Historical Influences on Contemporary Tobacco Use by Northern Plains and Southwestern American Indians (2024)

Abstract

There are great differences in smoking- and tobacco-related mortality between American Indians on the Northern Plains and those in the Southwest that are best explained by (1) ecological differences between the two regions, including the relative inaccessibility and aridity of the Southwest and the lack of buffalo, and (2) differences between French and Spanish Indian relations policies. The consequence was the disruption of inter- and intratribal relations on the Northern Plains, where as a response to disruption the calumet (pipe) ceremony became widespread, whereas it did not in the Southwest. Tobacco was, thus, integrated into social relationships with religious sanctions on the Northern Plains, which increased the acceptability of commercial cigarettes in the 20th century. Smoking is, therefore, more deeply embedded in religious practices and social relationships on the Northern Plains than in the Southwest.

It has been known for several decades that American Indians on the Northern Plains smoke cigarettes at higher rates and suffer higher smoking-related death rates than do American Indians in the Southwest (Table 1 presents a list of the states and tribes in each region). In the 1960s it was noted that smoking was less common among Southwestern than non-Southwestern American Indians,1 and data from 1980 to 1982 revealed great differences in smoking-related health conditions. The ratios of death rates of American Indians on the Northern Plains and in the Southwest were myocardial infarction, 3.1; lung cancer, 5.9; cerebrovascular diseases, 1.9; and all-cause mortality, 1.4.2

I attempt to account for these patterns.

There are three possible explanations for this:

1. There may be greater poverty, less education, and more alcohol misuse on the Northern Plains than in the Southwest, all associated with, or leading to, an increased likelihood of cigarette use.

2. Exposure to both native and commercial tobacco may be greater on the Northern Plains.

3. There may be a greater association on the Northern Plains of tobacco use with social relationships and religious practices.

Table 2 displays recent data on regional patterns of tobacco use and smoking-related mortality. The differences in the prevalence of smoking and its health-related consequences are consistent with those observed in the 1980s. Conversely, education, poverty, and median income do not differ between regions; neither does alcohol-related mortality, although American Indian women on the Northern Plains report drinking more heavily than do women in the Southwest. Thus, whatever the associations at the individual level,10 at a regional level there is not a persuasive association of cigarette use with education, income, poverty, or alcohol use. That leaves exposure to various forms of tobacco and the social functions of tobacco.

EXPOSURE TO TOBACCO

Native tobacco (Nicotiana spp.) use, both smoked and chewed, was widespread across North America well before European contact.11 Two kinds of tobacco were cultivated, and several varieties grew wild.12 Where tobacco was neither gathered nor cultivated it was traded.13 Both of the cultivars had diffused from South America. The most ubiquitous cultivar in continental America north of Mexico was Nicotiana rustica. In the precontact period the other domesticated type, Nicotiana tabacum, appears to have had a limited range in what is now the continental United States. N. rustica has on average higher nicotine content than does N. tabacum and is also more difficult to inhale deeply.

N. tabacum began to be grown commercially in the 17th century in the southeastern United States, on Caribbean islands,14 and in Brazil.15 The French started to grow it commercially in the 18th century from Montreal, Quebec, to St. Louis, Missouri. In 1798, the French engineer Nicolas de Finiels16 observed that 2000 pounds of tobacco were grown in St. Louis, 1000 to 1200 pounds along the Meramec River (a tributary of the Mississippi), 6000 pounds in St. Ferdinand, and 3000 pounds in Marais des Liards; the last two located between the Mississippi and Missouri rivers. Because N. tabacum is milder than N. rustica, it was easier to smoke and inhale. It was thus more likely to cause addiction, and it was readily integrated into trade. Indians of the prairies and plains increasingly used N. tabacum, not just for ceremonial practices but for secular purposes as well.

The situation was different in the Southwest, where the cultivation and gathering of several different varieties of tobacco was of great antiquity.17 In 1765 Spain declared a monopoly on the growing of tobacco, which was forbidden in New Mexico.18 Until then, tobacco had been an important crop, desired by both the settlers and the American Indians.19 The loss of the crop endangered relations with the Comanches and thus endangered the security of the entire colony.20 In fact, trade often went the other way. In his description of the missions of New Mexico in 1776, Fray Francisco Atanasio Dominguez wrote that the Comanches got trade items, including tobacco, from the Jumanas (probably the Witchita) Indians, who in turn got them from the French and then sold them to the Spanish settlers.21 Nonetheless, the Spanish persisted in their policy, despite considerable resistance and with only limited success,22 into the 19th century.23 By the American period, beginning in the mid-19th century, tobacco was being grown in great quantities elsewhere in the country, and the expanding railroad system made distribution increasingly efficient and local production less economical than it might have been earlier.

