Smoking rates among American Indian youth and adults are the highest in the nation. Funded by the University of Minnesota Cancer Center, the Tobacco Policies Among Plains Indians Project held focus groups on seven reservations during 2001-2002. Members of three Ojibwe reservations in Minnesota, three Sioux reservations in South Dakota, and one Winnebago reservation in Nebraska participated. Areas investigated included smoking knowledge, initiation, attitudes and behaviors, and perceptions of harm. Findings indicate that lenient attitudes toward smoking behaviors, low harm value, and partiality toward the smoking habit and the ritualistic behavior it invokes are long-standing and powerful to overcome. To initiate interventions for persistent smoking, tribes will need to target efforts toward the creation of healthy communities.