Tobacco Product Use Health Equity Among Non-Hispanic American Indian Alaska Native Youth in 29 States, 2007–2013

American Indian/Alaska Native (AI/AN) youth are more likely to smoke than non-Native youth. The aim of this study is to compare tobacco product use among youth by AI/AN race and region over time to identify populations and geographies of higher risk. From 2015 to 2018, biennial U.S. Youth Risk Behavior Surveillance data from 29 states were examined to compare ever and current cigarette use, current cigar use, current smokeless tobacco use, and cigarette initiation before the age of 13 years between non-Hispanic AI/AN and non-Native youth by region from 2007 to 2013. Although cigarette use among AI/AN and non-Native youth decreased significantly from 2007 to 2013, AI/AN youth were significantly more likely than non-Native youth to ever use (AOR=1.88, 95% CI=1.71, 2.06) or currently use (AOR=1.88, 95% CI=1.69, 2.09) cigarettes, currently use cigars (AOR=1.17, 95% CI=1.03, 1.34), currently use smokeless tobacco (AOR=1.84, 95% CI=1.63, 2.07), or initiate cigarette use before the age of 13 years (AOR=1.92, 95% CI=1.72, 2.15). Disparities between AI/AN and non-Native youth varied by region, with the largest disparity in Northern Plains and Alaska. The prevalence of AI/AN youth cigarette, cigar, and smokeless tobacco use is significantly higher than that of non-Native youth. Tobacco control efforts to address AI/AN cigarette use disparities may consider those younger than 13 years.