1. Understanding Tobacco Use
Amongst Youth in Four First
Nations
Funded by the CIHR and CTCRI (a partnership of
the CCS, CIHR and Health Canada)

2. 2
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.

3. Outline
Introduction
Background
Purpose
Objectives
Partnership Framework Model
Project and Community Research Teams
Methodology
Key Preliminary Findings
Community Action Plans
3

4. 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.
4

5. 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.
5

6. 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.
6

7. 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.
7

8. 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
8

9. 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
9

10. 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.
10
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

11. 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.
11

12. 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.
12

13. 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
13

14. 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).
14

15. 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

16. 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
16
 The average age at which participants tried their first
cigarette was 13.
 The average age participants first began to smoke daily
was 13.6.

17. 17
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

18.  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.
18

19. 19
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.

20. 20
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

21. What caused you to
continue to smoke? (top
three responses)
Smokers and
Non-Smokers Current
Smokers
Stress-work, personal,
relationships 34 27
Others smoking around
me
16 9
Cravings 15 15
21
Challenges

22. 22
Probably
Impossible
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

23. 23
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.

24. 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.
24

25. 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…
25

26. 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
120
Participant Level of Concern About Smoking in Their Communities
26

27. 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. 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

29. 29
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

30. 30
Limitations
 Length of the survey may have contributed to unanswered
questions.
 Literacy and/or comprehension may have been issues.
 Competing priorities in the community.

31. 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 31