Thus, French and Spanish policies with regard to the growth, trade, and sale of tobacco were very different. It was an integral part of the French fur trade with Native Americans in the woodlands and on the prairies and plains,24 but it was a monopoly that was controlled and used with some difficulty in trade by the Spanish in the Southwest. In terms of exposure to commercial tobacco in the 18th and early 19th centuries, then, American Indians on the prairies and plains had a somewhat different experience than did those in the Southwest. Native tobacco was, however, ubiquitous.

COMMERCIAL TOBACCO SINCE THE EARLY 20TH CENTURY

By the early 20th century roll-your-own cigarettes had become widely available, with Bull Durham being the most popular brand. The Annual Report of the Commissioner of Indian Affairs observed in 1903 that the Sioux were very actively taking up the practice of smoking cigarettes:

There is a vice indulged in by these Indians that is very deplorable, and it has only in recent years taken hold of them. I mean the habit of cigarette smoking. If I am not mistaken, it is a misdemeanor in some of our States to deal or trade with them. Discussion of the demerits of the cigarette is out of place here. It is well known to be the most deadly form in which tobacco can be used, and in a people whose lungs are distinctly tubercular it is superlatively contraindicated. The old-fashioned Indian pipe, which is reasonably innocuous, has almost disappeared, and now nearly every Indian or mixed blood you meet, who uses the weed, has his folded cigarette paper, his little bag of Bull Durham, and a vest pocket full of matches.25

Bull Durham was also used in the Southwest. It was sold at trading posts and used by Hopis and Navajos in the late 19th and early 20th centuries.26 It was used by at least one Pima shaman in the 1910s and 1920s.27 It figured in household accounts recorded at Zia Pueblo in the early 1940s.28 And in the 1930s Elsie Clews Parsons reported that among Pueblo Indians, “Tobacco is the most compulsive of all offerings or presents. If you accept the cigarette, you must perform the ritual service asked of you.”29 She gave the following example:

To this day any request made by a White person is facilitated by tobacco. Once the manager of Ohewa kiva in Zuni was willing to send out the bogey kachina because I asked for him with Bull Durham.30

In 1916 Robbins et al., based on fieldwork done before World War I, wrote of tobacco use among the Tewa (one of several groups of Pueblo Indians in New Mexico):

The native tobacco (N. attenuata) [as contrasted with the two forms of domesticated tobacco] seems to be irritating to the throat and eyes, and few men at Santa Clara smoke it for pleasure. Three or four cigarettes at the most are smoked by each person at a meeting and the smoker complains of the effects next day. Commercial tobacco is more freely used, but most men profess not to smoke by daylight except after a journey. Until lately boys were forbidden to smoke “until they had killed deer, buffalo, jack-rabbit, and coyote,” and if they transgressed they were thrown into the river. Unmarried men were not allowed to smoke in the presence of their elders. Quite recently the ojike (winter cacique) of San Juan called a council because 3 young boys had been found smoking commercial tobacco; the culprits were publicly reproved, and a dance of all the children in the pueblo was ordered in expiation of the scandal.31

Describing a Christmas celebration in 1899 at Saint Michael’s Mission on the Navajo Reservation, Father Anselm Weber wrote,

The children . . . lost no time in tasting their candy while the grownups, among them not a few women, rolled cigarettes and began to smoke them before leaving. Pipes are not used by the Navajo, neither do they smoke cigars, for they have not yet acquired a heavy smoker’s taste, but they do enjoy a small, thin cigarette and love to expel the smoke through their noses.32

Aleš Hrdlicka observed in 1908 of American Indians in northern Mexico and the American Southwest,

Tobacco is smoked by the men in all the tribes, but nowhere to excess. The preferred way of using it is in the form of cigarettes, made usually of a little tobacco and much corn husk. It is probably never the cause of any sickness.33

It is not clear from the context whether the tobacco to which he referred was locally grown or commercial. What is clear (although reservation sales data are not available from the early 20th century) is that both native and commercial tobacco use occurred among American Indians in the Southwest and on the Northern Plains, but in the Southwest use was moderate and in some cases strictly controlled.

