Tobacco has become a much-maligned plant in modern society. Cigarettes, which typically contain dried leaves from a tall, hybrid species called Nicotiana tabacum, are blamed for more than 480,000 deaths per year in the United States. And reams of scientific findings indicate that cigarette smoking—inhaling a toxic brew that can contain at least 70 cancer-causing chemicals—harms nearly every organ of the body.

But tobacco itself is not the problem, according to Gina Boudreau. In fact, she considers it sacred. And she is not alone. Many Native American communities, including hers, use the substance in traditional rituals and pass down stories about how and why the creator gave it to them. Yet customs related to growing and respecting tobacco have eroded over time, leaving communities exposed mostly to commercial versions of the plant—and furthering smoking addiction.

Boudreau hopes to change that. She is helping lead a movement within her tribe, the Minnesota-based White Earth Nation, to boost traditional tobacco use. This shift is not just for the sake of rebuilding a vanishing tradition; it is part of a surprising strategy to tamp down the tribe’s high smoking rate. Essentially, the plan is to fight tobacco with tobacco.

Even as smoking and lung cancer rates have plummeted across most of the United States, current intervention strategies have not proved as effective in tribal communities; they continue to have some of the country’s highest smoking rates. In Boudreau’s state, Minnesota, only about 15 percent of the overall adult population smokes—but the rate jumps to nearly 60 percent among tribal members. The U.S. Centers for Disease Control and Prevention says about 32 percent of Native American adults nationwide are smokers. By comparison, smokers make up only about 16 percent of the overall U.S. adult population.

The situation has become so alarming that two years ago the National Congress of American Indians—the country’s oldest and largest organization of tribal governments—passed a resolution designed to tamp down smoking rates and save lives. Among other steps it urged all tribes to create and enforce tobacco-free air policies in indoor workplaces and public spaces (including tribal casinos), and to offer access to high-quality tobacco cessation services.

Boudreau’s White Earth Nation has taken some of these actions, including banning smoking in various government buildings. Those restrictions force smokers to leave public areas—even during Minnesota’s harsh winters. But beyond that, Boudreau and other tribal members say addressing the problem should go beyond rolling out generic advertisements about how bad tobacco is, or pushing “just say no to tobacco” messages. Instead they believe promoting tobacco use in more traditional ways, and rebuilding respect for the plant as a sacred element of Native culture, would have a better chance at making a real difference. “We’re trying to change community norms,” Boudreau says. The White Earth plan is backed by the Minnesota Department of Health, which helps pay for anti-smoking work, including Boudreau’s salary as the tribe’s tobacco prevention coordinator. The state now spends $1 million a year partnering with its tribes to try to drive down smoking rates across tribal communities.

The first step toward this shift, according to Boudreau, is growing an indigenous tobacco species on the reservation. About eight years ago she started planting seeds of Nicotiana rustica, a short and spindly-looking tobacco plant with a long history of growing wild throughout the Americas—and of ritual use by Native American tribes. It typically contains more nicotine than its lush-leafed commercial cousin N. tabacum, a characteristic that makes the indigenous plant’s smoke harder to inhale. N. tabacum is more attractive to commercial interests because it produces more tobacco per plant and its smoke is less irritating, making it a good choice for mass production. N. tabacum and N. rustica both likely originated in South America about 200,000 years ago, and the latter still grows wild there and in Central America. But tobacco companies have modified N. tabacum to enhance certain traits for flavor or growth. So today’s version—much like other commercialized crops—bears little resemble to its ancestors, says Ramsey Lewis, a professor of crop science who focuses on Nicotiana genetics at North Carolina State University. Now, he says, N. tabacum is rarely found in nature.

There are other key differences between industrialized tobacco and the substances used for ritual purposes. The term “traditional tobacco” can refer to other indigenous plants that may not contain nicotine at all, including the dried leaves of bearberries and the bark from red and spotted willows. American tribes also use traditional tobacco in a variety of ways. Often it is not smoked, and when it is, it is usually not inhaled into the lungs. Some tribes place it on the ground or burn it in dish or shell; the smoke is believed to carry prayers to the creator. Dried tobacco may be sprinkled on or near a car to ensure a safe journey. Presenting a gift of tobacco when a deal or contract is being forged can make the agreement more binding. Tobacco is also employed medicinally: Sprinkling it on the bed of an ill family member is thought to protect the patient and serve as a healing agent, as Minnesota-based Chippewa tribal members noted in the American Journal of Preventive Medicine. Practices differ from tribe to tribe, and citizens of the White Earth Nation and the Ho-Chunk tribe in Wisconsin were reluctant to reveal details of their religious rites to a visiting outside journalist. But David Greendeer, a former Ho-Chunk legislator, told me that the complex process of growing actual tobacco itself—talking to the plant and imbuing it with the grower’s thoughts and energy—can be a key part of sacred tradition. The work can be difficult, and produces a relatively small yield: Once the leaves from Greendeer’s personal plot of 150 plants in Wisconsin are harvested and dried, there are only about four medium-sized coffee cans of traditional tobacco to last him and his family throughout the year. So if tobacco is grown and used in the traditional way, Greendeer reasons, it would be challenging to feed an addiction. “We can only grow so much,” he says. “It’s a shitload of work to get that done.”

