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Smoking and Death. Smoking and Increased Health Risks. Smoking and Cardiovascular Disease. Smoking and Respiratory Disease. Smoking and Cancer. Smoking and Other Health Risks. Quitting and Reduced Risks. References. Cigarette smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general. 1,2.
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In 2021, approximately one in nine (11.5%) U.S. adults aged ≥18 years currently smoked cigarettes. Although this finding represents the lowest smoking prevalence recorded since 1965 (1), nearly one in five adults continue to use tobacco products. Cigarettes and other combustible tobacco products constitute the largest proportion of overall tobacco product use and are the foremost cause of tobacco-related morbidity and mortality in the United States (1). Consistent with the declines during recent decades, the prevalence of cigarette smoking decreased during 2020–2021. Comprehensive tobacco control strategies (e.g., smoke-free laws, media campaigns such as Tips from Former Smokers, and price increases) at the national, state, and local levels likely contributed to the lower cigarette smoking prevalence (3,4).
Nearly one in five adults who currently used tobacco products used two or more products, with nearly one third of these persons (31.4%) reporting use of both cigarettes and e-cigarettes. Further, the prevalence of e-cigarette use increased during 2020–2021. In addition to continued surveillance of tobacco product use, it is equally important to monitor use of combinations of tobacco products to characterize multiproduct use trends.
Adults identifying as LGB, living in rural areas, or who are uninsured or have Medicaid insurance continue to report high prevalences of tobacco product use (6). Further, smoking prevalence is higher among adults who ever had diagnosed depression than among those who never had diagnosed depression, although, consistent with previous studies, prevalence declined from 2019 to 2021 (1,6,7). Racial and ethnic differences in tobacco product use are more pronounced among adults who ever had diagnosed depression than among those who never had diagnosed depression. Racial and ethnic differences in smoking prevalence might be related to a combination of lived experiences, such as discrimination and frequent tobacco product advertising exposure: disproportionate tobacco product advertising in low-income neighborhoods or areas with high proportions of Black or AI/AN persons has been documented (1,8,9). Racial and ethnic differences in smoking prevalence by diagnosed depression might also be partially attributed to differences in access to mental health care and tobacco cessation services (8,9).
The findings in this report are subject to at least five limitations. First, because NHIS is limited to noninstitutionalized U.S. civilian populations, results are not generalizable to institutionalized populations or persons in the military. Second, responses to questions were self-reported and were not validated by biochemical testing; however, self-reported smoking status has been determined to correlate with serum cotinine levels (10). Third, 2021 tobacco product estimates for AI/AN populations were not statistically reliable***** and therefore are not presented. Fourth, changes in the 2020 and 2021 NHIS survey administration from in-person to primarily telephone-based (because of the COVID-19 pandemic) might affect 2020 and 2021 estimates††††† (5). Finally, these data are cross-sectional, and trends in tobacco product use changes among individual persons cannot be assessed.
In 2021, the 11.5% prevalence of current cigarette smoking was less than the 12% end-of-decade goal set by Healthy People 2020§§§§§. Although cigarette smoking decreased over the past year, e-cigarette use increased, from 3.7% to 4.5%, largely driven by higher prevalence in use among persons aged 18–24 years. Further, declines in cigarette smoking among populations with diagnosed depression represent important successes in tobacco control (7). However, disparities in tobacco use remain. Continued implementation of evidence-based strategies, such as increasing the unit price of tobacco products, enforcing comprehensive smoke-free policies, and conducting linguistically and culturally appropriate educational campaigns, combined with FDA regulation of tobacco products and innovative strategies, will support activities and programs to reduce tobacco use and tobacco-related disparities (3,4).
Corresponding author: Monica E. Cornelius, yex8@cdc.gov.
1.CDC. Smoking & tobacco use. Smoking cessation: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/tobacco/sgr/2020-smoking-cessation/index.html
2.Martell BN, Garrett BE, Caraballo RS. Disparities in adult cigarette smoking—United States, 2002–2005 and 2010–2013. MMWR Morb Mortal Wkly Rep 2016;65:753–8. https://doi.org/10.15585/mmwr.mm6530a1 PMID:27491017
3.CDC. Best practices for comprehensive tobacco control programs. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. https://www.cdc.gov/tobacco/stateandcommunity/guides/pdfs/2014/comprehensive.pdf
4.King BA, Graffunder C. The tobacco control vaccine: a population-based framework for preventing tobacco-related disease and death. Tob Control 2018;27:123–4. https://doi.org/10.1136/tobaccocontrol-2018-054276 PMID:29475955
5.National Center for Health Statistics. National Health Interview Survey: 2021 survey description. Hyattsville, MD: US Department of Health and Human Services, CDC; National Center for Health Statistics; 2022. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2021/srvydesc-508.pdf
6.Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco product use among adults—United States, 2020. MMWR Morb Mortal Wkly Rep 2022;71:397–405. https://doi.org/10.15585/mmwr.mm7111a1 PMID:35298455
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