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Prior reports and case studies have suggested that tribes often distribute a portion of the profits to tribal members (called per capita payments) and invest profits in community resources that may affect health ( 22– 24). Many studies indicate that populations with higher incomes and levels of community resources have better health outcomes compared with populations with lower incomes and community resources ( 9– 21). Increases in family income and health-related community resources related to casinos are hypothesized mechanisms through which tribal casino ownership may improve Native Americans’ health. Longitudinal findings in North Carolina indicate that the opening of a casino in the community and subsequent improvements in individual income among Native American families was significantly associated with decreased risk of some behavioral issues in childhood ( 7) and of substance abuse in young adulthood ( 8). Among Native Americans in California, time-series data suggest that living in a community with a Native American–owned casino was significantly associated with decreased childhood obesity ( 4) and newborn large-for-gestational age ( 6).

Among Native American adults, living in a community with a casino has been associated with greater decreases in mortality, obesity, diabetes, smoking, and binge drinking, compared with living in a community without a casino ( 2, 5). Although there can be unintended consequences of opening a casino (eg, higher crime rates) ( 2), several studies show that economic indicators have improved to a greater degree for tribes with gaming facilities compared with tribes who do not own gaming facilities ( 3, 4).Īdditionally, casinos have been significantly associated with improved health outcomes among Native Americans. A key goal of Native American gaming is to promote economic development among Native American tribes.

This Act stipulates that profits from Native American–owned casinos are required to be spent on tribal governance - providing for the welfare of the tribe and tribal members, promoting tribal economic development, and funding of local government agencies - or donated to charitable organizations ( 1).

Native American–owned casinos were legalized by the US federal government with the Indian Gaming Regulatory Act of 1988.

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