Cigarette smoking among adults has reached an all-time low of 13.7% in 2018 — a decline of approximately two-thirds in the more than 50 years since the first Surgeon General’s report warned of the health consequences of smoking, according to the Centers for Disease Control.
“This marked decline in cigarette smoking is the achievement of a consistent and coordinated effort by the public health community and our many partners,” said CDC Director Robert R. Redfield, M.D. “Yet, our work is far from over. The health benefits of quitting smoking are significant, and we are committed to educating Americans about the steps they can take to become tobacco-free.”
To assess recent national estimates of tobacco product use among U.S. adults 18 years or older, CDC, the Food and Drug Administration (FDA), and the National Cancer Institute (NCI) analyzed data from the 2018 National Health Interview Survey. The survey measured current cigarette smoking (ever smoked at least 100 cigarettes in a lifetime and smoked “every day” or “some day”) and current (“every day” or “some day”) use for other tobacco products: cigars, cigarillos, filtered little cigars; pipes, water pipes, hookahs; e-cigarettes; and smokeless tobacco.
The study found that an estimated 49.1 million (19.7%) U.S. adults currently used a tobacco product in 2018. Cigarettes remained the most commonly used tobacco product (13.7%), followed by cigars, cigarillos, or filtered little cigars (3.9%); e-cigarettes (3.2%); smokeless tobacco (2.4%); and pipes, water pipes, or hookahs (1.0%). Most tobacco current product users (83.8%) reported using combustible products (cigarettes, cigars, pipes, water pipes, or hookahs), and 18.8% reported using two or more tobacco products.
During 2017–2018, e-cigarette use among adults increased from 2.8% to 3.2%, a reversal from the decline observed among adults during 2014-2017. The increase during 2017-2018 was primarily driven by an increase in e-cigarette use among young adults (18-24 years old), which rose from 5.2% in 2017 to 7.6% in 2018. Smokeless tobacco use also increased from 2.1% to 2.4% among adults during the same time period. No significant changes occurred in the use of the other tobacco products included in the study.
“The sustained drop in adult smoking is encouraging as we work to reduce tobacco-related disease and death in the U.S. through science-driven policy, compliance and enforcement in addition to public education,” said Admiral Brett Giroir, M.D., Assistant Secretary of Health and Acting FDA Commissioner. “We remain dedicated to keeping pace with the evolving tobacco product landscape to ensure strong regulatory oversight in light of the increases in youth use of e-cigarette products in the U.S.”
Cigarettes remain the most commonly used tobacco product among adults. The study found that disparities exist.
By subgroups, use of any tobacco product in 2018 was highest among:
- Adults 25-44 years old (23.8%).
- Adults with a General Education Development (GED) certificate (41.4%).
- Adults who were uninsured (29.9%), insured by Medicaid (27.8%), or received some other public insurance (23.0%).
- Non-Hispanic American Indian/Alaska Native (32.3%), multiracial (25.4%), white (21.9%), or black adults (19.3%).
- Lesbian, gay, or bisexual adults (29.2%).
- Adults with an annual household income under $35,000 (26.2%).
- Adults living with a disability (24.3%).
- Adults living in the Midwest (23.6%) or the South (21.4%).
- Adults divorced, separated, or widowed (22.6%), or adults who were single, never married, or not living with a partner (21.1%).
- Adults who reported serious psychological distress (36.7%).
The study also assessed cessation behaviors that are contributing to the overall decline in cigarette smoking. Among adult cigarette smokers, those making a quit attempt in the past 12 months increased from 52.8% in 2009 to 55.1% in 2018. Recent successful smoking cessation increased from 6.3% in 2009 to 7.5% in 2018, and the quit ratio, or the percent of adults who ever smoked 100 cigarettes or more during their lifetime who have quit smoking, increased from 51.7% in 2009 to 61.7% in 2018.
Cigarette smoking is the leading cause of preventable disease, disability, and death in the U.S. Cigarette smoking is responsible for more than 480,000 deaths per year including more than 41,000 deaths resulting from secondhand smoke exposure, CDC said.