Several innovations contributed to the growing availability and popularity of Bull Durham in particular and roll-your-own cigarettes more generally in the early 20th century: great expenditures on advertising across the country34; the development of flue-cured tobacco, which made tobacco smoke milder and more easily inhaled35; the invention of a machine that made small bags in which tobacco was sold36; the invention of friction matches in the mid-19th century and their mass production by the end of the century, which made it easier to light up anywhere37; and the growth of a railroad network, which made distribution relatively easy.

By the 1910s and 1920s, however, sales had begun to decline as machine-made cigarettes gained in popularity.38 There was an uptick in sales during the Great Depression because the price of a roll-your-own cigarette was substantially less than that of a machine-made cigarette. Nonetheless, by the late 1930s the sale of Bull Durham tobacco was again in decline nationwide, although it continued to be the tobacco of choice in the 1960s on the Northern Plains.39 The brand was finally terminated in 1988.40 Until that time, however, it was widely used on the Northern Plains for both ceremonial and secular purposes.41 Indeed, a Lakota author has used the ubiquity of Bull Durham as a metaphor for the many ways American Indian nationalisms are expressed.42

Although I have been unable to find sales data relating to American Indian tobacco use in the early decades of the 20th century, the scattered references to roll-your-own cigarettes suggest that commercial tobacco was readily available in both the Southwest and on the Northern Plains in those years. Data do exist from later in the century, however, indicating that American Indians were the target of aggressive marketing by cigarette manufacturers. Consultants for the Lorillard Company in 1991 argued that because bingo games on reservations were exempt from state regulations, they were an ideal place to market cigarettes.43

A report by analysts for the Lorillard Company in 1996 describing sales on reservations in Arizona, New Mexico, North Dakota, and South Dakota claimed similarly that because reservations are sovereign, there are significant tax and price advantages to purchasing cigarettes in American Indian–owned or tribal smoke shops. The largest number of such shops was in Arizona (31) and accounted for 14.0% of cigarette sales in the state, followed by New Mexico (16), accounting for 13.8% of cigarette sales, and then by North Dakota and South Dakota combined (8), accounting for 2.7% of sales.44 Survey data from 2010 show that 24% of New Mexico smokers had made their most recent cigarette purchase on a reservation, compared with 12% to 17% of smokers in Arizona and the Dakotas.45 Consistent with the evidence displayed in Table 2, however, the Lorillard analysts also noted that American Indians in Arizona and New Mexico were not smokers, unlike those in the Dakotas. In the two Southwestern states other local residents, tourists, and patrons of casinos were the main buyers, whereas in the two Northern Plains states American Indians were a substantial proportion of the buyers.46

REGIONAL DIFFERENCES IN THE 20^TH CENTURY

Survey research has been used in an attempt to reconstruct the history of commercial tobacco use in the 20th century, with inconsistent results. Investigators have asked people of different ages about their histories of tobacco use; for example, whether they ever smoked and the age at which they started. One study, comparing an unnamed tribe on the Northern Plains with another in the Southwest, found that divergence began between men in each region in cohorts born in the 1950s. Among women differences were observed beginning with cohorts born before 1930. In each region, men smoked more than women. Among Southwestern men the rate had not increased over the decades, whereas it had for each of the other groups. Initiation of smoking began at younger ages among American Indians in the Northern Plains than it did in the Southwestern tribe.47

Another study, also of several anonymized tribes, showed no trend or divergence between men in each region but did show an increasing trend in rates of smoking before age 18 years among women.48 A comparison of a Northern Plains and a Southwestern tribe indicated that having spent more time away from the reservation was associated with a greater risk of being a smoker in the Northern Plains tribe but not in the Southwestern tribe.49 Unpublished data collected among Navajo Indians in the 1990s showed that age at first use of tobacco had declined among men born since 1941 but that there had been no change among women.50

The analysis of temporal trends using survey methods is potentially biased because of problems of recollection and selective mortality. An alternative is to examine historical changes in causes and rates of mortality. We have seen that American Indians on the Northern Plains have had higher death rates than have those in the Southwest since at least 1980. These differences were new at the time, because 30 years earlier, in the late 1940s and early 1950s, mortality rates of American Indians in each region had been virtually the same; the mortality rate was, if anything, slightly higher in the Southwest (Table 3).

