http://www.tobaccofreekids.org/research/factsheets/pdf/0251.pdf
1400 I Street, NW - Suite 1200 · Washington, DC 20005
Phone (202) 296-5469 · Fax (202) 296-5427 · www.tobaccofreekids.org
Despite reductions in smoking prevalence achieved since the first Surgeon General’s report on
the consequences of smoking in 1964, smoking remains the leading cause of preventable death
in the United States.1 Smoking accounts for more than 400,000 deaths in the United States
each year, and is a major risk factor for the four leading causes of death: heart disease, cancer,
stroke, and chronic obstructive pulmonary disease.2 Native Americans, as a whole, have an
especially high risk of suffering from tobacco-related death and disease because they have the
highest prevalence of smoking and other tobacco use compared to any other population group
in the United States.
Smoking Among Native American Adults
While smoking rates vary considerably from one tribe to another, American Indians and Alaska
Natives (AI/AN) are, overall, more likely than any other racial/ethnic subgroup to be current
smokers. According to the 2011 National Health Interview Survey (NHIS) of adults ages 18 and
over, 31.5 percent of AI/AN currently smoke, compared to 20.6 percent of Whites, 19.4 percent
of African Americans, 12.9 percent of Hispanics and 9.9 percent of Asian Americans. Overall,
19 percent of U.S. adults are current smokers.3 According to a 2005 study, 14 percent of
Southwest tribal members were smokers compared to a 50 percent smoking rate among
Northern Plains tribal members.4
The 2011 NHIS reports that AI/AN men have the highest smoking prevalence of all racial/ethnic
groups at 34.4 percent. In comparison, the smoking prevalence is 24.2 percent among African
American men and 22.5 percent among white men.5 The smoking prevalence among AI/AN
women also is disproportionately high. 29.1 percent of AI/AN women smoke, compared to 18.8
percent of white women and 15.5 percent of African-American women.6
According to the National Center for Health Statistics, 17.8 percent of AI/AN women smoked
during their pregnancy, compared to 13.9 percent of non-Hispanic white women.7 This disparity
has been growing over time. Since 1978, the prevalence of cigarette smoking in women of
reproductive age (18 to 44 years old) has declined in every subgroup of the American
population except among AI/AN women.8 Tobacco use during pregnancy is one of the key
preventable causes of adverse pregnancy outcomes.
Smoking Among Native American Youth
In 2001, cigarette use among high school students in National Bureau of Indian Affairs (BIA)
funded schools was 56.5 percent, almost double the smoking prevalence rate among all U.S.
high school students (28.5%).9 There was no significant difference between smoking rates
among AI/AN boys and girls. Almost one-quarter (24.4%) of students at BIA-funded schools
reported frequent cigarette use (having smoked ≥ 20 of the 30 days preceding the survey).10 In
comparison, 13.8 percent of all U.S. high school students reported frequent cigarette use
2001.11 BIA funds 185 schools located on 63 reservations in 23 states with approximately 8,500
high school students.12
Native Americans and Other Tobacco Use
While good current data is not available, data from the National Health Interview Survey (NHIS,
1991) indicate that prevalence of smokeless tobacco use has been highest among AI/AN men
NATIVE AMERICANS & TOBACCO USE
Native Americans & Tobacco Use / 2
and women, compared to other racial/ethnic subgroups. 5.4 percent of AI/AN adults (8.1% of
men and 2.5% of women) were current smokeless tobacco users, compared to 2.9 percent for
the overall U.S population (5.6% of men and 0.6% of women).13
According to aggregated data from the 1987 and 1991 NHIS, the prevalence of current pipe and
cigar use has also been higher among AI/AN than among other racial/ethnic subgroups.
