Background:
In Canada, there is a poor understanding of commercial (non-traditional) tobacco use and effective tobacco reduction strategies among the Indigenous population. This is predominately due to data collection systems that misclassify and/or exclude Indigenous peoples and weak Indigenous health service and program evaluation systems. The most recent statistics are outdated (2006) and underestimate the prevalence of Indigenous tobacco use. This research generated a unique primary dataset in a major urban area in one of Canada's largest Indigenous communities.

Methods:
Our Health Counts Toronto uses Indigenous community driven processes to generate a comprehensive health information platform to understand and address critical gaps in urban Indigenous health and tobacco use. Trained local interviewers implemented a survey using Response Driven Sampling among Indigenous adults in Toronto for the generation of population-level prevalence estimates, including information on tobacco use. Statistical analysis was used to characterize and describe the results, determining prevalence of tobacco use by age, sex, education and household income.

Results:
This research recruited a sample of 935 Indigenous adults. Preliminary analysis indicated the prevalence of current daily smoking among Indigenous people in Toronto was 62.3% (95%CI:55.0,69.6). Of current smokers, 42.7% (95%CI:33.1,52.3) smoked 11 sticks or more per day, and 53.1% (95%CI:44.1,62.1) of all Indigenous smokers had tried to quit in the last 12 months.

Conclusions:
Canada is a signatory to the Framework Convention on Tobacco Control which recognizes the disproportionate harm caused by tobacco use and the need to engage with Indigenous peoples in planning, delivery, and evaluation of tobacco reduction programs and policies. However, the Indigenous population in Toronto continues to experience smoking rates nearly four times greater than the general population. This research highlights the need for recent and accurate population health data to inform tobacco reduction programs and policies; reducing a completely preventable cause of morbidity and mortality.