Although the rates were similar at midcentury, they declined very unequally subsequently. At midcentury among the leading causes were tuberculosis and infant and child deaths stemming from infectious diseases. Thirty years later those causes had receded, chronic diseases and manmade conditions had become particularly important,51 and, as the rate ratios displayed in Table 2 reveal, among the newly important causes were several smoking-related conditions that had become much more common on the Northern Plains than in the Southwest.

It has been suggested that diagnostic imprecision makes it problematic to infer historical changes in smoking from changes in mortality rates. In a study of the changing accuracy of diagnoses of lung cancer and tuberculosis in a university hospital, Wells et al. showed that, according to diagnostic criteria accepted when they were writing, the adequacy of diagnosis increased from 1921 to 1982.52 They concluded that increased diagnostic precision may have contributed to changing rates of death stemming from these causes, with tuberculosis and lung cancer being mistaken for one another; most commonly in the early years, lung cancer was mistaken for tuberculosis. If that was the case, lung cancer would have been higher than usually reported and its temporal connection with smoking more tenuous.

Diagnostic imprecision, although undoubtedly real, is an unlikely explanation for the patterns we observed. The rates of death stemming from tuberculosis were very similar on the Northern Plains (111 per 100 000) and in the Southwest (134 per 100 000) in 1949 to 1953 and again in 1999 to 2009 (1.2 and 1.4, respectively).53 Malignancies in general were so uncommon among American Indians at midcentury that regional rates were not even reported,54 only rates for the entire population.55 A brief report of cancer among a Northern Plains population was published around midcentury, which mentioned lung cancer only in passing.56 Several were published showing extremely low rates of lung cancer among Southwestern Indians.57 If lung cancer among Northern Plains tribes had been mistaken for tuberculosis, the rate of tuberculosis should have been much higher than in the Southwest at midcentury. The same temporal change is observed with heart disease and cerebrovascular disease. Both were less common among American Indians than among non-Indians at midcentury,58 and both have increased since then, to higher levels on the Northern Plains than in the Southwest.

It is unlikely that lung cancer was being masked by tuberculosis on the plains but not in the Southwest. It is more likely that lung cancer and other smoking-related conditions emerged as a major health problem on the Northern Plains in the generations entering their 50s and 60s in the years between 1950 and 1980; that is, among cohorts born in the first several decades of the 20th century, just as the shift to cigarettes was occurring. These data demonstrate that smoking commercial tobacco has been more prevalent among American Indians on the Northern Plains than in the Southwest since at least the early 20th century, and probably earlier.

The evidence indicates that native tobaccos have been widely available in both regions of the country since the pre-European era. Commercial tobacco was used in trade more actively by the French and Anglo-Americans than by the Spanish and Mexicans in the 17th, 18th, and 19th centuries, but by the American period in the late 19th century commercial tobacco had become widely available in each region; it has continued to be readily available on and near reservations to the present time. Despite its ubiquity in the 20th century, however, use of commercial tobacco by Southwestern American Indians was not as great as it was among Northern Plains American Indians. This was the case even as American Indians from each region had increasing contact with institutions of the larger society (e.g., the army, education, employment, and urban migration). Thus differential access to tobacco products since the early 20th century does not explain regional differences in contemporary use.

CEREMONIAL TOBACCO USE

Numerous authors have suggested that the ceremonial use of tobacco among American Indians on the Northern Plains was much greater than that among those in the Southwest, thus preparing the way for the increased use of commercial tobacco for secular purposes when Europeans introduced it.59 However, tobacco use in the precontact and early contact periods was ubiquitous for both ceremonial and secular purposes across the Americas,60 including on the Northern Plains61 and in the Southwest.62 An important exception was the calumet (pipe) ceremony in the 17th, 18th, and 19th centuries. It was a frequent ceremony on the Northern and Southern plains, the prairies, and in the east, but not in the Southwest.63

Pipe smoking was widespread across North America in the precontact period,64 and the calumet ceremony may have originated before contact with Europeans.65 However, Thorne has argued that, beginning near Pipestone Quarry in Minnesota “at the prairie-plains margin,” it spread and became pervasive “in the early historical period due to the conditions of population dislocation and migration.” These conditions were caused by Europeans pushing westward, by the attraction of buffalo on the plains, and by the impact on the Plains tribes of acquiring horses.66 The result during the 18th and 19th centuries was, as Hämäläinen has shown,67 intertribal warfare and the disruption of tribal relationships all across the Northern Plains, as well as across the Great Plains more generally. The ceremony, which involved sharing a pipe and tobacco, singing, and dancing, was a way of establishing alliances and ensuring peace, at least temporarily, by creating fictive kin relations involving reciprocity and mutual obligations within and among tribes.68 As such, some suggest, it assumed a different character than did the pipe smoking of the precontact period. Its significance, according to Thorne,69 was threefold:

1. “It reified an ideology of peace for humankind based on the rule of law.”

