The greatest prevalence of tobacco use in the United States occurs with the American Indian and Alaskan Native (AI/AN). A critical need exists for a culturally specific tobacco cessation option for AI/AN youth. The nurse practitioner is positioned to provide a culturally specific commercial tobacco cessation option by incorporating the transcultural nursing theory into the development of a decision tree to expand understanding of culturally appropriate best practices regarding screening and management of tobacco smoking cessation in AI/AN youth. Presented is the Nurse Practitioner Culturally Specific American Indian and Alaskan Native Youth Decision Tree for Smoking Cessation with supporting evidence-based best practices.