Recent national estimates of commercial tobacco use among US adults

By Neha MathurReviewed by Danielle Ellis, B.Sc.May 8 2023

In a recent Morbidity and Mortality Weekly Report (MMWR), researchers working at the United States Center for Disease Control and Prevention (US-CDC), Food and Drug Administration (FDA), and National Cancer Institute analyzed the 2021 National Health Interview Survey (NHIS) data to assess recent national estimates of commercial tobacco use among US adults.

Background

Tobacco consumption remains one of the top reasons for disease and death in the US. Despite declining commercial cigarette smoking among US adults in the past five decades, i.e., since 1965, some sections of the US population remain inexplicably affected by tobacco use.

About the study                                                                                          

In the present study, researchers weighted NHIS data to provide nationally representative estimates of tobacco use prevalence among US adults aged ≥18, adjusted for selection probabilities and nonresponses variations.

Specifically, they assessed prevalence estimates and quit ratios for five tobacco products, cigarettes, e-cigarettes, cigars, pipes (e.g., hookahs), and smokeless tobacco, e.g., snuff, dip, or dissolvable tobacco. They stratified 2021 results by gender, age group, race/ethnicity, US census bureau region, marital and educational status of adults, income-to-poverty ratio, sexual inclination, insurance coverage, disability, and presence of psychological distress.

Further, they determined trends for using the top five combinations of tobacco products among adults and compared them with the previous year's data. The team also computed variations in cigarette smoking during 2019–2021 by diagnosing depression among all racial and ethnic groups covered in this study. Finally, the team used chi-squared tests to determine statistical significance, with p-values <0.05 indicating statistical significance.

Results

During 2020-2021, the prevalence of cigarette smoking was the lowest since 1965, while that of e-cigarettes increased. Yet, around one in nine, i.e., 11.5% of US adults, smoke cigarettes, and one in five adults use other tobacco products, including e-cigarettes, cigars, smokeless tobacco, and pipes, including hookah.

In 2021, the percentage of e-cigarette, cigar, smokeless tobacco, and pipe smokers was 4.5%, 3.5%, 2.1%, and 0.9%, respectively, corresponding to 46 million, i.e., 18.7% of US adults using any tobacco product. While 77.5% self-reported using combustible tobacco products, e.g., cigars, 18.1% reported using multiple tobacco products.

The use of tobacco products was higher among men aged <65 years and people of non-Hispanic White and other races. Likewise, its prevalence was higher in people of rural areas among financially disadvantaged falling under the income-to-poverty ratio ranging between zero and 1.99.

Tobacco use was higher in lesbian, gay, or bisexual (LGB) adults vs. heterosexual adults (27.4% vs. 18.4%). Nearly ~28% of uninsured or insured by Medicaid individuals also reported higher prevalences of tobacco. Similarly, adults who received higher education, e.g., owning a general educational development (GED) certificate, some disability, or serious psychological distress, e.g., depression, reported higher prevalences of tobacco.

Conclusions

The present study highlighted that tobacco use mitigation strategies (e.g., media campaigns, such as Tips from Former Smokers) at the national and local levels likely reduced cigarette smoking prevalence among US adults.

Enforcement of smoke-free policies and increasing the unit price of tobacco products remain relevant. Yet, it remains equally important to continuously survey tobacco product use and monitor the use of combinations of tobacco products to characterize multiproduct use trends.

More importantly, innovative but culturally and linguistically apt educational media campaigns combined with the regulation of tobacco products by the Food and Drug Administration could most effectively reduce tobacco use-related inequities, diseases, and death.