The CDC reports that 43.8% of Native American (also known as First Nation or American Indian) adults have reported current use of commercial tobacco and have the highest prevalence of cigarette smoking among all racial/ethnic groups in the U.S. The leading cause of death for Natives are cardiovascular disease and lung cancer, both diseases proven to be related to the use of commercial tobacco products.[1] There are disparities around smoking in many other communities as well, but the smoking disparities for Native Americans in one of the highest in the United States.

A number of factors may contribute to this disparity. The tobacco industry has exploited Native American images, strategically and opportunistically taking advantage of a long history of some Native Tribes growing and using tobacco for their own sacred and medicinal purposes. The tobacco industry has used images representing Native cultures and bodies as a means of targeting Natives and other communities.[2] The use of Native images on commercial tobacco products is a manipulation of a cultural history and practice for the sake of cigarette sales. It is common for cigarette brands to use stereotypical Native American images and motifs for branding and advertising, sometimes as a ploy to convince smokers that these cigarettes are more “natural” or health conscious. Research has found that Non-Hispanic American Indians and Alaska Natives are also more exposed to tobacco advertisements in stores than Non-Hispanic Whites.[6] Learn more about product packaging and the use of exoticism in tobacco advertising, and listen to a podcast on tobacco industry misappropriation of American Indian culture and traditional tobacco.

While commercial tobacco is readily available to Native Americans on and off of reservations, and needs to be addressed, strategies to address tobacco sales and use within Native American communities must be culturally aware and respect the historical and cultural practices of the tribes. Tribes are already very aware of the health and community impacts of commercial tobacco and have created campaigns, such as “Keep It Sacred” as a means of refocusing Native American tobacco use back to cultural tradition rather than deadly commercial tobacco use.

What is Traditional Tobacco?

Not all Native tribes have a cultural practice that involves the use of burning tobacco leaves, but in areas of the United States that have the warm and humid weather appropriate to growing tobacco, many Native Americans have traditions of using traditional tobacco in spiritual ceremonies, gift giving, medicine, and teachings. Many tribes continue to pass down teachings and stories about the origins of traditional tobacco and its religious significance.

Tobacco used by Natives in tradition is usually grown, cropped, and prepared very specifically for its purpose. Some tribes have special containers that hold the prepared tobacco until it is ready to use. When tobacco is ceremonially burned, the smoke is generally held in the mouth, and not inhaled into the lungs. Many tribes that burn tobacco believe that it carries their thoughts and prayers to their spiritual deities.3

Commercial tobacco is not grown or prepared with the same intentions as traditional tobacco. Commercial tobacco is grown, prepared, and sold in mass quantities and include thousands of extra chemicals and substances including menthol and ammonia that are not present in traditional tobacco used by Natives. For more information on traditional tobacco and its use check out Northwest Portland Area Indian Health Board’s report on Traditional Tobacco, and listed to this podcast on traditional vs. commercial tobacco from the National Native Network.

Reservations and Policy

While not all Native Americans live on reservations, many do. Native reservations have treaties with the government giving them tribal sovereignty. Tribal Sovereignty allows tribes to control the laws and policies on the reservation without influence of the federal or state government. This means that the policy process may look different for each tribe, and it is important to use engagement strategies to partner with tribal leaders to best understand the process for a particular reservation.

Because of tribal sovereignty, many of the federal policies that restrict forms of predatory marketing and selling of commercial tobacco may not impact reservations, which may also give tribes the opportunity to create their own policies without being impacted by preemption.

For more information on tribal sovereignty, see Partnerships with Native American’s article What is Tribal Sovereignty.

Policy Strategy

Native tribes are working towards decreasing the influence of commercial tobacco by emphasizing the cultural and historical significance of traditional tobacco and by creating policies around commercial tobacco. Tribes in Minnesota are working on tobacco control policies to create smoke free spaces and pow wows, offering cessation help in clinics, and offering monthly classes on how to grow and harvest traditional tobacco. Learn more about the strategies used by Minnesota tribes here.

Several Tribes have taken action to restrict the sale of e-cigarettes, both in response to the outbreak of lung injuries associated with use of the products(EVALI) and in response to companies like JUUL pushing their products on the reservations. While some bans were temporary, others chose to enact permanent bans. For example:

  • In September 2019, the Oglala Sioux Tribe permanently banned all e-cigarettes on the Pine Ridge Reservation.
  • In October 2019, the Turtle Mountain Band of Chippewa Tribe banned the sale of all vaping products on Tribal land, and the Lac Courte Oreillles Tribe banned the sale of all vaping products in all tribal retail outlets.
  • In November 2019, the Muckleshoot Tribe banned the sale of flavored vaping products and raised the minimum legal sales age for all tobacco products to 21.
  • In December 2019, the Saint Regis Mohawk Tribe banned the sale and distribution of all flavored vaping products and raised the minimum age for vaping products to 21. 

Native community members can advocate to decrease the influence of the commercial tobacco industry on reservations and the Native community at large using point-of-sale policies such as price increases, minimum pack sizes, limiting retailers in close proximity to schools through licensing and zoning, and restricting flavored and menthol products.

However, policies in areas surrounding Tribal lands may also impact use. Stores located within a 1-mile radius of Tribal lands in California were more likely to sell e-cigarettes, offer price promotions for cigarettes, sold significantly more flavored and total little cigars and cigarillos, displayed more of these items for less than $1, and were more likely to advertise price promotions on these products than stores located on Tribal lands. [4, 5 ]

Learn more about traditional Native American use of tobacco: is a project of Counter Tools. Counter Tools (logo)