by Kevyn Burger. This article originally appeared on Next Avenue.

Mary Owl still remembers her first cigarette, puffed when she was 13 years old.

“I was never so high in my life,” recalled Owl, now 58. “I inhaled, got dizzy and then sick to my stomach.”

A tribal citizen of the Cherokee Nation, Owl lit up the day she arrived at a boarding school in rural Oklahoma.

Away from home for the first time, the lonely teen was susceptible to peer pressure.

“I was in the bathroom with some girls I’d just met. They asked me if I smoked and I said, ‘sure,’” Owl said. “I went back to my dorm and wrote my mother and told her I smoked now. I wasn’t allowed to have contact with my family for 30 days, but when my mother came to visit she brought me a carton of cigarettes.”

High Rates of Smoking

Tobacco has deep roots in Native culture. While smoking rates are on the decline, American Indians and Alaska Natives register the highest smoking rates among all ethnic or racial groups, according to the Centers for Disease Control. Its findings conclude that Native smokers, who light up at twice the national rate, also have more difficulty quitting and are among the least successful in staying cigarette-free.

As a result, American Indians continue to experience a higher risk of tobacco-related disease and death compared to the rest of the population.

That stark disparity can be linked in part to chronically high rates of chemical dependency and poverty in Native populations, risk factors that are associated with the cigarette habit.

With 22 percent of American Indians living on reservations or trust lands that are often in isolated areas, access to health care has been limited. But the historic role of tobacco in Native culture is also connected to the high number of smokers.

Tobacco in Native American History

Most of the 573 federally recognized tribes in the United States have their own customs and rituals for the use of tobacco, known as cansasa in the Dakota language and called asemaa in Ojibwe.

For centuries, American Indians have turned to tobacco for many purposes. Traditionally, it has been set out as an offering or burned in sacred ceremonies to carry prayers to the Creator. Tobacco also has historic importance among American Indians as medicine, is used for purification and protection and continues to be recognized as a gift to show honor or respect.

A federal law passed in 1890 in made it illegal for American Indians to practice their religion, including the use of traditional tobacco. Until that law was rescinded with the Indian Religious Freedom Act of 1978, many Native people resorted to the use of commercial tobacco as a substitute.

“The conventional strategy for programs to help people quit smoking says ‘tobacco is bad.’ We have to modify that message because it doesn’t work in our community,” explained Clinton Isham, program director of the Wisconsin Native American Tobacco Network and an enrolled member of the Lac Du Flambeau Band of Lake Superior Chippewa.

New Smoking Cessation Efforts

In the past decade, newly developed smoking cessation efforts that target American Indians acknowledge this complicated history.

Now, various culturally sensitive approaches contextualize the value of tobacco while aiming to decrease consumption of commercial cigarettes.

These programs, which augment prescription medications and nicotine patches, gum or lozenges, are not one-size-fits-all.

Efforts to help people break their nicotine addiction rely on a range of techniques that respect the languages, customs and rituals of individual tribes. Various programs offer enrollees options including peer support groups, Native phone coaches and even traditional flute music played during relaxation sessions.

Elders, held in high regard in Native communities, are often brought in to motivate people trying to quit.

The Second Wind smoking cessation curriculum, developed in conjunction with the American Cancer Society, is used by the Muscogee Nation in Oklahoma. It relies on Talking Circles, which puts quitters-to-be in a familiar format long used by tribes to discuss important matters.

“To change the norm, we look for resources that are developed with tribal needs in mind; that’s going to be more effective,” said Isham, who lives on the Lac Du Flambeau reservation in northern Wisconsin.

Bringing Back Sacred Tobacco

Another shift away from commercial tobacco is the effort to provide the traditional plant for use in religious ceremonies and sacred healing practices.

Several Native organizations now grow an ancient strain of tobacco, which looks, smells and grows differently than its commercial counterpart.

Back in the year 2000, Sharon Day, a 66-year-old Ojibwe elder, planted a medicine garden with indigenous tobacco seeds from pods given to her by a woman from the Mohawk Nation.

As executive director of the Indigenous Peoples Task Force, Day works with Native youth. She found them enthusiastic about tending tobacco, and receptive to learning about its traditional use while cultivating the crop.

“We grow it without pesticides, dry it naturally and package it,” said Day.

“When we start our seeds, we sing a song in Ojibwe. The act of growing tobacco brings them to our language and our ceremonial ways.”

Day and her young proteges advise tribes on how to get their own medicine gardens going. Seeds they’ve harvested have been given as gifts to dozens of Native communities across North America.

“Up until that point, many of them were using commercial tobacco. It was the only way they could make an offering,” she said.

Cigarettes Entrenched in Native Society

When Day was a child growing up on the remote Boise Forte reservation along the Canadian border, most of the adults smoked. She took up the habit in her teens.

As she came of age, packaged cigarettes were integrated into tribal rituals.

“At some funerals, we would have a ceremony where we would pass cigarettes in a birch bark basket. Everyone would take one and smoke it,” she recalled.

Happily smoke-free for almost two decades, Day is optimistic that the next generation of American Indians may hold a more nuanced perspective on tobacco, thanks in part to the guidance of today’s elders.

“They’re growing up differently, learning our values,” she said. “We teach them that our bodies are the vessels that hold us in this realm and is our responsibility to take care of them.”

Setting a Good Example

Mary Owl managed to break her cigarette habit during her pregnancies and when her children were small, but she resumed smoking in middle age. She only quit her Kools when diagnosed with breast cancer in 2012.

Around that time, Owl began working for the Cherokee Nation as a public health educator in the small town of Sallisaw, Okla. Wanting to practice what she preaches stopped her from lighting up.

“I was promoting nutrition, physical activity and tobacco prevention. I didn’t want to reveal that I smoked,” she said.

Part of the curriculum she uses spells out how commercial tobacco differs from the traditional tobacco of the ancestors.

‘Never Something to Be Smoked Every Day’

“Tobacco is woven into our experiences as Indian people, but we stress that ceremonial tobacco was never something to be smoked every day,” she explained. “We explain that habitual use is abuse.”

As a former smoker who understands the power of the addiction, Owl has compassion not only for those who come to the smoking cessation classes she teaches, but also for those who are still hooked.

“Quitting is especially hard for the older people who have been lifelong smokers. It’s sad how many elders come in with COPD; they can’t breathe,” Owl said. “It’s been part of their lifestyle since they were kids. Old habits are hard to break.”