And to a lesser extent, they were perceived to disrupt the social landscape of communities with impacts on tribal community value systems. Casinos were also perceived to alter built environments, resulting in increased availability and access to unhealthy food. Yet, higher disposable incomes were perceived to also contribute to negative health behaviors, most notably increased drug and alcohol abuse. Higher disposable incomes have led to better financial stability, increased access to healthy food, and more opportunities for physical activity. ![]() Specifically, improved cash flow has resulted in new wellness programs, community centers, places for recreation, and improved social services. ![]() Improvement of the tribal economy, through both job creation for tribal members and improved tribal cash flow, was perceived by participants to both influence health. Forming these pathways are a series of interrelated health determinants. ![]() American Indian-owned casinos are perceived to influence the health of tribal communities through three pathways: 1) improving the tribal economy 2) altering the built environment, and 3) disrupting the the social landscape.
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