Boudreau and her allies are now working on growing the plant, teaching community members about traditional use and urging them to quit using cigarettes, or never start. So far interest has been slow to develop—but Boudreau says the ideas are starting to take root. If kids build a relationship with traditional tobacco at an early age by growing it at school, for example, harvesting it and engaging with it in traditional gatherings and ceremonies, they may be less likely to smoke as adults. “It’s about keeping tobacco sacred,” says Dana Goodwin, 53, a White Earth Nation language and culture teacher at the Circle of Life Academy—a Bureau of Indian Education Grant school on the White Earth Nation reservation that offers K-12 education steeped in cultural traditions.

White Earth Nation members say their smoking issues metastasized against a complicated historical backdrop. Until the passage of the Indian Religious Freedom Act of 1978, laws banned many Native American cultural practices, including various traditional uses of tobacco. And in the late 19th and early 20th centuries, churches or the U.S. government routinely took Native American kids from their homes and sent them to faraway boarding schools where tribal cultural and language practices were forbidden. This also contributed to the breakdown in teaching traditional customs, Goodwin says.

But some tribes managed to hold onto their historic practices in hidden or secret ways, such as substituting cigarettes for indigenous tobacco at traditional ceremonies. For example, at funerals among the Ojibwe (a larger tribal distinction that includes the White Earth Nation), ritually grown tobacco would be placed on the ground to offer prayers to the spirit world for the deceased. To continue this custom when traditional tobacco use was prohibited, the tribe instead started passing a birch-bark basket of cigarettes among attendees to smoke as a group, so the prayer tradition survived. Similarly, since tribal members could no longer keep traditional tobacco with them, they started carrying commercial tobacco and using it for daily offerings and ceremonies.

Traditional tobacco growing in a garden on the White Earth reservation. Credit: Jean Dakota

Tobacco companies may also have contributed to the high smoking rates among Native Americans. Historically these companies marketed to tribal communities by appealing to their cultural connections with tobacco—thus becoming one of the few outside groups that strongly supported tribal sovereignty and economic development (internal tobacco company documents, now public, suggest they had also hoped for more access to tribal casinos and stores as places to sell their products). That legacy of apparent support for tribal interests has left some Native American communities with mixed feelings toward these companies, possibly hampering smoking cessation efforts.

The reasons tribal members start smoking remain complex. As is the case in any other community, a person may light up in response to social pressures, to relieve stress, or due to many other factors. Cigarettes remain ubiquitous at some Native American traditional ceremonies. Also, people with lower socioeconomic status generally have the highest rates of smoking prevalence across the United States, and most tribal communities remain disproportionately poor. About 30 percent of American Indians live in poverty compared to 15 percent of the general population, says Brian King, a senior scientist and epidemiologist at the CDC who serves as deputy director for research translation in the agency’s Office on Smoking and Health. There are also education disparities: about 23 percent of Native Americans have no high school diploma or its equivalent, versus 14 percent of Americans nationally, King says, citing census data.

Whether the White Earth Nation’s fight-tobacco-with-tobacco effort will work remains unclear. The quit rate among the small number of people who visit the local smoking cessation clinic reached almost 14 percent in fiscal 2017—roughly doubling from fiscal 2016, according to the clinic’s preliminary internal numbers. The tribe’s own data also suggests there has been a modest improvement—from a 44 percent smoking rate in 2014 to 38 percent in 2017. And smokers do not appear to be shifting to e-cigarettes, devices which have generally remained unpopular in the community.

Yet on a recent visit to the tribe’s reservation, the immediate prospects for smoking prevention and cessation seemed far from assured. Traditional tobacco plants grow on small plots throughout the community, but there are also constant reminders of commercial tobacco use that could undercut a cultural shift. When I visited the Circle of Life Academy school, a small amount of tobacco had been grown on campus. But kids were dipping their hands in a store-bought bag of loose leaf “Smokin Joes Pipe Tobacco” to put the substance in traditional fabric pouches that would be used in a school ceremony. The plastic bag, still sporting its price tag, featured a picture of a Native American figure wearing a headdress—above the required surgeon-general warning. I also chatted with a small group of nine- and 10-year-old girls, and when I asked them for their thoughts on smoking they all agreed that it was bad for one’s health. But when I asked if they plan to smoke cigarettes when they grow up, one girl quickly said “yes” and another said “maybe.” The latter leaned in and confided, “My cousin smokes. He’s 10.”

