Cigarette Smoking at Lowest Level Recorded Among US Adults

Troy Brown, RN

November 08, 2018

Cigarette smoking among US adults has fallen to the lowest level ever recorded, according to a report from the Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA), and the National Cancer Institute (NCI). However, 1 in 5 US adults still used a tobacco product, such as a smoked, smokeless, or electronic tobacco product, in 2017.

"This new all-time low in cigarette smoking among US adults is a tremendous public health accomplishment — and it demonstrates the importance of continued proven strategies to reduce smoking," CDC Director Robert Redfield, MD, said in a news release. "Despite this progress, work remains to reduce the harmful health effects of tobacco use."

The findings, which appeared in an article by Teresa W. Wang, PhD, from the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, and colleagues, were published online November 8 in Mortality and Morbidity Weekly Report.

The data come from the 2017 National Health Interview Survey (NHIS) on tobacco products, including cigarettes, cigars, e-cigarettes, hookah/water pipes/pipes, and smokeless tobacco. Among US adults, 14.0% reported current ("every day" or "some day") cigarette smoking in 2017, down from 15.5% in 2016. The prevalence of tobacco use has fallen by 67% since 1965, when the NHIS first began collecting these data.

Cigarette smoking among adults aged 18 to 24 years fell from 13% in 2016 to 10% in 2017.

In 2017, an estimated 47.4 million adults (19.3%) in the United States used any tobacco product. Of those, 86.7% smoked combustible tobacco products, and 19.0% used at least two tobacco products.

Significant disparities in prevalence were identified. The highest use was found among those with a General Educational Development (GED) certificate (42.6%). Insurance status was associated with tobacco use; 31.0% of those who were uninsured reported use, as did 28.2% of those insured by Medicaid (28.2%), and 26.8% of those who received some other public insurance (26.8%).

Rates were highest among non-Hispanic American Indian/Alaska Native (29.8%) and multiracial individuals (27.4%), compared with white (21.4%) or black adults (20.1%) and lesbian, gay, or bisexual adults (27.3%). Other groups with high rates included people with an annual household income of less than $35,000 (26.0%); those living with a disability (25.0%); adults living in the Midwest (23.5%) or the South (20.8%); divorced, separated, or widowed adults (23.1%); and those who were single, never married, or not living with a partner (21.0%).

One of the most glaring disparities in tobacco use was found among adults who reported serious psychological distress. Of these, about 2 in 5 (40.8%) used tobacco, compared with about 1 in 5 adults (18.5%) who were without serious psychological distress.

"For more than half a century, cigarette smoking has been the leading cause of cancer mortality in the United States. Eliminating smoking in America would, over time, eliminate about one-third of all cancer deaths," NCI Director Norman E. Sharpless, MD, said in the news release. "The persistent disparities in adult smoking prevalence described in this report emphasize the need for further research to accelerate reductions in tobacco use among all Americans."

New tobacco products have emerged in recent years. The most commonly used product among US adults in 2017 was cigarettes (14%), followed by cigars, cigarillos, or filtered small cigars (3.8%); e-cigarettes (2.8%); smokeless tobacco (2.1%); and pipes, water pipes, or hookahs (1%).

"The continued drop in adult smoking rates to historic lows is encouraging and the FDA is committed to accelerating declines in smoking and shifting the trajectory of tobacco-related disease and death through our comprehensive approach to tobacco and nicotine regulation," FDA Commissioner Scott Gottlieb, MD, said in the news release. "We've taken new steps to ultimately render combustible cigarettes minimally or non-addictive and to advance a framework to encourage innovation of potentially less harmful products such as e-cigarettes for adults who still seek access to nicotine, as well as support the development of novel nicotine replacement drug therapies. At the same time we're also working to protect kids from the dangers of tobacco product use, including e-cigarettes."

"Full implementation of comprehensive tobacco control programs at the national, state, and local levels, including tobacco price increases, high-impact anti-tobacco mass media campaigns, comprehensive smoke-free laws, and barrier-free access to tobacco cessation counseling and approved medications, along with FDA regulation of tobacco products, can accelerate progress toward reducing tobacco-related death and disease in the United States. Given the increasing diversity of available tobacco products, coordinated efforts are key to implementing proven strategies while also exploring promising new strategies," the authors write.

Examples include the CDC's National Tobacco Control Program and the Tips From Former Smokers campaign, which were responsible for half a million sustained quits among us adults from 2012 to 2015, and the FDA's Every Try Counts campaign. Programs from the NCI include its Smokefree.gov website, its toll-free national quitline network (1-800-qUITNOW), and its LiveHelp online resource.

"These coordinated strategies, in combination with state and local level tobacco prevention and control strategies that address the diversity of tobacco products, can reduce tobacco related disease and death in the United States," the authors write.

The authors have disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. Published online November 8, 2018. Full text

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