CDC: US Adult Tobacco Product Use is Down, but More Work is Needed

The prevalence of overall tobacco product use, combustible tobacco product use, use of cigarettes, e-cigarettes, and of ≥2 tobacco products decreased in the US from 2019 to 2020, according to newly released data from the Centers for Disease Control and Prevention (CDC).

Although the data published in Morbidity and Mortality Weekly Report showed an overall reduction in tobacco use compared with previous years, Karen Hacker, MD, MPH, director, CDC’s National Center for Chronic Disease Prevention and Health Promotion, said in a press release “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,” continued Hacker, who was not involved in the analysis, in the statement. “We must continue to address tobacco-related health disparities and inequities to ensure everyone has the opportunity to be as healthy as possible.”

Led by CDC epidemiologist Monica E. Cornelius, PhD, researchers analyzed data from the 2020 National Health Interview Survey to assess recent national estimates of commercial tobacco product use among US adults aged ≥18 years. Researchers evaluated use of 5 different products: cigarettes, cigars (including cigarillos and filtered little cigars), pipes (including regular pipes, water pipes, and hookahs), e-cigarettes, and smokeless tobacco.

Investigators found, overall, approximately 19% of adults reported using at least 1 tobacco product in 2020, a decrease from 20.8% in 2019. 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%).

Among adults who reported current tobacco product use, 79.6% said they used combustible products and 17.3% reported using ≥2 tobacco products, according to the report.

Regarding adult cigarette smoking, the study found use declined to the lowest prevalence recorded since data became available starting in 1965, when the prevalence of cigarette smoking among adults was 42%.

In addition, Cornelius and colleagues found the percentage of adults using other tobacco products decreased from 2019 to 2020, including use of e-cigarettes (4.5% to 3.7%), combustible tobacco products (16.7% to 15.2%), and use of ≥2 tobacco products (3.9% to 3.3%).

Disparities in tobacco product use was another key finding from the report. In 2020, the prevalence of any current tobacco product use was higher among:

  • Men
  • Adults aged <65 years
  • Non-Hispanic American Indian or Alaska Native adults and non-Hispanic adults categorized as of “other” race
  • Adults living in rural areas
  • Those with an annual household income of <$35 000
  • Adults whose highest level of education was a general education development certificate
  • Adults who identify as lesbian, gay, or bisexual
  • Uninsured adults or those with Medicaid
  • Adults living with a disability
  • Adults who regularly had feelings of anxiety or depression

“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,” wrote Cornelius and colleagues.

According to investigators, factors that may have contributed to the overall decline in tobacco use include high-impact antitobacco media campaigns—such as the CDC’s Tips from Former Smokers and Every Try Counts—and policies at the local, tribal, state, and national level that limit the availability of specific types of tobacco products (eg, flavored tobacco products).

“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,” concluded authors. “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.”

Reference: Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco product use among adults—United States, 2020. MMWR. 2022;71:397-405.