2. It contributed to political stability “at both the intratribal and intertribal level, for it simultaneously promoted interdependency via trade and kinship ties while enhancing the authority of the chiefs and rule of law.”

3. It became a way to integrate Europeans into trading and kinship systems.70

The situation was different in the Southwest. A glance at a map of America north of Mexico suggests one reason for this. Rivers and the Great Lakes provided passage down the Saint Lawrence River and ultimately into the Mississippi River and its tributaries, including the Missouri River. The two great rivers of the Southwest, the Rio Grande and the Colorado, were not navigable for their full length. The result was that traveling from Mexico City, Mexico, to Santa Fe, New Mexico, was a long, difficult overland journey; the trip from Montreal or New Orleans, Louisiana, to Saint Louis was comparatively easy. It was far more difficult—and less rewarding—for the Spanish to penetrate large swathes of the desert Southwest than it was for the Euro-Americans to penetrate the prairies and plains. Spanish settlement was focused on the Rio Grande Valley and its tributaries in what is now New Mexico. In what is now Arizona and Baja California, Spanish occupation was primarily for missionizing, as the land was too arid to support settlement,71 there were few or no buffalo west of the Rio Grande72 to attract large numbers of traders and hunters as there were on the Northern Plains,73 and the region could not support the large number of horses that had transformed the Plains tribes into warrior societies in competition for resources.74

Although warfare had been widespread in the pre-Hispanic Southwest75 and intertribal raiding and conflict persisted into the 18th and 19th centuries,76 it does not appear to have been as frequent or intense as it was on the plains.77 The Spanish contained interpueblo fighting but used pueblo warriors to fight Navajo and Comanche raiders.78 Basso’s distinction between raiding (for cattle and horses, primarily) and warfare (to avenge the death of a family or band member), on the basis of the narratives of Western Apaches recorded by Grenville Goodwin, suggests that low-level raids were by far more common. By contrast with plains warfare, the intention was not to take territory or eliminate non-Apaches, who were a useful source of booty.79

Moreover, Spanish policy was based on conquest, the collection of tribute, and the extraction of wealth.80 Until the Pueblos revolted in 1680 in New Mexico, the Spanish, through the encomienda system, had extracted both labor and tribute (i.e., corn). The system was not reestablished when the Spanish returned in the 1690s and had never been established in what is now Arizona, Utah, and Colorado.81 By contrast, because Canada and what became the United States attracted few French immigrants, their small number required consent from the native population rather than conquest.82 Trade, especially the fur trade, thus became paramount.83 Trade required trust, and trust was created by social relationships, often involving kinship. The French willingly participated in such relationships. Not only did they participate in the calumet ceremony, which led to fictive kin relations, but many French men married native women; this was advantageous to both parties because it enhanced the status of the woman’s kin group and gave the man privileged access to trading partners. Such relationships were crucial to the workings of the fur trade.84

Although scarcely models of tolerance and peaceful accommodation,85 the French were more likely than were the Spanish to make the native peoples kin and allies to promote trade.86 The French Jesuits were devoted to converting natives to the Catholic faith, they criticized Native Americans’ ceremonies and beliefs as the work of the devil, their efforts were integral to advancing French interests in New France,87 and their presence was highly disruptive in many instances.88 However, “for some reason, [they] seemed far more open to theological discussion than were their brethren in New Spain.”89

The Spanish appear to have been far less tolerant of what they perceived to be pagan rituals than were the French. In 1660, a Spanish expedition to the plains led by Diego Romero encountered the Plains Apache. He was “honored with an Apache version of the calumet ceremony,” for which he was accused of heresy by the Inquisition in Mexico City.90 Although anecdotal, the story is significant, for unlike the French, the Mexican Inquisition after 1571 dealt primarily with mestizo and Spanish settlers to investigate cases of witchcraft, idolatry, blasphemy, heresy, and bigamy.91 This example suggests that one possible reason the pipe ceremony was unimportant in interracial relations in the Southwest is that the Inquisition discouraged Spanish and mestizo participation.

