Studies examine tobacco use in Native communities
· Medical Xpressby Iqbal Pittalwala, University of California - Riverside
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Two studies examining commercial tobacco use in Native American communities underscore the importance of culturally responsive prevention and a deeper understanding of how substance use fits into people's everyday lives.
Led by Claradina Soto (Navajo and Jemez Pueblo), an associate professor of social medicine, population and public health in the UC Riverside School of Medicine, the studies show how research grounded in Native communities' experiences and priorities can inform prevention and cessation efforts.
The first study, published in Translational Behavioral Medicine, tested a culturally adapted vaping-prevention curriculum for Native American youth. The second study, published in Addictive Behaviors Reports, explored how Native American young adults use commercial tobacco and cannabis together, including the social and practical factors that shape their use.
Culturally responsive vaping prevention
The first study evaluated Vaping Endgame, a culturally adapted vaping-prevention curriculum for Native American youth. It found increases in students' knowledge about vaping and commercial tobacco and in their perceived behavioral control against vaping.
The pilot study involved 32 Native American students in grades 7–12 who participated in a five-day vaping-prevention program. The researchers used community-based participatory research and positive youth development principles to adapt an existing nicotine-prevention curriculum, incorporating community perspectives and teachings about ceremonial and commercial tobacco.
"This pilot study shows that prevention works differently when the community is a partner in designing it, not simply its audience," Soto said. "The students' feedback and engagement suggest that cultural relevance can be an important part of making prevention education meaningful and accessible."
In the paper, Soto and her team describe the study as the first culturally responsive vaping curriculum developed and assessed specifically for Native American youth. They caution that larger studies are needed to evaluate its effectiveness and feasibility.
An important part of the program, Soto said, was helping youth understand the distinction between ceremonial or traditional tobacco and commercial tobacco.
"Prevention needs to recognize that commercial tobacco and ceremonial tobacco are not the same," she said. "Creating space for cultural teachings alongside evidence about the harms of commercial tobacco allowed us to address vaping in a way that respected the community's values and perspectives."
Understanding commercial tobacco and cannabis co-use
The second study examined the combined use of commercial tobacco and cannabis among 52 Native American adults ages 21–29 in California.
Through interviews conducted in 2023 and 2024, Soto and her team examined participants' patterns of use, including co-use of products, and how their use was connected to their daily routines, relationships and responsibilities.
Participants described using the substances for different desired effects, including cannabis for relaxation and nicotine for alertness. Social settings also played a role, with some participants describing vaping or sharing cannabis products as a form of social bonding.
The study found participants adapted their use around work, caregiving responsibilities and public settings. Some parents said they waited until their children were asleep or otherwise kept substance use separate from family life. Some participants also reported combining commercial tobacco and cannabis to reduce costs.
"These interviews show co-use isn't driven by one factor," Soto said. "People's patterns can change depending on what they need to do that day, who they are with, the products available to them and the effects they are seeking."
The longitudinal study also allowed participants to reflect on their substance use over time. Some recognized the harms of commercial tobacco and expressed a desire to quit, while describing cannabis as something they felt helped them relax, manage anxiety or sleep.
"Understanding the context around use gives us a better foundation for developing interventions," Soto said. "Rather than treating tobacco and cannabis use as isolated behaviors, we need to understand how they can become connected to routines, relationships, responsibilities and social environments."
Publication details
Lizbeth Becerra et al, Vaping Endgame : cultural approaches and preliminary findings of an adapted vaping pilot intervention for American Indian youth, Translational Behavioral Medicine (2026). DOI: 10.1093/tbm/ibag053
Karla D. Llanes et al, Understanding commercial tobacco and Cannabis co-use in American Indian young adults in California, Addictive Behaviors Reports (2026). DOI: 10.1016/j.abrep.2026.100742
Journal information: Translational Behavioral Medicine
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