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Breathing clean air is Są’áh Naagháí Bik'eh Hózhóó (SNBH): a culturally centred approach to understanding commercial smoke-free policy among the Diné (Navajo People)
  1. Carmenlita Chief1,
  2. Samantha Sabo1,
  3. Hershel Clark2,
  4. Patricia Nez Henderson2,
  5. Alfred Yazzie2,
  6. Jacqueline Nahee2,
  7. Scott J Leischow3
  1. 1Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
  2. 2Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
  3. 3Health Services Research, Mayo Clinic, Scottsdale, Arizona, USA
  1. Correspondence to Carmenlita Chief, Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin, P.O. Box 245163, Tucson, AZ 85724, USA; cchief{at}


Introduction Indigenous worldviews and research approaches are fundamental to make meaning of complex health issues and increase the likelihood of identifying existing cultural protective factors that have contributed to the resilience and survival of Indigenous people worldwide.

Objective We describe the process for applying the Diné (Navajo) paradigm of Są’áh Naagháí Bik'eh Hózhóó (SNBH), a belief system that guides harmonious living, and demonstrate how the application of SNBH enhances understanding of Navajo principles for well-being. Specifically, we juxtapose this analysis with a conventional qualitative analysis to illuminate and interpret Diné perspectives on the health and economic impact of commercial secondhand smoke and smoke-free policy.

Methods Focus groups were conducted throughout Navajo Nation to assess the appeal and impact of several evidence-based messages regarding the health and economic impact of smoke-free policy.

Results Diné perspectives have shifted away from family and cultural teachings considered protective of a smoke-free life, and struggle to balance the ethical and economics of respect for individual and collective rights to live and work in smoke-free environments.

Conclusions Indigenous-centred approaches to public health research and policy analysis contribute to understanding the cultural knowledge, practices and beliefs that are protective of the health and well-being of Indigenous people.

  • Public policy
  • Public opinion
  • Secondhand smoke
  • Disparities

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