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Indigenous Smoking Program Fosters Shift From Commercial Tobacco

The Pine Hill Indian Tribe launched a cultural smoking cessation program making a stand against the industry’s impact.

Detail of a man holding a smoking cigarette in his hand.

Ramona Bowles began smoking commercial cigarettes when she was a teenager. For decades, she smoked as many as four packs a day. Then in 2021, the Pine Hill Indian Tribe, the First People of Fort Jackson in South Carolina, launched a smoking cessation program to address high usage rates among tribal members like Bowles. The program offered peer support, accountability, and an Indigenous lens to tobacco use and consumption. Bowles is down to one and a half packs per day.

Many public health agencies offer smoking cessation support, but few do so for Indigenous peoples with an Indigenous lens, said Michelle Mitchum, Chief of the Pine Hill Indian Tribe. “Our view on tobacco is different culturally,” Mitchum said. “Historically, tobacco is one of the sacred tools that we use for ceremony. We honor tobacco.”

According to Mitchum, about 120 people went through the tribe’s smoking cessation program in 2022. Counselors help participants understand the cultural roots of tobacco use and learn to see commercial cigarettes as antithetical to Indigenous life.

“The misuse of tobacco commercially is no different than if you were to set a Bible on fire,” Mitchum told Prism.

For decades, major tobacco companies have targeted Indigenous peoples, young people, and African Americans with marketing for commercial cigarettes. A variety of other factors — including anti-Indigenous religious practice laws, food insecurity, and stress — have led Native and Indigenous peoples to account for the highest rates of cigarette consumption while constituting less than 2% of the U.S. population.

But commercial tobacco, which exposes people to hundreds of chemicals, toxins, and carcinogens, is just one part of tobacco’s colonial history and contemporary role in the U.S. economy.

Ninety percent of tobacco is grown in North Carolina, Tennessee, Kentucky, and Virginia. During the summer, tobacco farms across these sweltering Southern states are sites of dehumanizing labor practices, illness, and exploitation. But wrestling tobacco from its colonial use won’t be achieved through policy alone, advocates say. Rather, what’s required is a sustained and persistent objection to the anti-Indigenous use of commercial tobacco that simultaneously harms the planet and its people.

From Culture to Commercial

Tobacco was the first cash crop of the U.S. colonies. Though tobacco is native to North America, colonizers stole and harvested a nonnative variant taken out of the West Indies likely in 1609. The plant made its way to Virginia in the early 1600s. The state’s soil was rich in nutrients, offering ideal growing conditions. Tobacco was even used as a form of currency; the American colonies used the plant to pay for ammunition from France during the American Revolution.

Reliant on enslaved West Africans’ labor, the tobacco plantation system established an economic foundation on which settlers could gain access to more land, labor, and goods. Tobacco is a time-intensive crop, however, and as other lucrative crops like cotton, rice, and sugar required farmland, tobacco lost its role as currency.

Throughout the 19th century, as colonized territories expanded into what’s now the American South, the federal government forcibly removed Indigenous and Native communities from their traditional homelands and made room for plantations. The eviction of Indigenous peoples during this period allowed the U.S. to amass land, consolidate power, and pass laws that further destabilized Native cultures.

The Indian Civilization Fund Act of 1819 imposed assimilation as a way of killing Indigenous peoples and cultures. A federal law passed in 1883 threatened Indigenous peoples with incarceration if they took part in spiritual or religious practices, some of which included traditional tobacco. The federal government wouldn’t overturn the law for another 100 years. In the 1950s, the federal government fashioned a plan to undercut the reservation system it created by assimilating Indigenous peoples into “urban” places to address what officials referred to as the “Indian Problem.” According to some accounts, as the federal government terminated treaties and dissolved Native Tribes and Bands, they removed more than 1 million acres of land from federal trust protection. As a result, about 35,000 people were relocated from their land.

It was because of this removal and prohibition of cultural practices that Indigenous peoples began using commercial tobacco, some historians say. “It is believed that the need to conduct ceremonies in secret and begin using commercial tobacco to, ‘hide in plain sight,’ was a factor in the inculcation of commercial tobacco into American Indian cultures in this region,” according to a report by the American Indian Community Tobacco Project.

Tobacco allowed an economic system to flourish, facilitating the making of a country. Four hundred years later, advocates are pushing back against abuse of the plant and neglect of the people harvesting it.

The Mixteco/Indigena Community Organizing Project (MICOP) is one such organization. Living and working in California, far from the communities in Mexico and Central America where they’re from, Indigenous migrants are able to access support systems and healing practices through the organization’s programming, which includes traditional and ceremonial use of tobacco.

Tobacco is a “contract between ourselves … and our Creator. The smoke carries that commitment to creator,” said Victor Espinosa, the director of behavioral wellness at the Southern California organization.

Espinosa said that the organization is collaborating with the University of California, Los Angeles, to research how tobacco is used recreationally in Indigenous communities, if at all. Based on the research results, the organization will design a prevention and early intervention program.

The connection between tobacco and Indigenous cultural practices has been severed because of structural barriers created and perpetuated by dominant power systems in the U.S., Espinosa said. Low-earning migrant workers are often forced into housing, employment, and education opportunities that create stress and negative health outcomes.

MICOP is currently looking into the availability of tobacco outlets within the Oxnard, California, area and investigating how close these outlets are to schools and other places where Indigenous community members reside.

“There’s food insecurity, there’s housing insecurity, all those social determinants of poor health outcomes are present in the migrant Indigenous community,” Espinosa told Prism.

