Tribal Casinos Respond to COVID-19 by Going Smoke-free

According to the Center for Disease Control and Prevention American Indian and Alaska Native (AI/AN) populations are disproportionately impacted by serious health conditions, such as, chronic obstructive pulmonary disease (COPD), type 2 diabetes, chronic kidney disease and a compromised immune system. AI/ANs are also at increased risk of lower respiratory tract infections, obesity, complications from pregnancy and have high rates of habitual smoking, which make AI/Ans communities at higher risk for a more serious COVID illness. AI/AN youth and adults, unfortunately, have the highest prevalence of cigarette smoking among all racial/ethnic groups in the U.S.[1],[2].

Tribal casinos, restaurants, bars, etc. are common places that a person could be exposed to second-hand smoke – a combination of smoke generated at the end of a cigarette and the smoke exhaled by smokers. Overall, there are 7,000 chemicals that are released from second-hand smoke and it is known that 70 of those can cause cancer. Also, exposure to second-hand smoke is linked to some of the serious health conditions experienced by AI/AN communities.

In response to the contagious nature of COVID-19, Tribal nations across the country temporarily closed many economic and gaming facilities, making it tough to generate much needed revenue that often supplements funding for Tribal health and social services. For Tribes to stablish a safe re-opening plan for casinos, many of which allow smoking facilities, they must adhere to special requirements to mitigate the spread of coronavirus. can be as easy as posting signage, training staff, deep cleaning to remove tobacco residue and reminding patrons that smoking is no longer allowed within the facility. These steps may be easier to implement since many facilities have been closed for nearly a year due to the pandemic.

So, many Tribes are considering re-opening as smoke-free to help combat COVID-19 and promote an overall healthier community. Currently, there are over 500 Tribal casinos across the United States and over 160 of those Tribal casinos have re-opened smoke-free or they have plans to re-open smoke-free[3]. Transitioning to a smoke-free environment gives Tribal gaming staff the bandwidth to focus on preventing the transmission of the COVID-19 by sanitizing their slot machines & chairs, re-filling hand sanitizers in the area, and attending to possible handwashing stations. There may also be a financial benefit to Tribal enterprises converting to smoke-free status. According to the American Cancer Society, employees exposed to second-hand smoke have higher average health insurance premiums and facilities exposed to smoking residue have higher maintenance costs.”[4]

As part of its Commercial Tobacco Cessation Learning Community, the National Indian Health Board hosted a webinar featuring Hershel Clark from the Southwest Navajo Tobacco Education Prevention Project and Clinton Isham from the Americans for Nonsmokers’ Rights Foundation who shared the approaches and lessons learned in moving toward smoke-free gaming facilities. NIHB also works with Tribes, Tribal Organizations, public health leaders, and federal funders like the Center for Disease Control and Prevention to increase commercial tobacco cessation among Tribal communities.

Additional Resources:

National Indian Health Board

American Nonsmoker’s Rights Foundation

[1] U.S. Department of Health and Human Services. Tobacco Use Among U.S. Racial/Ethnic Minority Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, Hispanics: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1998

[2] Garrett BE, Dube SR, Winder C, Caraballo RS. Cigarette Smoking—United States, 2006–2008 and 2009–2010. Morbidity and Mortality Weekly Report 2013;62(03):81–4

[3] American Nonsmoker’s Rights Foundation. “Reopening Smoke Free: The New Normal (updated 03/05/2021).” March 2021.

[4] American Cancer Society, “Smoke-Free Policies: Good for Business.” November 3, 2018.

[Image: American Nonsmokers’ Right Foundation. “Current Smokefree Indian Gaming Property Status Map.” 2021. ] .