Literature review of the traditional use of tobacco as a cultural practice and harm reduction effort for Indigenous communities

Abstract

This literature review aims to highlight cultural strengths and protective health factors associated with traditional/ceremonial tobacco (versus commercial tobacco) use among Indigenous communities. While commercial cigarette smoking rates have decreased over the past 50+ years in the US, Indigenous communities continue to smoke commercial tobacco at higher rates compared to other racial/ethnic groups, and thus, experience significantly higher tobacco-related health inequities. Traditional use of the tobacco plant, most often Nicotiana rustica or Nicotiana tabacum, may include smoking (but not inhaling), burning for offering, smudging in ceremonies, or sprinkling on the bed of an ill person for healing among Indigenous communities. Unlike traditional tobacco, commercial tobacco refers to a product (i.e., cigarettes, chewing tobacco) containing thousands of added chemical compounds associated with cancer-related disparities. Furthermore, the negative health outcomes associated with commercial tobacco use, such as premature death, remain a significant cause for concern in public health efforts. Contemporarily, an issue arises from the use of commercial tobacco use in traditional practices, out of convenience or lack of knowledge about the cultural significance, which can result in earlier initiation of tobacco use, and reduce cultural respect for the plant. Interventions developed with predominantly non-Hispanic White (NHW) populations are typically less effective for Indigenous populations due to a lack of cultural considerations. Recent research suggests that Indigenous populations benefit from culturally inclusive adaptations for tobacco control and tobacco dependence interventions. This literature review will identify effective ways to address the need for culturally inclusive efforts to reduce tobacco-related health disparities while also acknowledging the unique difference between using traditional tobacco and commercial tobacco use. In addition, it will discuss results from previous studies that suggest protective factors associated with engaging in these cultural practices. These findings will inform future studies that investigate whether traditional tobacco use could be promoted for Indigenous communities as a way that supports traditional tobacco use in tandem with reducing the harm of commercial cigarette smoking and chewing tobacco for Indigenous communities.