Cigarette smoking among the adults

Cigarette Smoking and its Impact

Cigarette smoking remains the biggest cause of preventable diseases and deaths in the United States, accounting for about 480,000 fatalities per year (Jamal, Homa, O'Connor, Babb, Caraballo, Singh, & King, 2015). It is a risk factor for a variety of noncommunicable diseases, including cancer, heart disease, stroke, and respiratory infections.

Variation in Smoking Habits

In the United States, smoking habits vary according to age, gender, race/ethnicity, education, socioeconomic status, geography, disability/limitation, and sexual orientation. According to Jamal et al. (2015), the prevalence of cigarette smoking was highest among non-Hispanic American Indians and Alaska Natives, at about 21.9%. These are people with origins in any of the places of North and South America and are tribally affiliated or share community attachment whose population was 5.4 million forming about 2% of the total population by 2014 (US Census Bureau, 2014). The prevalence of smoking in the US has significantly declined over the recent years; however, smoking and other tobacco use including ceremonial, spiritual or religious purposes still lead to highest prevalent among the Native Americans (Jamal et al., 2015). This situation together with the high risk of tobacco-related deaths and diseases call for effective strategies for reducing smoking among this population such as health education intervention as will be discussed in this paper.

Relationship with Healthy People 2020

Health education intervention or health promotion would be critical in enabling persons from these communities to improve their health by having more control over their health as well as health determinants. It is in line with Leading Health Indicators of tobacco use under Healthy People 2020 whose goal is to reduce tobacco-related illness, disability and death as well as secondary exposure to tobacco smoke [Centers for Disease Control and Prevention (CDC), 2016]. Under this indicator, it is acknowledged that several millions of Americans have died of smoking or suffer from the harmful effects of tobacco use including cancer, heart disease and stroke and lung diseases. As a result, a Healthy People 2020 framework that involves various effective strategies was developed to end tobacco use epidemic. Some of these interventions included price increase for the tobacco products, enactment of policies that discourage smoking and controlling access to tobacco products among others. More importantly, the framework also recognized the role of anti-tobacco campaigns and the need for consideration of the risk factors such as race and ethnicity in reducing smoking among populations and therefore could be effective in addressing this problem among the Native Americans.

Literature Support to Address the Problem

Various studies have examined smoking and its impacts on the American Indians and Alaska Natives. For instance, Cobb, Espey, and King (2014) investigated the health behaviors and risk factors that could contribute to death among this population. From the previous data collected between 2000 and 2010, the authors found tobacco use, physical inactivity, obesity, poor diet and low level of cancer screening as well as seatbelt use to be behavioral risk factors that are responsible for the mortality and chronic disease patterns among the American Indians and Alaska Natives. Similarly, it was established that American Indians and Alaska Natives in the US experience higher mortality rate patterns than Whites due to a high incidence of smoking prevalence, diabetes, problem drinking and social determinants (Espey, Jim, Cobb, Bartholomew, Becker, Haverkamp, & Plescia, 2014). Plescia, Henley, Pate, Underwood, and Rhodes (2014) also found out that lung cancer was strongly associated with smoking among the American Indians and Alaska Natives and there were significant regional differences in lung cancer death rates between this population and Whites.

These studies suggest that smoking among the Native Americans that lead to serious health consequences can be addressed through effective interventions at the population level. For example, Espey, Jim, Cobb, Bartholomew, Becker, Haverkamp, and Plescia (2014) observed that only public health interventions that address the health disparities and inadequate healthcare for this population would help to address the factors that lead to higher death rates compared to the Whites. This is similar to the assertion of Cobb, Espey, and King (2014) who advocate for identification and prevention of the health behaviors and risk factors that contribute to high mortality rates. Plescia, Henley, Pate, Underwood, and Rhodes (2014) also observed that addressing smoking among the American Indians and Alaska Natives equal control and prevention interventions to reduce the disparities in tobacco control and prevention interventions.

Approach of Educating the Population

These articles emphasize on the identification of the risk factors and population-based solutions in addressing the problems that affect a particular group. Edelman, Mandle, and Kudzma (2013) also noted that health promotion should be sensitive to the culture and needs of the target population. As a result, the approach that was adopted for this health promotion targeted the population with the aim of reducing smoking among the adults. Mass education using media was used to improve awareness about tobacco use and its harmful effects that would subsequently lead the communities to stop smoking and adopt healthy lifestyle habits such as engaging in physical activity and eating healthy diets. It was part of an equitable educational program tobacco control and preventative strategies as identified in the articles.

Conclusion and Summary

The prevalence of smoking in the US is highest among the American Indians and Alaska Natives leading to high mortality rates and disease burden. This trend could be reduced through appropriate interventional strategies targeted at the population level. Health education intervention involving a wide coverage could effectively educate these communities to reduce smoking and practice healthy living thus improving their health. This would require identifying the risk factors as well as understanding of the cultural beliefs and values of the population.


Centers for Disease Control and Prevention. (2016). Healthy People 2020 – Tobacco use. Retrieved from

Cobb, N., Espey, D., & King, J. (2014). Health behaviors and risk factors among American Indians and Alaska Natives, 2000–2010. Journal Information, 104(S3).

Edelman, C. L., Mandle, C. L., & Kudzma, E. C. (2013). Health promotion throughout the life span. Elsevier Health Sciences.

Espey, D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American journal of public health, 104(S3), S303-S311.

Jamal, A., Homa, D. M., O’Connor, E., Babb, S. D., Caraballo, R. S., Singh, T., ... & King, B. A. (2015). Current cigarette smoking among adults—United States, 2005–2014. MMWR Morb Mortal Wkly Rep, 64(44), 1233-1240.

Plescia, M., Henley, S. J., Pate, A., Underwood, J. M., & Rhodes, K. (2014). Lung cancer deaths among American Indians and Alaska Natives, 1990–2009. American journal of public health, 104(S3), S388-S395.

U.S. Census Bureau. (2014). 2014 American Community Survey. Retrieved from

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