American Indian and Alaska Native People Experience a Health Burden from Commercial Tobacco

At a glance

  • On average, AI/AN people are more likely to smoke cigarettes than other racial or ethnic groups in the U.S.
  • AI/AN people, compared to the other racial and ethnic groups, have a higher risk of death and disease caused by using commercial tobacco products like cigarettes, smokeless tobacco, and cigars.
Group of smiling teen girls

Commercial tobacco prevents achieving health equity for AI/AN people

  • American Indian and Alaska Native (AI/AN) people, compared to the other racial and ethnic groups, have a higher risk of death and disease caused by using commercial tobacco products like cigarettes, smokeless tobacco, and cigars.A123
  • On average, AI/AN people are more likely to smoke cigarettes than other racial or ethnic groups in the United States. Additionally, some AI/AN people are less likely to be covered by rules that reduce exposure to secondhand smoke.4567
  • Cardiovascular (heart and blood vessel) disease, which can be caused by cigarette smoking, is the leading cause of death among AI/AN people.89
  • Lung cancer, which can be caused by cigarette smoking and exposure to secondhand smoke, is the leading cause of cancer deaths among AI/AN people.389
  • Diabetes is the fourth leading cause of death among AI/AN people.89 The risk of developing type 2 diabetes is 30% to 40% higher for people who smoke than for people who don't smoke, and smoking can worsen complications from diabetes.10
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Content Source:
National Center for Chronic Disease Prevention and Health Promotion; Office on Smoking and Health
  1. "Commercial tobacco" means harmful products that are made and sold by tobacco companies. It does not include "traditional tobacco" used by Indigenous groups for religious or ceremonial purposes.
  1. 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. MMWR Morb Mortal Wkly Rep. 2017;66(50):1374–1378.
  2. Substance Abuse and Mental Health Services Administration. 2018 NSDUH Detailed Tables. Substance Abuse and Mental Health Services Administration; 2019. Accessed March 19, 2022. https://www.samhsa.gov/data/report/2018-nsduh-detailed-tables
  3. Espey DK, Jim MA, Cobb N, et al. Leading causes of death and all-cause mortality in American Indians and Alaska Natives. Am J Public Health. 2014;104(Suppl 3):S303–S311.
  4. U.S. Dept of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2020. Accessed March 19, 2022. https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf
  5. O'Donald ER, Miller CP, O'Leary R, et al. Active smoking, secondhand smoke exposure and serum cotinine levels among Cheyenne River Sioux communities in context of a Tribal Public Health Policy. Tob Control. 2020;29(5):570–576.
  6. Public Health Law Center. Smoke-free Tribal Housing Policies. June 2020. Accessed March 19, 2022. https://www.publichealthlawcenter.org/sites/default/files/resources/Smoke-free-tribal-housing-policies.pdf
  7. Williams v Lee, 358 U.S. 217 (1958). Accessed March 19, 2022. https://www.loc.gov/item/usrep358217/
  8. Heron, M. Deaths: leading causes for 2017. Natl Vital Stat Rep. 2019;68(6):1–77. Accessed March 19, 2022.
  9. Kochanek KD, Murphy SL, Xu JQ, Arias E. Deaths: final data for 2017. Natl Vital Stat Rep. 2019;68(9):1–77.
  10. U.S. Dept of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2014. Accessed March 19, 2022. https://www.ncbi.nlm.nih.gov/books/NBK179276/