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Smoking prevalence rates have been documented within certain Tribes as being greater than 70% using the American Indian Adult Tobacco Survey, which was developed by the CDC and Tribes to improve the quality of data collection among AI/AN populations who are underrepresented in national surveys

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Loneliness or insufficient social relationships is also a major underlying factor, which may be comparable to smoking and, according to one meta-analysis of 148 studies, "exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity)"

In some cases, sulfur burps may also be related to acid reflux and indigestion (17)