In October 2022, APA released an announcement advocating for psychologists to help clients stop smoking and promote the reimbursement of clinicians who support tobacco cessation. This is a critical effort toward alleviating the health disparities for communities of color caused by cigarette use. However, this panel will discuss unique cultural elements that clinicians should consider when working with Native American clients who use commercial tobacco products outside traditional and healing use. Further, we will offer insight into the continual increase in Native American smoking rates even as other populations observe stark declines and the impact of the COVID-19 pandemic on smoking rates. Panelists are currently conducting ecological momentary assessment research with Native American smokers to understand the many factors influencing failed cessation attempts including affect, emotion, and the interaction of stress from discrimination experiences. We also invite the audience to consider the higher rates of smoking among clients who struggle with Depressive Disorders and Substance Use Disorders. Panelists and the Chair work with a variety of Indigenous-serving organizations, tribal nations, and invite participants to consider access to care, geographical location and benefits of reimbursement but also culturally focused considerations for Indigenous serving institutions such as Indian Health Services.