Research ArticleGambling with Our Health: Smoke-Free Policy Would Not Reduce Tribal Casino Patronage
Introduction
Tribal casinos can intervene on the social determinants of health, reducing poverty and improving SES,1, 2, 3, 4, 5, 6, 7 in American Indian (AI) communities experiencing significant health disparities.8, 9, 10 The smoking prevalence among AIs is 40%—the highest of any racial/ethnic group—and more than double that of the general U.S. population.8, 9, 10 The incidence of heart disease among AIs is twice that of the general U.S. population,11, 12 and mortality rates for both heart disease and stroke are 20% and 14% greater for AIs than all U.S. races.13, 14 Although the cancer incidence rate is decreasing among whites, it is increasing among AIs.15, 16 With poverty rates as high as 85%17 and unemployment rates nearly 80%,3 it is hardly surprising that, in AI communities where casinos are located, health outcomes are improving.1, 5, 7, 18, 19
Nevertheless, despite the potential benefits casinos provide, both casino workers and patrons continue to be exposed to secondhand smoke in the face of the Surgeon General’s warning that there is no safe level of tobacco smoke exposure.20, 21 Indeed, even brief exposure increases the risk of heart attack or cancer.22, 23, 24, 25 Consequently, 26 states have banned smoking in public places.26 Because the tobacco industry has lobbied hard against smoke-free laws, particularly in casinos,27 only eight of these states have banned smoking in casinos.26
Tribal casinos are exempt from statewide bans because of tribal sovereignty. As smoking has declined among the non-Hispanic white population, the tobacco industry has increasingly targeted tribal casinos. As a result, only six of the 237 tribes operating casinos have voluntarily implemented casino-wide smoking bans.28 This statistic is particularly troubling given that one in four casino employees is an AI,29 as AIs are the least likely of any racial/ethnic group to have smoke-free worksites or homes30 and are more likely than any other racial/ethnic group to be exposed to secondhand smoke.31
Although there is broad support for banning smoking in public places,32 only one published study by Timberlake et al.33 in 2012 assessed the views of tribal casino patrons with regard to a proposed casino smoking ban, as well as the characteristics of those patrons who might prefer or oppose a smoke-free casino. Using secondary data from the 2008 California Tobacco Survey, the study assessed smoking prevalence by casino visitation, predictors of casino visitation, avoidance of secondhand smoke among casino patrons, and willingness to extend one’s stay and visit again if smoking were prohibited. The study found that smoke-free tribal casinos would increase patronage by Californians, including first-time and repeat visits.33
This article reports on a community-led assessment conducted with the Lake of the Torches Resort Casino in northern Wisconsin, which surveyed current casino patrons. The characteristics of the patrons and their preferences for a smoke-free casino environment were assessed, and the results were reported back to the tribal leadership and community for health infrastructure planning. This assessment is, to our knowledge, the first of its kind to be led by Native American tribal members and work in partnership with a tribally owned casino to directly survey active casino patrons.
Section snippets
Community Profile
The project team included the Great Lakes Inter-tribal Council (GLITC), a non-profit consortium created to expand the self-determination of 12 federally recognized member tribes located in Wisconsin and Upper Michigan, and the Lac du Flambeau Band of Lake Superior Chippewa Indians (LDF) tribal nation—a member of the GLITC consortium—located in a reservation in northern Wisconsin.
The smoking rate in the LDF reservation is 44%,8, 34 similar to other tribes in the Great Lakes region where AIs have
Results
The characteristics of the surveyed patrons (respondents and non-respondents) and known characteristics of the players club patrons who met the initial selection criteria are shown in Table 1. The majority of survey respondents were white (92%); had at least passed high school or the General Educational Development test (96%); and had an annual household income greater than $40,000 (51%). The majority were nonsmokers (77%); were bothered to some extent by smoke in the casino (69%); and believed
Discussion
Overall, the majority of survey respondents in this study reported being more likely to visit the casino if it banned smoking, whereas fewer patrons were likely to visit less. The patrons who were more likely to prefer a smoke-free casino tended to be white, elderly, middle class and above, and patrons of the casino restaurants. Patrons within the lower tiers of the players club (smaller gamblers), almost half of the players club members, also showed a higher preference for a smoke-free casino.
Acknowledgments
The project was supported in part by a contract with the CDC (No. U158DP002617). Portions of this project’s work involve the Communities Putting Prevention to Work initiative supported by CDC funding. However, the findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the CDC. The authors would like to thank the Lake of the Torches Resort Casino and casino patrons, Lac du Flambeau Band of Lake Superior Chippewa Indians, Lac du
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