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Studies show that "rates of diabetes and its complicationsare substantially higher among Native Americans than among the US general population, and the frequency of diabetes among Native Americans is increasing." [11] This increase is proposed to be based upon, as the same study states, "several potentially modifiable factors, including obesity, dietary composition, and physical inactivity." [11] It is estimated that diabetes afflicts 40%-50% of adults in Native American communities, [12] compared with the national average of around 8%

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Growing cigarette tax levels and differentials have made cigarette smuggling both a national problem and a lucrative criminal enterprise, the report states