Because there seems to have been greater intertribal disruption and warfare on the Northern Plains than in the Southwest and because the French were more likely than were the Spanish to engage in trade rather than conquest, tobacco smoking was more frequently used to facilitate intertribal as well as interracial encounters and to give them a religious sanction. Thus the pipe ceremony embedded tobacco more thoroughly in social relationships on the plains than in the Southwest: indeed it facilitated those relationships.

CONCLUSIONS

Rates of smoking among American Indians in the Southwest have been lower than among those on the Northern Plains for more than a century, even though commercial tobacco and then machine-made cigarettes have been available in each region since the early 20th century. Neither contemporary rates of poverty, which do not differ between the two regions, nor differences in educational attainment, which are slightly higher among American Indians on the Northern Plains, explains the differences in prevalence, which long predate these measures. Two reasons have been proposed.

First and most significant, although tobacco was ubiquitous across North America in the pre-European period and more varieties of tobacco were available in the Southwest than anywhere else, the absence of the pipe ceremony from the Southwest meant that tobacco use was not as deeply embedded in social relationships among and within tribes and between natives and Europeans there as it was among Northern Plains tribes, among whom it was a vehicle to affect reconciliation and peace among people as well as relationships between humans and spiritual beings.

The difference in the use of the pipe stems from the importance of the ceremony as a response to the disruption of intertribal relationships precipitated by the Euro-American intrusion that displaced many tribes onto the Northern Plains. By contrast, the absence of buffalo and the aridity of large parts of the Southwest meant that Spanish intrusion was less extensive; intertribal and American Indian–non-Indian conflict although real was less intense than on the Northern Plains; and the pipe ceremony never became established and never served the same function there as it did elsewhere.

Second were differences between the colonial powers. The French were concerned with trade and the Spanish with conquest, control of native populations, and extraction of resources. Consistent with this difference, in the 18th and early 19th centuries the French were growing tobacco along the Mississippi and Missouri rivers and trading it with American Indians, whereas the Spanish had placed restrictions on planting tobacco in New Mexico and had attempted, although with limited success, to control its use in trade. Thus commercial tobacco was integrated more thoroughly into Northern Plains trade and at an earlier date than it was into that of the Southwest.

Alternatively, it may be that Southwestern American Indians were sufficiently isolated geographically from pipe-using American Indians elsewhere that the practice never diffused to them. This seems unlikely because there was in fact a great deal of contact among the Spanish, Apaches, Utes, Comanches, and pueblos at Pecos Pueblo until its abandonment, at the Taos, New Mexico, fair, and when Pueblo Indians traveled to the plains to trade.92 It is more likely that the combination of ecological differences and differing colonial policies and trading practices shaped intertribal and interracial relations in such a way that the use of tobacco was more highly integrated into social and religious life on the Northern Plains than in the Southwest.

The nature of the evidence is of course not definitive, but these circ*mstances suggest that the greater integration of tobacco into trade, social relationships, and spiritual life among Northern Plains than Southwestern tribes enhanced its acceptability and made American Indians on the Northern Plains more likely to use flue-cured tobacco in cigarettes when it became widely available at the turn of the 20th century.93 The mortality data indicate that by the early decades of the 20th century the use of commercial tobacco was more prevalent among Northern Plains than Southwestern American Indians.

In recent years tribal governments, community groups, and the Indian Health Service have distinguished between the sacred and secular use of tobacco,94 encouraged smoking prevention and cessation among tribal members, and mandated smoke-free communities and public buildings.95 Not surprisingly, there has been resistance from many tribal casinos, and only a few are smoke-free.96 Tribal governments are thus in a position similar to that of other government entities, which receive revenues from the sale of tobacco products while attempting to control exposure to tobacco and secondhand smoke. Change is occurring, but declining age at first use, the addictive nature of nicotine, and lavish advertising by cigarette manufacturers at rodeos, casinos, and other venues97 suggest that tobacco use is likely to persist for some time to come.

ACKNOWLEDGMENTS

I thank Maggie Brady, Mac Marshall, and David H. Snow and 2 anonymous reviewers for their helpful comments and suggestions.

ENDNOTES