For Wisconsin’s Oneida Nation, developing a robust stroke-awareness program is essential; one step in that project is tackling commercial tobacco, a leading cause of strokes.
A group of Oneida Health Coaches, working with a UW team led by Sarah Thompson and including Dr. Michael Fiore, have partnered on a series of events to bring awareness to stroke risks and highlight available resources—like medications and coaching—for staying healthy in the long term.
One of the leading factors that contributes to strokes is smoking but, when addressing smoking prevalence among First Nations peoples and Alaska Natives, it is important to distinguish between commercial tobacco use and traditional, sacred tobacco use.
The latter is an essential part of many First Nations cultures: the way that tobacco is used in traditional ceremonies is a communal act that cements cultural identity and traditions. The amount of ways tobacco is used in these ceremonies is as diverse as the groups using it; however, we know that as a sacred practice, traditional tobacco use is taken seriously, approached intentionally, and handled spiritually. This is in sharp opposition to commercial tobacco, the consumption of which has no cultural significance, no spiritual element, no communal angle. For First Nations tribes, traditional tobacco use is essential: commercial tobacco use represents not only a threat to the health of tribe members, but a threat to their sacred traditions.
“Strokes are incredibly deadly, and one of the most powerful ways to combat them is quitting commercial cigarettes,” said Dr. Fiore. “There’s nothing better we can do than get people to take advantage of the treatments that work.”
This initiative combines the efforts of a Wisconsin Partnership Program Grant and Oneida Comprehensive Health Division to develop a ‘Stroke Awareness Team,’ said Sarah Thompson, UW-CTRI Regional Outreach Specialist.
“We want to provide educational resources to all members of the Oneida Nation,” Thompson said, “to help with recognizing the signs of stroke and transient ischemic attacks.”
Part of this Stroke Awareness Team’s project is not only creating both in-person and virtual content to bring attention to the contributing factors of stroke risk, but also to certify and train new Oneida Health Coaches.
“Wellness Coaching will assist participants in finding their personal motivation to create healthier lifestyles,” said Dawn Krines Glatt, Health Promotion Specialist, Oneida Comprehensive Health Division. “Guided by the coaches, the participants will gain confidence as they draw upon their own strengths and chosen strategies to successfully achieve individual health goals.”
To get these prospective Health Coaches ready for face-to-face work with patients, Dr. Fiore first presented a lecture then met virtually with the Wellness Coaches to answer their questions—all designed to provide additional information on smoking for the coaches. Some of the effects of smoking that contribute to stroke risk include increased heart rate and blood pressure, constricted blood vessels and an increase in carbon-monoxide levels in the blood stream.
“It is exciting to know how impactful we can be in the Oneida community to reduce the risk of stroke,” said Glatt. “Nearly a quarter of the respondents to the Oneida 2017 Community Health Assessment Survey indicated that they are smokers. We learned about the effects of smoking and nicotine on the brain, and the importance of nicotine replacement therapy in addition to coaching. We will use the resources provided to help our participants quit, especially the new American Indian Quitline, which will be culturally appropriate.”
The recorded lecture was followed up with a Q&A with Dr. Fiore.
In addition to newly certified Health Coaches, the project will also produce and provide educational resources for all members of the Oneida Tribe, helping everyone from children to adults to elders recognize and address the signs of stroke.
In addition, a study conducted by the Wisconsin Partnership Program is including 100 Oneida people at high risk for stroke (and 20 at low risk) and will be taking place for two years to evaluate the effectiveness of the new stroke-awareness programs.
The 100 high-risk individuals will be divided into two groups: One group will receive advice about standard therapy and risk factors; the other group will receive the same, plus intensive health coaching.
“When looking at the smoking rates of First Nations Tribes in Wisconsin compared to the average Wisconsin adult, we see a huge disparity,” said Dr. Fiore, “First Nations Tribes have a smoking rate nearly double that of the state overall.
“However, this high percentage is also matched by a high percentage of quit attempts and interest in quitting: for example, in 2015, more than half of all First Nations members in the United States reported a quit attempt. Given this interest in quitting, we want to help by providing science-based help on quitting commercial tobacco successfully.”
UW-CTRI has developed a new fact sheet on tobacco use, strokes, and other cardiovascular diseases.