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American Indians and Alaska Native (AI/AN) adults have the highest rate of commercial tobacco use of any racial/ ethnic group in the United States. (Learn More) While, 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 commercial tobacco use. As a response to this public health problem, an interagency agreement was initiated between the Indian Health Service (IHS) and the Centers for Disease Control and Prevention (CDC) to support the IHS Tobacco Program.