This paper discusses the practice of Primary Health Care (PHC) in dealing with the issue of smoking and excessive consumption of alcohol in the United States of America. It establishes the correlation between the various Social determinants of health (SDHs) and smoking and alcohol consumption is USA, reviews various epidemiological studies conducted in USA on Alcohol and smoking, conducts analysis of the PHC nurse role in combating the problem and looks into the pertinence of cultural competency of a modern-day PHC nursing practitioner in USA.