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1998 Surgeon General's Report—Tobacco Use Among U.S. Racial/Ethnic Minority Groups

American Indians and Alaska Natives and Tobacco

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Highlights

Although many tribes consider tobacco a sacred gift and use it during religious ceremonies and as traditional medicine, the tobacco-related health problems they suffer are caused by chronic cigarette smoking and spit tobacco use. Because of the cultural and geographic diversity of American Indians and Alaska Natives, tobacco use often varies widely by region or subgroup.

Health Effects of Tobacco

• Nationally, lung cancer is the leading cause of cancer death among American Indians and Alaska Natives.
• Smoking-attributable deaths from cancers of the lung, trachea, and bronchus were slightly higher among American-Indian and Alaska-Native men (33.5 per 100,000) and women (18.4 per 100,000) than those among Asian-American and Pacific-Islander men (27.9 per 100,000) and women (11.4 per 100,000) and Hispanic men (23.1 per 100,000) and women (7.7 per 100,000) but lower than rates among African-American men (81.6 per 100,000) and women (27.2 per 100,000) and white men (54.9 per 100,000) and women (27.9 per 100,000).
• Cardiovascular disease is the leading cause of death among American Indians and Alaska Natives, and tobacco use is an important risk factor for this disease.

Cigarette Smoking Prevalence

• Smoking rates and consumption among American Indians and Alaska Natives vary by region and state. Smoking rates are highest in Alaska (45.1%) and the North Plains (44.2%) and lowest in the Southwest (17.0%). The prevalence of heavy smoking (25 or more cigarettes per day) is also highest in the North Plains (13.5%).
• Since 1978, the prevalence of cigarette smoking has declined for African-American, Asian-American and Pacific-Islander, Hispanic, and white women of reproductive age (18–44 years) but not for American-Indian and Alaska-Native women. In 1994–1995, the rate of smoking among American-Indian and Alaska-Native women of reproductive age was 44.3%, compared with white (29.4%), African-American (23.4%), Hispanic (16.4%), and Asian-American and Pacific-Islander (5.7%) women of reproductive age.
• Aggregated 1990–1994 Monitoring the Future Survey data show that racial/ethnic smoking prevalence is highest among American Indian and Alaska Native high school seniors (males, 41.1%; females, 39.4%) followed by white high school seniors (males, 33.4%; females, 33.1%), Hispanics (males, 28.5%; females, 19.2%), Asian Americans and Pacific Islanders (males, 20.6%; females, 13.8%), and African Americans (males, 11.6%; females, 8.6 %).

Cigarette Smoking Behavior

• Compared with whites, American Indians and Alaska Natives smoke fewer cigarettes each day. In 1994–1995, the percentage of American Indians and Alaska Natives who reported that they were light smokers (smoking fewer than 15 cigarettes per day) was 49.9%, compared with 35.3% for whites.

Prevalence of Other Forms of Tobacco Use

• Aggregated National Health Interview Survey data from 1987 and 1991 show that 5.3% of American-Indian and Alaska-Native men smoked cigars, compared with 4.8% of white men and 3.9% of African-American men.
• Pipe smoking prevalence was higher among American Indians and Alaska Natives (6.9%), compared with whites (2.9%), African American (2.4%), and Asian Americans and Pacific Islanders (2.3%), who smoked pipes at nearly similar rates.
• Among men and women combined, the use of chewing tobacco or snuff was 4.5% among American Indians and Alaska Natives, compared with 3.4% for whites, 3.0% for African Americans, 0.8% for Hispanics, and 0.6% for Asian Americans and Pacific Islanders.
• The use of smokeless tobacco among American-Indian and Alaska-Native men varies by state and region. The prevalence among men is highest in the Northern Plains (24.6%) and lowest in the Pacific Northwest (1.8%).

Tobacco Industry Influence

• To build its image and credibility in the community, the tobacco industry targets American Indians and Alaska Natives by funding cultural events such as powwows and rodeos.
• The tobacco industry commonly uses cultural symbols and designs to target racial/ethnic populations that include American Indians and Alaska Natives. American Spirit^™ cigarettes were promoted as "natural" cigarettes; the package featured an American Indian smoking a pipe. In addition, certain tobacco product advertisements have used visual images, such as American-Indian warriors, to target their product.

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