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To examine the influence of traditional tobacco use on smoking cessation among American Indian adult smokers.A cross-sectional survey of self-identified American Indians was conducted from 2008 to 2009. A total of 998 American Indian adults (18 years and older) from the Midwest participated in the study.Traditional tobacco use and method of traditional use were both assessed. Commercial tobacco use (current smoking) was obtained through self-reported information as well as the length of their most recent quit attempt. We also assessed knowledge and awareness of pharmacotherapy for current smokers.Among participants in our study, 33.3% were current smokers and they reported smoking an average of 10 cigarettes per day. American Indian current smokers who used traditional tobacco reported a greater number of days abstinent during their last quit attempt compared to those who do not use traditional tobacco (P = 0.01). However, it appears that this protective effect of traditional tobacco use is diminished if the person smokes traditional tobacco. Finally, very few (fewer than 20% of current smokers) were aware of more recent forms of pharmacotherapy such as Chantix or bupropion.American Indians appear to show low levels of awareness of effective pharmacotherapies to aid smoking cessation, but those who use ‘traditional tobacco’ report somewhat longer periods of abstinence from past quit attempts.