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Tobacco use remains higher among American Indian/Alaskan Native teens than among other racial and ethnic groups in the United States with the exception of native Hawaiians and other Pacific Islanders, according to the CDC.

Newly published data on smoking prevalence and use of other tobacco products among middle and high school students in the U.S. confirms that recent smoking declines among U.S. teens have left some racial and ethnic youth behind.

American Indian/Alaskan Native adults have long had compared with other racial/ethnic groups in the United States, according to the CDC.

"Data from this report and involving the Monitoring the Future survey show a continuing high prevalence of tobacco use among American Indian youth, and this involvement increases with age," said Spero Manson, PhD, director of the Center for American Indian and Alaska Native Health at the Colorado School of Public Health in Aurora.

For the new study, published Thursday online in , CDC researchers pooled data from the 2014 to 2017 (NYTS) to assess the prevalence of ever smoking and current (defined as ≥1 or more time in the past 30 days) users of seven tobacco products -- including cigarettes, cigars, smokeless tobacco, electronic cigarettes, and hookahs.

Manson told MedPage Today that both the NYTS and the Monitoring the Future surveys may include an over-representative sample of Native American youth attending schools on rural reservations: "More than 70% of the American Indian population now lives in urban centers, and these students may not be represented in the surveys," he explained. "Supplementing these national surveys to acquire data on American Indian youth in both rural and urban areas would be helpful."

Manson said that despite this potential flaw in data gathering, the continued high prevalence of tobacco use among Native American/Alaska native youth is cause for concern. "We need to increase our investment in prevention and cessation programs aimed at American Indian adolescents."

Among high school students responding to the NYTS surveys from 2014 to 2017, roughly a third of Native American/Alaskan Indians (35.4%) and Hawaiian/Pacific Islanders (32.8%) reported current use of a tobacco product, compared with 23% of white high school students surveyed, 15.8% of blacks, 19.6% of Hispanic high school students, and 7.4% of Asians.

Just under half of Native American/Alaskan Native (43.8%) and native Hawaiian/Pacific Islanders (45.1%) reported having ever used a tobacco product, compared with 32% of white high school and middle school students surveyed, 32.3% of blacks, 35.1% of Hispanics, and 16.3% of Asians.

E-cigarettes were the most common currently used tobacco product overall -- 9.2% and among all racial/ethnic groups except black students, for whom cigars were the most commonly used tobacco product (6.7%), followed by e-cigarettes (5.1%).

Among the other findings from the survey:

• Current use of e-cigarettes was highest among native Hawaiian/Pacific Islanders (18%), followed by American Indian/Alaska natives (12.7%), whites (10.2%), Hispanics (9.9%), blacks (5.1%), and Asians (3.6%)
• Current use of cigars or little cigars/cigarillos was highest among native Hawaiian/Pacific Islanders (9.5%), followed by Hispanics (6.2%), American Indian/Alaska natives (5.9%), whites (3.7%), blacks (3.5%), and Asians (1.9%)
• Current cigarette use was highest among American Indian/Alaska natives (10.3%), followed by native Hawaiian/Pacific Islanders (9.5%), whites (6.6%), Hispanics (5.7%), blacks (3.3%), and Asians (2.0%)

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