However, the NHIS did not distinguish between ceremonial and addictive daily pipe smoking
which may contribute to the higher prevalence rates among this group.14
Nationally, Native American youth living on reservations have the highest smokeless tobacco
use than any other group. Again, these children seem to have early, frequent and heavy use of
chewing tobacco and snuff.15 In 2001, approximately 1 in 5 AI/AN students in BIA funded
schools were current users of smokeless tobacco,16 compared to 1 in 12 students at all U.S.
high schools.17
Tobacco Use Health Consequences Among Native Americans
Cardiovascular disease is the leading cause of death among AI/ANs, and tobacco use is an
important risk factor.18 Cancer is the second leading cause of death among AI/ANs nationally
and the leading cause of death among Alaska Natives; lung cancer is the leading cause of
cancer death.19
Alaska and Northern Plains tribal members, who have the highest smoking prevalence among
American Indians, also have the highest rates of lung cancer and heart disease.20 From 1994–
1998, rates of lung cancer death among AI/ANs in the North Plains and Alaska regions were
higher than the U.S. rate for all racial/ethnic populations combined.21
The 2007 annual report on the status of cancer in the U.S. found that there is wide variation in
AI/AN cancer surveillance, and that regional and tribe-specific data is needed to fully
understand the disease burden among Indian tribes. Regional and tribal variations in cancer
rates likely reflect geographic and tribal variations in risk factors and screening. For example,
among AI/AN, regional lung cancer rates mirrored regional smoking prevalence rates.22
Recommendations for lowering the high rate of smoking-caused cancer included reducing
tobacco use among this community by better tailoring tobacco cessation and treatment
programs to the AI/AN community, increasing tobacco product prices and increasing funding for
tribal tobacco control programs.23
Campaign for Tobacco-Free Kids, January 10, 2013 / Lorna Schmidt
Additional Sources of Information
• The National Tribal Tobacco Prevention Network, at the Northwest Portland Area Indian Health
Board, http://www.npaihb.org/programs/national_tribal_tobacco_prevention_network/
• National Indian Health Board, http://www.nihb.org, and its Area Health Boards
• Native CIRCLE, American Indian/Alaska Native Cancer Information Resource Center and Learning
Exchange, at Mayo Clinic, http://cancercenter.mayo.edu/native_circle.cfm
• Indian Health Service, http://www.ihs.gov/epi/index.cfm?module=epi_tobacco_main
• Bureau of Indian Affairs, http://www.bia.gov/
• Association of American Indian Physicians, http://www.aaip.org/
Native Americans & Tobacco Use / 3
1 Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service, PHS publication 1103, 1964,
http://www.cdc.gov/tobacco/sgr/sgr_1964/sgr64.htm. McGinnis, JM, et al., “Actual causes of death in the United States,” Journal of the
American Medical Association (JAMA) 270:2207-2212, 1993.
2 U.S. Centers for Disease Control and Prevention (CDC), “Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity
Losses—United States, 2000-2004,” Morbidity and Mortality Weekly Report (MMWR) 57(45), November 14, 2008,
http://www.cdc.gov/mmwr/PDF/wk/mm5745.pdf. McGinnis, JM, et al., “Actual causes of death in the United States,” JAMA 270:2207-2212, 1993.
3 CDC, “Current Cigarette Smoking Among Adults—United States, 2011,” MMWR 61(44):889–894, November 9, 2012,
4 Henderson, et al., “Correlates of Cigarette Smoking Among Selected Southwest and Northern Plains Tribal Groups: The Al-SUPERPFP
Study,” American Journal of Public Health (AJPH) 95:867-872, 2005.
5 CDC, “Current Cigarette Smoking Among Adults—United States, 2011,” MMWR 61(44):889–894, November 9, 2012,
6 CDC, “Current Cigarette Smoking Among Adults—United States, 2011,” MMWR 61(44):889–894, November 9, 2012,
7 CDC, National Center for Health Statistics, “Births: Final Data for 2005,” National Vital Statistics Reports, 56(6), December 5, 2007,
8 U.S. Department of Health and Human Services (HHS), Tobacco Use Among U.S. Racial and Ethnic Minority Groups, Report of the Surgeon
General, 1998, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_1998/index.htm.
