessation with First

Nations populations & a need for more in-depth research at the community level.

This study addresses some aspects of this gap in research.

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Purpose To broaden understanding of how First Nations traditional

knowledge on the sacred uses of tobacco may assist with preventing tobacco misuse.

To address the unique needs of First Nations by focusing on

traditional knowledge. To build research capacity within participating First Nations.

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Objectives To share information with First Nations on culturally appropriate

tobacco prevention & promising practices in intervention based on traditional knowledge.

To engage Elders in order to further our understanding of how traditional teachings about sacred tobacco can be included within Youth prevention and tobacco cessation.

To build & strengthen relationships particularly between First Nations Elders and Youth in order to better understand the prevention of tobacco misuse and culturally based cessation.

To build First Nations capacity in conducting relevant, appropriate & responsive research.

To facilitate development of national First Nations tobacco policy initiatives through the Assembly of First Nations (AFN).

To contribute to model development around community based research related to tobacco control with First Nations.

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Partnership Framework Model for Community-Based Research

Research Partners

First Nation Community Partners

Maliseet Nation at Tobique

Sagamok Anishnawbek First Nation

Siksika Nation

Seabird Island Indian

Band

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Community Research Teams Maliseet Nation at Tobique Tina Martin, Community Research Partner Elaine (Arlene) Sappier, Elder Representative Carly Sappier, Youth Representative Tiffany Perley, Community Based Research Assistant Sagamok Anishnawbek First Nation Eileen Smith, Community Research Partner Delores Trudeau, Elder Representative Cheyenne Abitong, Youth Representative Audra Owl, Community Based Research Assistant Siksika Nation Tyler White, Community Research Partner Norton (Spike) Eagle Speaker, Elder Representative Armond Duck Chief, Youth Representative Richard Running Rabbit, Community Based Research Assistant Seabird Island Indian Band Edie Karacsonyi, Community Research Partner Andrew Louie, Elder Representative Emma McNeil, Youth Representative Genna Joseph, Community Based Research Assistant

Project Research Team Co-Principal Investigators Dr. Sheila Cote-Meek, BScN, MBA, PhD Sonia Isaac-Mann, BSc, MSc Co-Applicants Nicole Eshkakogan, BA, MA Peter Selby, MBBS, CCFP, FCFP, MHSc, Dip ABAM Tina Martin, Community Research Partner Eileen Smith, B. Ed., MSW, RSW, Community Research Partner Edie Karacsonyi, BSW, Community Research Partner Tyler White, Community Research Partner Assembly of First Nations Barney Williams, Elder Youth Representative, Rotational

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Methodology Community based,

participatory model, emphasizing capacity building and training, partnership and collaboration.

Respecting of OCAP™ (Ownership, Control, Access, Possession) principles in research with First Nations.

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Research Cycle

Sharing the Results:

Dissemination

Reaffirming the Vision: Developing

the Research

Working with the

Community: Data collection

and analysis

Building new understandin

g and knowledge: Feedback

and evaluation

Methodology The project used community-based

research strategies working in partnership with four First Nations across Canada.

Community Research Agreements were developed and signed with each participating First Nation (respecting OCAP ™ and the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans).

Each First Nation formed a Community Research Team and appointed a Community Research Partner (co-applicant), an Elder Representative, a Youth Representative and a part-time Community-based Research Assistant.

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Methods The Community Research Teams were involved in all aspects of

the research including the design & pre-testing of interview, focus group and youth survey questionnaires, as well as in the collection & analysis of data & preparation of reports.

A youth survey was added to the study at the request of the 4 First Nations.

Snowball and venue-based sampling strategies were used in the recruitment of participants.

Interviews were transcribed, coded and analyzed using qualitative thematic analysis.

Youth surveys were coded and analyzed using SPSS software. Community feedback sessions were held in each First Nation to

review draft results and validate findings.

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Initial findings are based on 252 Youth aged 12 – 24 living in 3 of 4 participating First Nations. Numbers are based on those who choose to respond to given question.

Age Group (Years)

Male Female

12-14 31 31

15-17 28 42

18-20 41 45

21-24 15 19

Total 115 137

Key Preliminary Findings

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Smoking and Tobacco misuse. 41.3% are current smokers (104 of 252 youth who answered this

question), and of these 43.3% were male and 56.7% were female. 63.9% of youth surveyed indicated that they have “ever smoked”

(159 of 249 who answered this question). 44% of youth reported smoking in the 30 days prior to

completing the survey (111 of 252 youth).

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15

Male, 3

Male, 1

Male, 0

Male, 4

Male, 9

Male, 28

Female, 7

Female, 4

Female, 3

Female, 11

Female, 17

Female, 24

0 5 10 15 20 25 30

1-2 Days

3-5 Days

6-9 Days

10-19 Days

20-29 Days

All 30 Days

Number of Participants

Number of Days Participants Smoked Tobacco in 30 Days Prior to Survey

Top Three Reported Reasons to Start Smoking

Male

Female

Total

Peer Pressure 20 51 71

Curiosity/ Experimentation

17

28

45

Family Influences 3 11 14

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The average age at which participants tried their first cigarette was 13.

