The 1998 Surgeon General's Report and this Fact Sheet include within the definition of Native Americans both American Indians and Alaskan Natives. Smoking rates among these groups are the highest of any U.S. minorities and much higher than whites.

Prevalence of tobacco use:

• In 1995, 39.2% of adult Native Americans smoked cigarettes (males and females). Thus, of approximately 1.45 million adult Native Americans in 1995, about 557,000 were smokers, or about 1.2% of the 47 adult million smokers in the U.S. Native Americans of all ages (adults and youth) in 1995 made up 0.7% of the overall U.S. population.

• Cigarette smoking among adult Native American males dropped from an astounding 63.0% in 1978 to a very high 45.4% in 1995; during this period, smoking among adult female Native Americans remained almost the same, going from 34.1% to 34.2%. Among younger adults, i.e., under 55, smoking rates among Native American men and women are much higher than white males and other minority groups. [Note: data on smoking among Native Americans is limited and there is evidence of variations in smoking rates in different states and regions; there is some evidence that smoking consumption (cigarettes smoked per day) may be quite low among Native Americans. But, this does not negate the conclusion that Native American smoking rates are dangerously high.]

• The cigarette smoking rate among older Native Americans is consistently lower than among younger Native American adults. The cigarette smoking rate among Native Americans aged 55 and over (male and female rates combined) in 1978 was 33.4% and dropped to 10.5% in 1995, versus a drop by male and female Native American adults aged 18-54 of about 53.4% in 1978 to about 45% in 1995. Likewise, the prevalence of smoking cessation among younger adults during this period showed no progress, whereas, among the 55 and over group, the percentage of smokers who quit rose from 44.8% in 1978 to 81.7% in 1995.

• Cigar and pipe smoking among adult Native American men in the early 1990's was 5.3% and 6.9% respectively; rates higher than among any other groups. [Note: the pipe smoking rate may be somewhat overstated because studies did not account for ceremonial use of pipes.] Male use of chewing tobacco or snuff was 7.8%, versus 6.8% among white men, the next highest group; among Native American women, the rate was 1.2%, higher than any other group except African American women (2.9%). Regional and tribal variations in use of chewing tobacco also appear to exist.

Health and mortality consequences of tobacco use:

• Virtually all cases of lung cancer are attributable to cigarette smoking. The lung cancer death rate among Native Americans is lower than among whites and African Americans, but somewhat higher than among other minorities. Differences in smoking rates among Native Americans seem to parallel different lung cancer death rates, with the lowest lung cancer rates among Indians in the Southwest and the highest rates in Alaska, North and South Dakota and Montana, where the rates are nearly as high as those in the general U.S. population..

• Smoking causes cancers of the lung, larynx, mouth, esophagus and bladder, and is a contributing factor for cancers of the pancreas, kidney and cervix. Data specific to Native Americans is limited, so it is difficult to determine how incidence and death rates for these cancers compare to other groups; but, African American rates are the highest of any group.

Data in this Fact Sheet has been taken from the following: Tobacco Use Among U.S. Racial/Ethnic Minority Groups: A Report of the Surgeon General, 1998; "Cigarette Smoking & Smoking Cessation Among Older Adults: United States, 1965-94" by C.G. Husten et al in Tobacco Control, Autumn, 1997. "Smoking-Attributable Mortality and Years of Potential Life lost -- U.S., 1984," in MMWR, May 23. 1997. Population Projections of the U.S. by Age, Sex, Race, & Hispanic Origin: 1995-2050, published by the U.S. Census Bureau, 1996.