9 CDC, “Tobacco, Alcohol, and Other Drug Use Among High School Students in Bureau of Indian Affairs-Funded Schools—United States,
2001,” MMWR 52(44):1070-1072, November 7, 2003, http://www.cdc.gov/mmwr/PDF/wk/mm5244.pdf. CDC, “Youth Risk Behavior
Surveillance—United States, 2001,” MMWR 51(SS04):1-64, June 28, 2002, http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5104a1.htm.
10 CDC, “Tobacco, Alcohol, and Other Drug Use Among High School Students in Bureau of Indian Affairs-Funded Schools—United States,
2001,” MMWR 52(44):1070-1072, November 7, 2003, http://www.cdc.gov/mmwr/PDF/wk/mm5244.pdf.
11 CDC, “Youth Risk Behavior Surveillance—United States, 2001,” MMWR 51(SS-4), June 28, 2002,
12 CDC, “Tobacco, Alcohol, and Other Drug Use Among High School Students in Bureau of Indian Affairs-Funded Schools – United States,
2001,” MMWR 52(44):1070-1072, November 7, 2003, http://www.cdc.gov/mmwr/PDF/wk/mm5244.pdf.
13 CDC, “Use of Smokeless Tobacco Among Adults—United States, 1991,” MMWR 42(14):263-266,
14 HHS, Tobacco Use Among U.S. Racial and Ethnic Minority Groups, Report of the Surgeon General, 1998,
15 Schinke, et al., 1989, Surgeon General’s Report, 1994, and Schinke, 1987, according to the Learning Center’s Tobacco and Native
Americans page.
16 CDC, “Tobacco, Alcohol, and Other Drug Use Among High School Students in Bureau of Indian Affairs-Funded Schools—United States,
2001,” MMWR 52(44):1070-1072, November 7, 2003, http://www.cdc.gov/mmwr/PDF/wk/mm5244.pdf.
17 CDC, “Youth Risk Behavior Surveillance—United States, 2001,” MMWR 51(SS-4), June 28, 2002,
18 HHS, Tobacco Use Among U.S. Racial and Ethnic Minority Groups, Report of the Surgeon General, 1998,
http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_1998/index.htm. National Center for Health Statistics, “Health, United States, 2011: With
Special Features on Socioeconomic Status and Health,” http://www.cdc.gov/nchs/data/hus/hus11.pdf.
19 HHS, Tobacco Use Among U.S. Racial and Ethnic Minority Groups, Report of the Surgeon General, 1998,
http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_1998/index.htm. See also, National Center for Health Statistics, “Health, United States,
2011: With Special Features on Socioeconomic Status and Health,” http://www.cdc.gov/nchs/data/hus/hus11.pdf. CDC, “Cancer Mortality
Among American Indians and Alaska Natives—United States, 1994–1998,” 52(30):704–707, August 1, 2003,
20 HHS, Tobacco Use Among U.S. Racial and Ethnic Minority Groups, Report of the Surgeon General, 1998,
http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_1998/index.htm. Espey, D, et al. “Annual Report to the Nation on the Status of Cancer,
1975–2004, Featuring Cancer in American Indians and Alaska Natives,” Cancer, 110(10):2119-52, November 2007. Henderson, et al.,
“Patterns of Cigarette Smoking Initiation in Two Culturally Distinct American Indian Tribes,” JAMA 99:2020-2025, 2009. Casper, M., et al. “Atlas
of Heart Disease and Stroke Among American Indians and Alaska Natives,” 2005, http://www.cdc.gov/dhdsp/atlas/aian_atlas/. CDC, “Cancer
Mortality Among American Indians and Alaska Natives—United States, 1994–1998,” 52(30):704–707, August 1, 2003,
21 CDC, “Cancer Mortality Among American Indians and Alaska Natives—United States, 1994–1998,” 52(30):704–707, August 1, 2003,
22 Espey, D, et al. “Annual Report to the Nation on the Status of Cancer, 1975–2004, Featuring Cancer in American Indians and Alaska
Natives,” Cancer, 110(10):2119-52, November 2007.
23 See, e.g., Espey, DK, et al., “Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and
Alaska Natives,” Cancer (DOI: 10.1002/cncr. 23044) Published online, October 15, 2007; Print issue date, November 15, 2007,