October 22, 2016
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Smoking Costs CA Indians $800M A Year

LOS ANGELES - Smoking takes a severe economic and health toll on American Indians, yet native communities face unique barriers to kicking the habit according to the authors of a new report from the UCLA Center for Health Policy Research.

Using data from the California Health Interview Survey (CHIS), the report estimates the cost of commercial tobacco use —in health care spending and lost productivity— totals nearly $800 million dollars a year among California’s American Indian community.

The report also discusses the role of traditional, or “sacred smoking,” as well as the underutilization of tobacco control policies on reservations, which can complicate prevention programs and approaches.

“What this report shows is there is a huge economic and social cost to commercial tobacco use,” said the report’s lead author, Delight Satter, a member of the Confederated Tribes of Grand Ronde. “We literally cannot afford to wait in bringing tobacco-control policies and prevention programs to our communities. We must protect future generations now.”

The report puts a price tag on commercial tobacco use in California’s native communities, based on both direct health expenditures and indirect productivity losses. Using data from the 2007 California Health Interview Survey (CHIS), the authors found that the estimated costs of smoking, on average, are $1,076 per American Indian per year – a total of $795 million annually.

The numbers refer both to direct costs – health care spending on tobacco-related illness – as well as indirect costs borne by individuals, communities, tribes and state and federal organizations. These costs include money spent or lost due to loss of life, disability, or loss of productivity due to tobacco related illnesses. (For example: wages never earned, due to a premature tobacco-related death.)

There are other costs as well. When one person becomes ill or dies from a smoking-related disease, a family is also affected. The community as a whole also suffers due to the loss of that person’s economic contributions, cultural knowledge, as well as societal and community contributions. For native communities, who are relatively small in size (739,000 in California) these preventable losses are felt community-wide and have lasting effects across generations.

Cigarette smoking is the single most preventable cause of premature death in the United States. American Indians smoke more than any other population nationally. In California, nearly 20 percent of the American Indian population smokes.

Native smokers also account for a disproportionate share of the state’s overall costs related to tobacco use. Of the total $16.3 billion in tobacco costs Californian residents shoulder each year, American Indians make up 4.4 percent of the costs even though they represent only 2.1 percent of the state population.

“Huge, smoking-related health disparities in native communities highlight the urgent need for targeted public health action,” said James Crouch, executive director of the California Rural Indian Health Board, which funded the study through a grant from the U.S. Centers for Disease Control and Prevention.

The report offers specific guidance to tribal communities on tobacco prevention and control, including information about culturally-appropriate community health programs as well as federal, state and county tobacco policy strategies. Successful strategies, including social marketing campaigns, community mobilization techniques, tribal taxation, smoking bans, and control of tobacco industry advertising on reservations, are examined and interpreted for use within the native context.

The report also discusses a complicating factor: traditional tobacco use, including “sacred smoking.” This practice, in which non-harmful plants are used in moderation for traditional ceremonies, has played an important role in American Indian culture. Yet marketing by commercial cigarette companies have preyed upon this traditional value, especially among youth, promoting harmful commercial products as “traditional” and “native.”

“American Indian communities need to separate sacred tobacco use from harmful commercial smoking,” said Satter. “One respects life and our ancestors while the other destroys it and our future generations.”

Among the report’s other findings:

American Indians smoke more
Commercial tobacco use among California’s American Indians continues to be high – approximately 19.7 percent of adults are current smokers and 25.5 percent are past smokers, one of the highest smoking rates of all racial and ethnic groups.

Mothers who smoke at risk
American Indian women who smoke during pregnancy contribute to $1.76 million in additional costs for care at delivery and for infants in the neonatal period.

American Indians less likely to be insured
Less than half (41 percent) of the American Indian population has job-based health insurance coverage and most (90 percent) of American Indians in California do not qualify for health coverage through the Indian Health Service (IHS) in California because they are members of tribes in other states. As a result, American Indians have fewer sources of support to confront a smoking-related illness.

Many lack a regular health care provider
Nearly one in five American Indian adults in California (19 percent) report that they do not have a usual source of health care to help them manage a tobacco-related condition.

Tribes left out of tobacco lawsuit settlements
Few states have funds from state tobacco lawsuit settlements dedicated specifically to minority communities who bear a disproportionate burden of tobacco-related disease and suffering. As sovereign governments, tribes were excluded from the “Master Settlement Agreement” negotiations for jurisdictional reasons, leaving them with fewer resources to combat tobacco.


The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health-related information on Californians.

The California Health Interview Survey (CHIS) is the nation's largest state health survey and one of the largest health surveys in the United States.

The California Rural Indian Health Board was formed to provide a central focal point in the Indian health field in California for planning, advocacy, funding, training, technical assistance, coordination, fund-raising, education, development and for the purpose of promoting unity and formulating common policy on Indian health care issues.




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