The Native American population of Montana has a high rate of tobacco product use that results in disease and premature death. However, tribal elders have resisted tobacco control policies that could potentially hinder the cultural traditions that involve tobacco use.

Over a four-year period, the Native American Tobacco Coalition of Montana engaged with tribal elders in a knowledge exchange. The elders taught the historical and ceremonial significance of traditional tobacco use, and in turn learned about the impact of commercial tobacco use on their community's health. This led to a distinction between sacred use of tobacco and the use of commercial tobacco.

To create successful smoke-free strategies that are rooted in cultural tradition.

By recognizing the cultural traditions of sacred tobacco use, an inter-tribal coalition was successful in implementing culturally appropriate tobacco protections for tribal members.

Since the sacred use of tobacco has been recognized as a cultural tradition to be protected, tribal elders have supported the implementation of tobacco use reduction efforts such as health fairs, youth-focused events, and trainings. The coalition has also created smoke-free indoor environments in tribal facilities, including casinos.