Tobacco Abuse Prevalence

A disproportionate percentage of American Indian and Alaska Natives (AI/AN) use commercial tobacco compared to other ethnic groups in the United States. In 2014, the CDC reported that 26.1% of all AI/AN adults were cigarette smokers. This rate is compared to 19.4% for whites, 18.3% for African Americans, 12.1% for Hispanics and 9.6% for Asians.

AI/AN adults also have the highest usage rate for smokeless tobacco and cigars, and for the use of multiple tobacco products.

Based on region, commercial tobacco abuse prevalence among AI/AN varies, with the Southwest being lower and the Northern Plains being much higher.

However, actual rates of commercial tobacco abuse could be much higher, not only across the board, but also within specific Tribes:

Smoking prevalence rates have been documented within certain Tribes as being greater than 70% using the American Indian Adult Tobacco Survey, which was developed by the CDC and Tribes to improve the quality of data collection among AI/AN populations who are underrepresented in national surveys. Tribe-specific data also documents smoking initiation beginning before age eight and regular smoking beginning during the tween and teen years.


Tobacco Abuse Impact

High commercial tobacco use rates among American Indians and Alaska Natives are directly reflected in the disproportionate rates of chronic diseases in AI/AN populations, where six of the top eight causes of death are linked to smoking. The leading cause of cancer death among American Indian and American Native populations is lung cancer.

AI/AN also suffer from much higher rates of asthma than any other ethnic group. The incidence of asthma among AI/AN children is 20% higher than any other ethnic group and AI/AN adults are 60% more likely to be diagnosed with the condition compared to adults in other ethnic groups.

There is no safe level of exposure to commercial tobacco smoke, and the damage from commercial tobacco smoke is immediate.  Commercial tobacco abuse prevention and cessation are vital for American Indian and Alaska Native health and well-being.


  1. U.S. Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress. A Report of the Surgeon General.
  2. U.S. Department of Health and Human Services. Vital Signs: Disparities in Nonsmokers’ Exposure to Secondhand Smoke—United States, 1999–2012 February 3, 2015 / Vol. 64 / Early Release
  3. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report: Racial/ethnic differences among youth's cigarette smoking and susceptibility to start smoking - United States, 2002-2004, Vol. 55(47), December 1, 2006.
  4. CDC, "Cigarette Smoking Among Adults and Trends in Smoking Cessation - United States, 2008," MMWR 58(44), November 13, 2009,
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CDC - Tobacco-Related Disparities - American indian/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."  There are approximately 5.4 million American Indians and Alaska Natives in the United States - about 2% of the total population.

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.  For this reason, it is important to make the distinction between commercial and traditional tobacco use.