A sacred relationship exists between tobacco and American Indian ceremonial activities and beliefs. This ancient connection continues to play an important role in American Indian communities including the Anishinabe (Ojibwe). Six Ojibwe traditional healers and spiritual leaders described the sacred use of tobacco during interviews. The research provides information on key-informant smoking behaviors, influence of tobacco-industry media, and 3 essential themes: the origin of sacred traditional tobacco; contemporary use and abuse of tobacco; and cultural strengths and meaning of tobacco in Anishinabe (Ojibwe) communities. Health professionals must recognize, be amenable to learn, and understand that sacred tobacco use and smoking commercial cigarette tobacco have separate purposes and functions. The challenge for health professionals, including nurses, is to retain the cultural use and value of tobacco while addressing the abuse and chronic effects of cigarette smoking when providing health care to American Indian clients.