Healthy People 2020: Leading Health Indicators for American Indian/Alaska Native Populations


Tobacco use is the single most preventable cause of disease, disability, and death in the United States, yet more deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.1, 2

In 2009, an estimated 20.6% of all American adults age 18 and older—46.6 million people—smoked,3 and every day another 850 young people age 12 to 17 began smoking on a daily basis.4 As a result of widespread tobacco use, approximately 443,000 Americans die from tobacco-related illnesses, such as cancer and heart disease, each year. An estimated 49,000 of these deaths are the result of secondhand smoke exposure.1 For every person who dies from tobacco use, another 20 suffer from at least one serious tobacco-related illness.5

Tobacco use poses a heavy burden on the U.S. economy and medical care system. Each year, cigarette smoking costs more than $193 billion in medical care costs, while secondhand smoke costs an additional $10 million.1, 6 Tobacco use is thus one of the Nation’s deadliest and most costly public health challenges.

Health Impact of Tobacco Use

Tobacco use in any form—even occasional smoking—causes serious diseases and health problems, including:
  • Several forms of cancer, including cancers of the lung, bladder, kidney, pancreas, mouth, and throat
  • Heart disease and stroke
  • Lung diseases, including emphysema, bronchitis, and chronic obstructive pulmonary disease (COPD)
  • Pregnancy complications, including preterm birth, low birth weight, and birth defects
  • Gum disease
  • Vision problems
Secondhand smoke from cigarettes and cigars also causes heart disease and lung cancer in adults and a number of health problems in infants and children, including:
  • Asthma
  • Respiratory infections
  • Ear infections
  • Sudden infant death syndrome (SIDS)
Smokeless tobacco causes a number of serious oral health problems, including cancer of the mouth and gums, periodontal disease, and tooth loss.


In 2008:
  • The rate of current smoking among adults varied among race and ethnicity groups. The lowest rates were seen among people who identified as Asian (9.7%, age adjusted) and as Hispanic or Latino (14.9%, age adjusted). The age adjusted prevalence observed for other race and ethnicity groups were as follows:
    • Non-Hispanic black: 20.7%
    • Non-Hispanic white: 22.6%
    • Native Hawaiian or Other Pacific Islander: 22.6%
    • American Indian or Alaska Native: 23.7%
In 2009:
  • For students in grades 9 to 12, the prevalence of smoking cigarettes in the past 30 days varied among race and ethnicity groups. The lowest rates were seen for those who identified as Asian (9.1%) and non-Hispanic black (9.5%). The rates observed for other race and ethnicity groups were as follows:
    • Hispanic or Latino: 18.0%
    • Native Hawaiian or Other Pacific Islander: 20.8%
    • Non-Hispanic white: 22.5%
    • American Indian or Alaska Native: 25.8%
  • Students who were obese had a higher prevalence of smoking cigarettes in the past 30 days than students who were not obese (22.1% and 18.8%, respectively).

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  1. Centers for Disease Control and Prevention. Annual smoking—attributable mortality, years of potential life lost, and productivity losses—United States, 2000–2004. MMWR. 2008;57(45):1226–1228. Available fromhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm.
  2. Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States. JAMA. 2004;291(10):1238–1245.
  3. Centers for Disease Control and Prevention. Vital signs: current cigarette smoking among adults aged ≥ 18 years—United States, 2009. MMWR. 2010;59(35):1135–1140. Available fromhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5935a3.htm?s_cid=mm5935a3_w
  4. Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Results From the 2009 National Survey on Drug Use and Health: National Findings. Rockville, MD: 2010. Available from http://www.oas.samhsa.gov/NSDUH/2k9NSDUH/tabs/Cover.pdf [PDF - 93KB]
  5. Centers for Disease Control and Prevention. Cigarette smoking—attributable morbidity—United States, 2000. MMWR. 2003;52(35):842–844. Available fromhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5235a4.htm
  6. Behan DF, Eriksen MP, Lin Y. Economic Effects of Environmental Tobacco Smoke Report. Schaumburg, IL: Society of Actuaries; 2005. Available from http://www.soa.org/files/pdf/ETSReportFinalDraft(Final%203).pdf [PDF - 546KB]

Public Health Inquiries:

Ahniwake Rose
Director, Public Health Policy and Programs

National Indian Health Board
910 Pennsylvania Ave, SE
Phone: 918-884-8274
Washington, DC 20003
[email protected]