American Indians/Alaska Natives and Tobacco Use
American Indian/Alaska Native is defined by the Office of Management and Budget as “a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.”1 There are approximately 2.6 million American Indians/Alaska Natives in the United States—about 1% of the total population.2
American Indians/Alaska Natives have the highest prevalence of cigarette smoking compared to all other racial/ethnic groups in the United States. Some American Indians use tobacco for ceremonial, religious, or medicinal purposes.3 For this reason, it is important to make the distinction between commercial and traditional tobacco use. When CDC references tobacco on this website, we are referring to commercial tobacco and not the sacred and traditional use of tobacco by some American Indian communities.
Traditional tobacco is tobacco and/or other plant mixtures grown or harvested and used by American Indians and Alaska Natives for ceremonial or medicinal purposes.
Traditional tobacco has been used by American Indian nations for centuries as a medicine with cultural and spiritual importance. Many Tribes maintain teachings and stories on the origin of tobacco. These teachings address tobacco in its purest form, today known as the tobacco plant Nicotiana rustica, and may include mixtures of other native plants.
Traditional tobacco preparation and use varies across Tribes and regions, with Alaska Natives not commonly using traditional tobacco. These variances are due to the many different teachings among Tribes of North America. In some cultures, the roles of growing, harvesting, and preparing traditional tobacco are held by specific groups of people who use traditional ways to prepare tobacco for a specific use.
Learn more about traditional tobacco at the Keep It Sacred websiteexternal icon.
Current Tobacco Use* Among American Indian/Alaska Native Adults—2016†4
* “Current Use” is defined as self-reported consumption of cigarettes, cigars, or smokeless tobacco in the past month.
† Data taken from the National Survey on Drug Use and Health, 2016, and refer to American Indians/Alaska Natives aged 18 years and older.
American Indians/Alaska Natives have a higher risk of experiencing tobacco-related disease and death due to high prevalence of cigarette smoking and other commercial tobacco use.5,6
- Cardiovascular disease is the leading cause of death among American Indians/Alaska Natives.7,8
- Lung cancer is the leading cause of cancer deaths among American Indians/Alaska Natives.5,7,8,9
- Diabetes is the fourth leading cause of death among American Indians/Alaska Natives.7,8 The risk of developing diabetes is 30–40% higher for smokers than nonsmokers.10
- American Indian/Alaska Native youth and adults have the highest prevalence of cigarette smoking among all racial/ethnic groups in the U.S.9,12
- Regional variations in cigarette smoking exist among American Indians/Alaska Natives, with lower prevalence in the Southwest and higher prevalence in the Northern Plains and Alaska.6
- More American Indian/Alaska Native women smoke during their last 3 months of pregnancy—26.0% compared to 14.3% of whites, 8.9% of African Americans, 3.4% of Hispanics, and 2.1% of Asians/Pacific Islanders.13
- Quitting rates are relatively low among American Indians/Alaska Natives compared to other racial/ethnic groups.6,9,10,11
- An estimated 55.6% of American Indians/Alaska Natives report that they want to quit compared to 72.8% of African Americans, 67.5% of Whites, 69.6% of Asians, and 67.4% of Hispanics.10,11
Tobacco companies target American Indian/Alaska Native communities through extensive promotions, sponsorships, and advertising campaigns.14
- Historically, tobacco industry product promotions to American Indians/Alaska Natives featured symbols and names with special meanings to this group. For example, the American Spirit™ cigarettes were promoted as “natural” cigarettes, and their packaging featured an American Indian smoking a pipe.9
Culturally appropriate anti-smoking health marketing strategies and mass media campaigns like CDC’s Tips From Former Smokers national tobacco education campaign, as well as CDC-recommended tobacco prevention and control programs and policies, can help reduce the burden of disease among the American Indian/Alaska Native population.
Because American Indian tribes are sovereign nations and have unique cultural practices and because data from national surveys may be limited or underestimated due to small sample sizes, CDC’s Office on Smoking and Health developed the American Indian Adult Tobacco Survey to assist tribes in collecting tribal- and village-specific commercial tobacco use and secondhand exposure data.
- Government Printing Office. Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity, 1997 [PDF–156 KB]pdf iconexternal icon. [accessed 2018 Jun 12].
- U.S. Census Bureau. American Fact Finder, 2016external icon. American Community Survey Demographic and Housing Estimates. [accessed 2018 Jun 12].
- Odani S, Armour BS, Graffunder CM, Garrett BE, Agaku IT. Prevalence and Disparities in Tobacco Product Use Among American Indians/Alaska Natives — United States, 2010–2015 . Morbidity and Mortality Weekly Report, 2017;66(50):1374-8 [accessed 2018 Jun 28].
- Substance Abuse and Mental Health Services Administration. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables [PDF–35 MB]pdf iconexternal icon. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2014 [accessed 2018 Jun 12].
- Espey DK, Jim MA, Cobb N, et al. Leading Causes of Death and All-Cause Mortality in American Indians and Alaska Nativesexternal icon. American Journal of Public Health, 2014;104(Suppl 3):S303–S311 [accessed 2018 Jun 12].
- Mowery PD, Dube SR, Thorne SL, et al. Disparities in Smoking-Related Mortality Among American Indians/Alaska Nativesexternal icon. American Journal of Preventive Medicine, 2015. doi:10.1016/j.amepre.2015.05.002 [accessed 2018 Jun 12].
- Heron, M. Deaths: Leading Causes for 2010 [PDF–5.08 MB]pdf icon. National Vital Statistics Reports, 2013;62(6) [accessed 2018 Jun 12].
- Xu JQ, Murphy SL, Kochanek KD, et al. Deaths: Final Data for 2016 [PDF–1.6 MB]pdf icon. National Vital Statistics Reports, 2018;67(5) [accessed 2018 Jul 31].
- 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 [accessed 2018 Jun 12].
- U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: 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, 2014 [accessed 2018 Jun 12].
- Centers for Disease Control and Prevention. Quitting Smoking Among Adults — United States, 2000–2015. Morbidity and Mortality Weekly Report, 2017;65(52):1457-64 [accessed 2018 Jun 12].
- 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 [accessed 2018 Jun 12].
- Tong VT, Dietz PM, Morrow B. Trends in Smoking Before, During, and After Pregnancy—Pregnancy Risk Assessment Monitoring System, United States, 40 Sites, 2000–2010. Morbidity and Mortality Weekly Report 2013;62(SS06):1–19 [accessed 2018 Jun 12].
- Satter DE, Roby DH, Smith LM, et al. Costs of Smoking and Policy Strategies for California American Indian Communities. Journal of Cancer Education, 2012; 27(Suppl 1):S91–S105 [cited 2018 Jun 12].
For Further Information
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Office on Smoking and Health
Media Inquiries: Contact CDC’s Office on Smoking and Health press line at 770-488-5493.