American Indian adults have the highest smoking rate of any racial group in the nation. By the turn of the 21st century, smoking rates for the general adult population were reported to be 24%. Among adolescents in the United States, 34.8% of high school students reported they currently smoked in 1999. In comparison, American Indian adults report smoking rates ranging from 34 to 79%. American Indian youth smoking rates range as high as 50%, especially among Northern Plains states. To date, there is no clear explanation as to why American Indians have extremely high smoking rates. The purpose of this study was to examine smoking initiation, smoking cessation, and tobacco-control policies among Plains Indian tribes. Seven tribes located in Minnesota, Nebraska, and South Dakota participated in the multi-reservation study from 2002 to 2003. Data presented in this article were collected during the focus-group phase. Results of this study show that smoking is often initiated by a family group in which adults introduce cigarette smoking to younger family members; thus smoking initiation is more of an accepted and expected behavior. There appears to be little or no sanctions against the use or initiation of cigarette smoking among Northern Plains groups. The phenomenon of starting smoking, as described in the stories of the focus-group participants, was examined and found to be associated with culture-bound attitudes, including noninterference, leniency, and collective orientation. In order to address the high rates of smoking among Northern Plains tribes, issues of early initiation, group smoking behaviors, lenient attitudes, and strong smoking habits need to be recognized and incorporated into smoking cessation and control programs. (Contains 1 table and 16 notes.)