Smoking continues to be a pervasive health issue in Canada, disproportionately impacting Indigenous populations, including First Nations, Inuit, and Métis communities. Commercial tobacco addiction among these groups is significantly higher than in the general Canadian population. As efforts to address smoking through culturally sensitive public health strategies increase, the use of vapes is emerging as a potential harm-reduction tool, though not without its complexities.
This article delves into the prevalence of smoking in Indigenous communities, the role of traditional versus commercial tobacco, and the prospects of vaping as a healthier alternative. It explores how Indigenous-led initiatives are integral to reversing these trends, while addressing systemic barriers and cultural dimensions that influence tobacco use.
High prevalence of smoking in Indigenous Communities
Indigenous communities in Canada experience alarmingly high rates of smoking. Among First Nations, the smoking prevalence is nearly three times higher than among non-Indigenous Canadians. In particular:
- 43% of First Nations adults smoke, with higher rates among those living on reserves (over 50%), compared to about 12% of the general Canadian population.
- Youth smoking rates are disproportionately high, with nearly 33% of on-reserve First Nations teens, compared to only 10.5% of non-Indigenous teens.
- Among Inuit, 34% of adults smoke, with Inuit women exhibiting an especially high prevalence (41%), almost double the rate of non-Indigenous women in Ontario.
For many Indigenous communities, the situation is exacerbated by limited access to cessation programs, systemic health inequities, and socioeconomic factors such as poverty and education barriers. Smoking’s impact manifests in higher rates of tobacco-related diseases, including cardiovascular issues, respiratory conditions, and cancers.
The role of traditional tobacco and its misuse
Tobacco has long held sacred significance in many Indigenous cultures. Traditional or sacred tobacco, considered one of the four sacred medicines alongside cedar, sage, and sweetgrass, is used in ceremonies for healing, prayer, and purification. Importantly, it differs from commercial tobacco, as it is additive-free and grown for ceremonial purposes rather than habitual use.
Mohawk Elder teachings emphasize that traditional tobacco use is about discipline, respect, and connecting with the Creator. In some cultures, ceremonies even help individuals seek forgiveness for the misuse of tobacco when quitting smoking. However, widespread availability and aggressive marketing of commercial tobacco have led to its misuse, often conflated with traditional practices. Efforts to separate the sacred use of tobacco from commercial addiction are ongoing, but the line between the two remains blurred for many. This conflation has been identified as a key challenge in reducing tobacco dependence among Indigenous populations.
The health risks of smoking
Smoking remains the leading preventable cause of death and disease in Canada, contributing to approximately 45,000 deaths annually. The harmful effects of smoking – caused by exposure to over 7,000 toxic chemicals in cigarette smoke – are well-documented. For Indigenous peoples, these effects are compounded by limited access to healthcare and support services.
Studies have shown that smoking rates are strongly linked to conditions of poverty and colonization. Systemic inequities, including overcrowded housing and restricted access to health education, contribute to the disproportionately high rates of smoking-related illnesses in Indigenous communities.
Vaping: A safer alternative or a new risk?
Vaping has been promoted as a harm-reduction tool, offering smokers a less harmful alternative to cigarettes. Unlike traditional cigarettes, vaping devices heat nicotine-infused liquid into an aerosol without combustion, eliminating tar and other harmful byproducts.
Public Health England and the Canadian Cancer Society support vaping as a safer alternative for individuals seeking to quit smoking. Scientists have estimated that using vaping products exclusively is about 95% less harmful than smoking cigarettes. While not risk-free, especially for youth, vaping poses significantly fewer health risks compared to smoking.
Advantages of vaping over smoking
There are generally three main advantages when comparing vaping over smoking traditional tobacco products. These three goes as follow:
- Reduced exposure to harmful substances: Unlike cigarettes, which contain carcinogens such as tar, vaping significantly limits exposure to harmful chemicals.
- Harm-reduction potential: Many smokers who transition to vaping report better respiratory health, reduced coughing, and lower risks of chronic diseases.
- Cost-effectiveness: Vaping is often less expensive than smoking, making it an appealing alternative for many individuals.
Challenges in promoting vaping
Despite its benefits, vaping is not without controversy in Indigenous contexts. Concerns about youth uptake are prevalent, as the promotion of vaping may inadvertently glamorize it. Furthermore, dual use, where individuals both vape and smoke, diminishes the harm-reduction potential of vaping.
Tailored education programs are critical to addressing these challenges, ensuring that Indigenous communities can make informed choices about vaping as a smoking cessation tool.
Indigenous-led solutions to smoking and vaping
Recognizing the unique cultural and socioeconomic challenges faced by Indigenous communities, several initiatives have emerged to combat commercial tobacco addiction while respecting traditional practices. The Indigenous Tobacco Program (ITP), operated by the Indigenous Cancer Care Unit at Cancer Care Ontario are pivotal in this regard.
These initiatives promote the distinction between traditional and commercial tobacco and integrate cultural teachings into smoking cessation strategies. They also provide resources for quitting smoking, including culturally appropriate ceremonies, community gatherings, and support from Elders.
Key programs and approaches
Some of the key approaches and programs run by the ITP includes the following:
- Sacred smoke programs: Combining traditional teachings with modern cessation tools, these programs offer a culturally grounded approach to quitting smoking.
- Youth engagement: Outreach efforts targeted at reducing youth smoking are vital, especially given the alarming rates of tobacco use among Indigenous teens.
- Community-led research: Encouraging Indigenous communities to lead research on vaping and smoking ensures that solutions are contextually relevant and culturally appropriate.
Future directions
Efforts to reduce smoking among Indigenous peoples must address systemic barriers while embracing community-led solutions. Increasing access to cessation programs, improving health literacy, and ensuring culturally relevant interventions are all crucial steps.
Vaping, while not a panacea, has the potential to serve as a bridge toward smoking cessation. To maximize its benefits, public health campaigns must educate communities on its risks and advantages, ensuring that individuals can make informed decisions. By supporting Indigenous autonomy in health initiatives and prioritizing harm reduction, Canada can make meaningful progress in reducing tobacco-related disparities while respecting the cultural significance of traditional tobacco use.
Conclusion
The challenge of reducing smoking rates among Indigenous peoples in Canada is multi-faceted, requiring a balance of cultural sensitivity, public health innovation, and systemic change. Vaping offers a promising avenue for harm reduction, but its integration into Indigenous contexts must be approached with care. With Indigenous-led solutions at the forefront, Canada can work toward a future where the health and well-being of Indigenous communities are no longer undermined by the commercial tobacco epidemic.