Pushing Back Against Industry Power

How colonization allowed the tobacco industry to flourish is just one part of the plant’s commodification.

The tobacco industry largely remains untouchable, inoculated from more stringent regulation by hefty lobbying and other forms of political influence, such as media. In 2022, the tobacco industry spent nearly $30 million on lobbying at the federal level. And then, of course, there’s the 2012 labor law that would have prevented youth under 16 from growing, harvesting, and curing tobacco. The bill was killed after farm lobbying groups got involved.

Due to industry power, harvesting tobacco remains dangerous work with few protections or even restrictions on who can labor in the fields. For instance, children as young as 12 can work alongside family members.

“The tobacco industry is insidious and should be outlawed,” said Thomas Arcury, a medical anthropologist and public health scientist who has published dozens of articles on farmworker health.

For years, advocates like Arcury have sounded the alarm on labor conditions for tobacco farmworkers, especially regarding a form of acute nicotine poisoning called green tobacco sickness, or GTS.

Arcury said that GTS will affect at least 25% of tobacco field workers at some point in the harvesting season. It’s contracted through skin contact with tobacco leaves, and since many farms still use hand-picking techniques rather than machinery to harvest the delicate leaves, there’s ample opportunity for workers to contract the illness.

Thousands of workers enter the U.S. each year to harvest tobacco, the majority of whom are migrants from Mexico on work visas as part of the federal government’s H-2A temporary agricultural program. In 2021, about 258,000 workers came to the U.S. with an H-2A visa, about 93% of whom were from Mexico. Once in the U.S., migrant workers typically work more than 12 hours a day and are often forced to live in unsanitary, unhealthy conditions.

Eli Porras has been working in North Carolina tobacco fields off and on since 2006, leaving his home in Mexico City for months at a time to harvest tobacco leaves by hand. Now 52 years old, Porras said that it’s nearly guaranteed workers will become ill with some symptoms of what he and other workers call the “Green Monster.” Usually, a day’s rest will clear the nicotine out of his body, and it helps that Porras is active and healthy when he’s home. Other workers who may have underlying health issues aren’t as lucky.

“This kind of work is very intense,” Porras said. “We’re out in the heat. It’s very humid out there. You can barely breathe.”

Part of the issue is that medical care isn’t easily accessible. While GTS, heatstroke, and other forms of illness are almost guaranteed for tobacco workers, medical care is not. Porras said that the contracting company that recruited him and facilitated his H-2A visa told him to call 911 if someone needs medical attention. “We don’t really do that,” Porras said.

“We’re in a remote field somewhere where it’s very difficult for an ambulance to get in,” he added. “In my mind, it’s God’s country. There’s really no way in or out of there.”

Instead, Porras said that workers look out for each other. They try to make sure someone can rest in the shade if they’re not feeling well, and they help loosen any tight clothing and get them water.

Yesenia Cuello, executive director of the farmworker advocacy organization NC Field, said she and other advocates help enroll migrant farmworkers in health care coverage through the Affordable Care Act for 60 days after they first arrive in the U.S. Children of migrant workers are also eligible for health care through Medicaid, but the challenge in both cases is making sure that the information is available. Even if someone can get seen, many physicians aren’t familiar with GTS and often misdiagnose patient symptoms, Cuello added.

How to Push Back Against Green Tobacco Sickness? Take Issue With the Industry

Short-term effects of GTS include nausea, vomiting, and headaches, among other serious symptoms. Making matters worse, the harvest takes place at the height of summer, so heatstroke is also a major concern. Even as summer months become increasingly dangerous due to rising average temperatures, there is still no federal heat standard — and few state labor departments have their own.

There is currently no long-term research into the continued effects of GTS on the body or how it affects the development of organs and neurological systems of children. Arcury attributes that lack of research prioritization to demographics.

“Green tobacco sickness historically has been the disease of small farmers, or of people of color, so no one has really been that concerned about its long-term effects,” Arcury said sarcastically.

With no antidote to GTS, the only tool left to farmworkers is to take a day or two off — the nicotine naturally works its way out of the body with time. But for most farmworkers, taking time off simply isn’t an option. Not only do workers experience retaliation for asserting their rights, they only get paid for the hours they work. As some of the nation’s lowest-paid workers, every dollar counts.

Porras echoed his concerns about wage theft, high customs fees when traveling home, and a lack of health care. And importantly, he’d like the wages tobacco workers are paid to reflect the grueling work, hazards, and sacrifices of the job. Porras is paid $14, but he said a just wage would be double that. Not to mention it’s work that Americans don’t really want to do — even if Americans want the product of Porras’ labor.

“When you think about U.S. citizens, even if they’re Latinos, you don’t see them out on the field doing this kind of work,” Porras said.

Expressing solidarity with tobacco workers, Arcury believes, requires a consumer boycott of commercial tobacco. What the tobacco industry cares about is sales, not its workers.

This was echoed by Cuello.

“I think if consumers were to mobilize and to make that happen, that would definitely help … I do feel like customers control the market, and there’s a lot of people that are oblivious to the fact that [child labor] continues to happen,” she said.

Cuello, who labored as a farmworker when she was a child, said that during the pandemic, there was an uptick in the number of children working in tobacco fields due to more time spent at home and a greater need for additional income.

As an organization, NC Field is focused on addressing the “social determinants” of health. Defined by the Centers for Disease Control and Prevention as the “nonmedical factors that influence health outcomes,” these are things like housing, income, racism, and climate change. According to Cuello, the biggest health risk to farmworkers is the work itself.

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