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This is particularly important given that smoking rates are declining in high-income countries but remain high in LMICs, which now account for over 80% of the worlds 1.3 billion tobacco users (World Health Organization, 2025)

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According to the Centers for Disease Control and Prevention (CDC) and the National Indian Health Board (NIHB) : Native American and Alaska Native adults have the highest commercial tobacco use rate in the U.S. nearly 1 in 3 adults report current use Native teens are more likely to begin smoking at a younger age than their peers Tobacco-related illnesses like lung cancer, heart disease, and stroke disproportionately affect Native people Source: CDC Office on Smoking and Health, 2023

The Chongzhen Emperor of China issued an edict banning smoking two years before his death and the overthrow of the Ming dynasty