Tobacco use is high among American Indian or Alaska Native (AI/AN) youths, according to a study that found family members’ smoking habits were significant in predicting tobacco use.

The study, reported by Science Daily, found that 54 percent of AI/AN teens smoked cigarettes, while 24 percent smoked cigars, 16 percent used smokeless tobacco and 13 percent used pipes. About one-third used two or more forms of tobacco, according to the study in Nicotine and Tobacco Research. Science Daily reports that lead researcher ManSoo Yu of the University of Missouri said that AI/AN youths have more opportunities to smoke “because tobacco use is common at traditional ceremonies and events related to their cultures.”

The researchers say that tobacco control strategies for these youths should include group-based programs that provide ways to respond to family members’ and friends’ smoking.