The average age participants first began to smoke daily was 13.6.

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Current Smokers Top Three Reported Reasons to Start Smoking

Male

Female

Total

Peer Pressure 15 32 47

Curiosity/ Experimentation

12

17

29

Family Influences 3 6 9

94% of the 248 youth who answered this question indicate they have heard the term “second-hand smoke”.

22.7% of the 247 youth who answered

this question indicate they have heard the term “third-hand smoke”.

78.3% of the 240 youth who answered

this question indicate they know what traditional tobacco is.

45.6% of the 237 youth who answered

this question indicate they know how to use tobacco in a traditional way.

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Attempts to Quit Smoking

100 youth indicate they have tried to quit smoking, including 80 current smokers (35 male and 45 female).

When asked how many times they have tried to quit, 82 youth

reported 209 attempts, an average of 2.5 quit attempts per youth.

56 youth reported successful smoke free periods ranging from

one month to 10 years, with the average period being 8.7 months smoke free.

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What Helped Youth to Quit Smoking

What Helped Youth to Quit (top three responses)

Male Female Total

Knowledge of Health Effects 21 26 47 Cost 13 12 25

Social or Family Pressure 6 9 15

What caused you to continue to smoke? (top three responses)

Smokers and Non-Smokers

Current Smokers

Stress-work, personal, relationships

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27

Others smoking around me

16 9

Cravings 15 15

21

Challenges

22

ProbablyImpossible

Very difficult Fairly Difficult Fairly Easy Very Easy

Age Group 12 - 14 9 1 3 7 6

Age Group 15 - 17 1 1 3 17 30

0

5

10

15

20

25

30

35

Access to Cigarettes - 12 - 17 Year Old Youth

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Source of last cigarette smoked (top three responses)

Youth 12 - 24

Youth 12 - 17

Friend 68 37

Commercial Vendor 58 4

Family Member 11 5

Access to Cigarettes When asked, 88.8% of 147 youth who answered this

question thought it would be fairly or very easy to access cigarettes.

Exposure to Commercial Tobacco 80.6% of the 247 youth who answered this question indicate that

their parents or guardians smoke. 96 of the 104 current smokers report a total of 217 smokers reside

in their homes – an average of 2.3 smokers per household. 200 of 252 participants report a total of 414 smokers in reside in

their homes – an average of 2.1 smokers per household.

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Program

Percentage of youth/# of youth

Effectiveness [1-5 with 1 meaning Not Very Effective, 3 is Effective and 5 is Very Effective]

Smoking cessation

32 = 12.7% 2.44

Support groups

30 = 11.91% 2.19

Nicotine Replacement

32 = 12.70% 2.38

Addiction Counselling

33 = 13.1% 2.52

Education Workshops

52 = 20.64% 3.09

Other 9 = 3.58% 2.14 Total 224 2.87

Youth Participation in Tobacco Related Programs and Services…

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Not Concerned At All Not Very Concerned Somewhat Concerned Very Concerned

Number 42 64 104 36

Percentage 17.07% 26.02% 42.28% 14.63%

0

20

40

60

80

100

120Participant Level of Concern About Smoking in Their Communities

26

27

Not Concerned At All Not Very Concerned Somewhat Concerned Very Concerned

Male 10 12 24 13

Female 14 16 28 10

0

5

10

15

20

25

30

Participant Level of Concern About Smoking in Their Communities by Gender

28

Not Concerned At All Not Very Concerned Somewhat Concerned Very Concerned

12-14 10 12 24 13

15 - 17 14 16 28 10

18 - 20 11 26 40 8

21 - 24 7 10 12 5

0

5

10

15

20

25

30

35

40

45

Participant Level of Concern About Smoking in Their Communities by Age Group

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Not Concerned At All Not Very Concerned Somewhat Concerned Very Concerned

Non-Smoker 24 30 60 29

Smoker 18 34 44 7

0

10

20

30

40

50

60

70

Participant Level of Concern About Smoking in Their Communities by Smoking Status

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Limitations Length of the survey may have contributed to unanswered

questions. Literacy and/or comprehension may have been issues. Competing priorities in the community.

Dr. Sheila Cote-Meek Associate Vice-President,

Academic & Indigenous Programs Laurentian University Ramsey Lake Road

Sudbury, ON P3E 2C6 (T) 675-1151 ext. 3429

Email: scotemeek@laurentian.ca

Sonia Isaac-Mann, BSc., MSc. Associate Director of Health

Safe, Secure and Sustainable Communities Assembly of First Nations

55 Metcalfe Street Ottawa, ON K1P 6L5

Tel: 613-241-6789 ext.358 Fax: 613-241-5808

Email: soniaim@afn.ca

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