‘Our work is far from over’: Nearly one in five adults report tobacco use

In the United States, 47.1 million adults reported using commercial tobacco products in 2020, including 30.8 million adults who reported smoking cigarettes, according to data published in Morbidity and Mortality Weekly Report.

Although researchers observed an overall reduction in tobacco use compared with previous years, Karen Hacker, MD, MPH, the director of CDC's National Center for Chronic Disease Prevention and Health Promotion, said “our work is far from over.”

“We have made significant progress in preventing and reducing tobacco product use in this country by using proven strategies and implementing effective policies,” she said in a press release. “We must continue to address tobacco-related health disparities and inequities to ensure everyone has the opportunity to be as healthy as possible.”

Monica E. Cornelius, PhD, an epidemiologist at the CDC, and colleagues used data from the 2020 National Health Interview Survey to determine the prevalence of tobacco use in the U.S. The researchers evaluated five different products: cigarettes, cigars (including cigarillos and filtered little cigars), pipes (including regular pipes, water pipes and hookahs), e-cigarettes and smokeless tobacco.

Overall, 19% of adults reported using at least one tobacco product in 2020, a decrease from 20.8% in 2019, according to the researchers. The most commonly used tobacco products were cigarettes (12.5%), followed by e-cigarettes (3.7%), cigars (3.5%), smokeless tobacco (2.3%) and pipes (1.1%).

About 75% of tobacco users said they used combustible products — “the predominant cause of tobacco-related morbidity and mortality,” Cornelius and colleagues wrote.

The researchers found that cigarette use declined to the lowest prevalence since these data were first recorded in 1965, when the prevalence of cigarette smoking was 42%. In addition, they reported that e-cigarette use decreased from 4.5% in 2019 to 3.7% in 2020.

Tobacco use was more often reported by men (24.5%), adults aged 25 to 44 years (22.9%), those who identified as non-Hispanic American Indian or Alaska Native (34.9%) or other non-Hispanic race (29.1%), adults in rural areas (27.3%), those with an annual household income of less than $35,000 (25.2%), those who identified as lesbian, gay or bisexual (25.1%), those with a disability (25.4%) and those who said they regularly had feelings of anxiety (29.6%) or depression (35.6%).

“The tobacco industry has historically targeted rural and low-income areas with increased advertising, price promotions, and access to tobacco retailers, thereby contributing to an environment where tobacco use is viewed as normal,” Cornelius and colleagues wrote.

According to the researchers, the overall decline in tobacco use may be due to media campaigns like the CDC’s “Tips From Former Smokers” and policies that limit the availability of certain products, including flavored ones.

“Continued monitoring of tobacco product use and tailored strategies and policies that reduce the effects of inequitable conditions (eg, poverty, housing and access to health care) could further aid in reducing disparities in tobacco use,” the researchers concluded. “Equitable implementation of comprehensive commercial tobacco control interventions, including smoke-free policies for public places and access to cessation services, is essential for maintaining progress toward reducing tobacco-related morbidity and mortality in the United States.”

References:

Cornelius ME, et al. MMWR Morb Mortal Wkly Rep. 2022;doi:10.15585/mmwr.mm7111a1.

U.S. adult tobacco product use decreased from 2019 to 2020. https://www.cdc.gov/media/releases/2022/p0318-US-tobacco-use.html. Published March 17, 2022. Accessed March 17, 2022.