American Indian and Alaska Native People Encounter Barriers to Quitting Successfully

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Most people who smoke want to quit, and more than half try to do so each year. An estimated 56% of American Indian and Alaska Native (AI/AN) people report wanting to quit.7 Proven treatments, such as FDA-approved medicines and behavioral counseling, make it more likely that people will quit smoking successfully—but AI/AN people who smoke can run into barriers when trying to find and use these treatments:

  • AI/AN people are less likely than white people to have private health insurance – and more likely to have no health insurance at all.44 About 43% of AI/AN people rely on Medicaid or other public insurance coverage.45 Still, as of 2018, only 15 state Medicaid programs fully covered commercial tobacco* cessation (quitting) services for all enrollees in traditional Medicaid.46
Sacred Traditional Tobacco For Healthy Native Communities

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  • To provide advice on how to quit, health care providers first routinely screen their patients for commercial tobacco use.
    • Only 56% of outpatient health care visits with AI/AN adults included tobacco use screening in 2005-2008.47
    • Only 38% of AI/AN adults who smoked and visited a health care provider in the last year received health professional advice to quit in 2015.48

These factors may help to explain why AI/AN people quit smoking at lower rates than other racial/ethnic groups.7,49

Connecting every person who wants to quit with treatment proven to help them quit for good is important for improving people’s health.

Examples of strategies that states and communities can use are:
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Provide barrier-free, widely promoted coverage for all evidence-based cessation treatments by all types of health insurance.
For example, as of 2018, only 15 state Medicaid programs fully covered tobacco cessation (quitting) services for all enrollees in traditional Medicaid.46

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Integrate clinical screening and treatment for commercial tobacco use in all health care settings and with all types of patients.
Community health centers and low-cost health clinics serve people who are more likely to use commercial tobacco products. Talking to people about commercial tobacco use and quitting as a regular part of health care visits in these settings will help make sure that all groups can get effective treatment to help them quit.50,51

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Support AI/AN public health professional in creating, selecting, and sharing tobacco prevention strategies, including strategies for encouraging and supporting cessation, that work in tribal settings.
When it comes to health issues, one size does not fit all. Different people and communities have varying needs and make decisions in different ways. Providing support, learning opportunities, and culturally tailored technical assistance in collaboration with AI/AN health experts can enhance efforts to reduce the health burden of commercial tobacco in communities.52

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Share health messages that population groups identify with and that are created by specific cultural groups.
Mass media campaigns are proven to increase smoking cessation, prevent tobacco use initiation, and reduce the prevalence of tobacco use.7,14 Anti-commercial tobacco messaging and mass media campaigns can have an impact when they speak to people using familiar terms and images. One organization creating messages like this for Indigenous people is the American Indian Commercial Tobacco Program.

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*“Commercial tobacco” means harmful products that are made and sold by tobacco companies. It does not include “traditional tobacco” used by Indigenous groups for religious or ceremonial purposes.
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Page last reviewed: June 27, 2022
Content source: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion