50.6 million US adults report currently using tobacco products

Cigarette smoking remains the leading cause of preventable disease and death in the United States, according to a new report published in Morbidity and Mortality Weekly Report.

Although the prevalence of cigarette smoking in the U.S. has declined over time, varieties of combustible, noncombustible and electronic tobacco products continue to be available.

“In 2019, approximately 1 in 5 U.S. adults (50.6 million) reported currently using any tobacco product,” Monica E. Cornelius, PhD, from the Office on Smoking and Health at the National Center for Chronic Disease Prevention and Health Promotion at the CDC, and colleagues wrote in MMWR. “Most of the death and disease from tobacco use in the United States is primarily caused by cigarettes and other combustible products. Therefore, continued efforts to reduce all forms of combustible tobacco smoking among U.S. adults are warranted.”

The CDC analyzed data from 31,997 adults who participated in the 2019 National Health Interview Survey. Of those, 20.8% of adults in the U.S. reported currently using any tobacco product, including cigarettes (14%), e-cigarettes (4.5%), cigars (3.6%), smokeless tobacco (2.4%) and pipes (1%).

Most current tobacco product users (80.5%) reported using combustible products, including cigarettes, cigars or pipes, and 18.6% reported using two or more tobacco products. Among adults aged 18 to 24 years, e-cigarette use was highest (9.3%), with 56% reporting never smoking cigarettes.

Current cigarette users reported smoking 100 or more cigarettes during their lifetime and reported smoking every day or some days. Current users of other tobacco products also reported smoking every day or some days.

E-cigarette use had the highest percentage of users aged 18 to 24 (24.5%) and 25 to 44 (49.3%) years. Cigarette use had the highest percentage of users aged 45 to 64 (40.2%) and 65 years or older (12.3%). Among current e-cigarette users, 36.9% reported being current cigarette smokers, 39.5% reported being former cigarette smokers and 23.6% reported having never smoked cigarettes.

Among those aged 18 to 24 years, the percentage of e-cigarette users who had never smoked before was highest (56%) and the percentage of e-cigarette users who were former smokers was lowest (20.5%).

Current tobacco use prevalence was higher among men than women (26.2% vs. 15.7%) and among those aged 25 to 44 years (25.3%), 45 to 64 years (23%) or 18 to 24 years (18.2%) compared with those aged 65 years or older (11.4%).

Current tobacco use prevalence was also higher among:

non-Hispanic American Indian/Alaska Native adults (29.3%);

those living in the Midwest (23.7%) or South (22.9%);

those with a GED certificate as the highest level of education (43.7%);

those who were divorced/separated/widowed (23.5%);

those who were single/never married/not living with a partner (23%);

those with an annual household income of $35,000 or less (27%);

lesbian, gay or bisexual adults (29.9%);

uninsured adults (30.2%);

Medicaid recipients (30%);

those with a disability (26.9%); and

those with mild (30.4%), moderate (34.2%) or severe (45.3%) generalized anxiety disorder.

According to the researchers, targeted interventions are warranted to reach subpopulations with the highest prevalence of use, which may vary by tobacco product type.

“The implementation of comprehensive evidence-based, population-level interventions in coordination with regulation of tobacco products, can reduce tobacco-related disease, disparities and death in the United States,” the researchers wrote. “These evidence-based, population-level strategies include implementation of tobacco price increases, comprehensive smoke-free policies, high-impact anti-tobacco media campaigns and barrier-free cessation coverage.”