For some adults the workplace can also be a hazard when it comes to picking up the habit or being exposed to secondhand smoke. The tribally owned and operated Shooting Star Casino, which is the community’s number one employer, says 50 percent to 70 percent of its 1,000 employees are members of the White Earth Nation. Here, as in many tribally owned casinos across the country, it can be difficult to stay away from cigarettes; many people like to smoke while they gamble, making managers hesitant to bar smoking. Cigarettes are also not taxed at tribally owned stores, which makes the product more affordable than elsewhere.

When it comes to approving or implementing anti-smoking policies in tribal communities, “it’s like gun control across the United States—it’s a touchy subject,” says Clinton Isham, a member of the Lac du Flambeau tribe in Wisconsin, who works to cut tribal smoking rates throughout his state on behalf of the Great Lakes Inter-Tribal Council. Each morning, he says, he uses traditional tobacco grown in his mother’s garden—either placing it on the ground as a sacred offering or smoking it in a pipe. But in his professional smoking-prevention work he has found that even when tribal elders use and promote traditional tobacco themselves, and worry about high smoking rates in their communities, it remains difficult to gain much ground on smoke-free casino policies. The main snag, he says, is that tribes worry that the shift could hurt one of their principal sources of revenue. Tightening restrictions on smoking in other public spaces, he says, is also difficult because such policies could frustrate smokers and feel unnecessarily onerous.

After weeks of reporting on traditional tobacco for this report, I wanted to see some of it up close and speak with someone who grows it at home. That’s when I called David Greendeer and asked him to meet up for lunch. The 38-year-old said he would be happy to make time. But he had a delicate question first: Would I be menstruating? If so, he said, tradition dictated that he could not bring or show me any of the tobacco. Fortunately I was not, so we agreed to convene at a sports bar in Wisconsin Dells, about an hour outside Madison. Over lunch (herbal tea and soup for him, a chicken sandwich and Coke for me) he explained that menstruation is not considered unclean. But tradition holds that growers’ thoughts and intentions are infused into the tobacco, and that a woman on her period is spiritually “very strong”—potentially making her more likely to absorb those unknown thoughts and intentions, which could cause problems for her and also alter the tobacco.

About an hour into a far-ranging conversation that bounced from Greendeer’s current role in helping grow the Ho-Chunk nation’s business side to his tribe’s story about the creation of humans, he pulled out a deerskin pouch of homegrown tobacco, which he asked me not to touch. It looked like oregano or any other dried herb, and did not have the strong smell of store-bought tobacco. Like Boudreau, Greendeer emphasized that to effectively curb smoking rates there needs to be a cultural change—one that stresses “keeping tobacco sacred”—and teaching that to children, he said. So far, he added, there have not been enough efforts to encourage such practices in his community.

But other Ho-Chunk community members told me there are some early indications that may be changing—at least on a small scale. In the last few years Jon Greendeer, the tribe’s recent former president and a relative of David’s, has led efforts to bring more traditional tobacco to community events, and to get others to do the same—fomenting greater awareness about traditional tobacco and what one’s relationship with it should be. Now, Jon Greendeer told me, he brings freshly grown and dried tobacco to community events; before, he would buy four packs of cigarettes to contribute. And although data on smoking cessation efforts within the tribe remains scarce, health surveys Ho-Chunk officials have taken among one significant subset of the community—its diabetic population—suggest their smoking rates are dropping substantially. Anecdotal evidence from Ho-Chunk members I interviewed also suggests fewer people have been smoking in the past few years.

Sara Peterson, the Ho-Chunk’s health and wellness coordinator, says several factors could explain declining numbers. New policies (such as banning smoking in public spaces) have been imposed; more smoking cessation education is available; the price of cigarettes has continued to rise; and more community leaders have started speaking publicly about quitting, along with other healthy lifestyle choices. Amy DeLong, a physician who sees many of the tribe’s members, says she now talks with each of her patients—regardless of the reasons for their visits—about quitting smoking or making sure they never start. Perhaps the combination of all those actions may help explain the decline, Peterson surmises. Moreover, one of the tribe’s largest casinos went smoke-free in August 2015—making it the only such casino in the state to do so. The casino actively advertises its smoke-free status and has not lost revenue. Several community members I interviewed speculated that the public discourse that swirled around that decision may have influenced people’s thinking.

Even with these possible improvements, however, members of both the Ho-Chunk and White Earth Nation tribes cautioned that progress will likely be slow, and many expect an uphill battle in the years ahead. Smoking is no different than other issues that disproportionately affect Native Americans’ health, Isham reminded me in Wisconsin. Pointing to the high diabetes rates, he said, “At many of our traditional events, a standard cultural food has become fry bread served with taco meat on it, and we jokingly call it an ‘Indian taco.’” Tribal members know it contributes to high obesity and diabetes rates, but the tacos are also an example of how the community adapted and remained resilient despite colonization. “When [tribes] were pushed onto reservations we were given some foods we had no familiarity with,” Isham says. “We created new foods from them in order to survive—like this fry bread. So now Indian tacos contribute to our problems, yes, but they are also a sign of our perseverance. Really, it’s the same thing with commercial cigarettes.”