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Keep It Sacred: Talking to American Indians and Alaskan Natives about Smoking

For Native American Heritage Month (November), learn how to tailor your smoking cessation message to this important group and decrease the health disparities created by commercial tobacco use

November is National Native American Heritage Month, a time to pay tribute to Indigenous people by learning more about their rich legacy, traditions, and culture. It is also important to understand the health disparities facing American Indians and Alaskan Natives (AI/AN). This group has one of the highest rates of smoking in the nation with more than 1 in 5 AI/AN adults (22.6%) using cigarettes. For context, the smoking prevalence among all U.S. adults is 12.5%. As a result of these high rates of commercial tobacco use, AI/AN adults are more likely to develop and die from tobacco-related illnesses, such as heart disease and lung cancer.

When speaking to members of the AI/AN community, it is important to draw a distinction between commercial tobacco products used for recreation, such as cigarettes and cigars, and traditional tobacco, which is used by many tribes for ceremonial and medicinal purposes. When talking to AI/AN patients it is important to respect the sacred, religious, and traditional use of the tobacco plant and focus on the harmful effects of commercial tobacco products.

The National Native Network has many great resources and education materials on the distinction between commercial and sacred tobacco. Please visit the Keep It Sacred National Native Network website at to learn more.

As part of our Comprehensive Tobacco Treatment Specialist Training, we engage the North Carolina American Indian Tobacco Coordinator, Lu McCraw, who shares information on how to address health disparities created by commercial tobacco use in the AI/AN community. Check out our upcoming trainings here!


About The Author Rachael Joyner is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certificate in Tobacco Treatment Practice and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.


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