Tobacco and Nicotine

Page last updated June 11, 2020 by Doug McVay, Editor/Senior Policy Analyst.

1. Estimated Prevalence of Tobacco Use in the US According to NSDUH

"The majority of the 58.8 million current (i.e., past month) tobacco users in 2018 were current cigarette smokers (Figure 2), as has been the case historically.18 Specifically, 47.0 million people aged 12 or older in 2018 were current cigarette smokers, 12.2 million people were current cigar smokers, 8.0 million people were current users of smokeless tobacco, and 2.1 million people currently smoked pipe tobacco.

"Among current users of any tobacco product who were aged 12 or older, 65.5 percent smoked cigarettes but did not use other tobacco products, 14.4 percent smoked cigarettes and used some other type of tobacco product, and 20.1 percent used other tobacco products but not cigarettes (Table A.2B). This same pattern was observed in 2018 among young adults aged 18 to 25 and adults aged 26 or older, with most current tobacco users smoking only cigarettes. Specifically, more than half of young adults (50.3 percent) and more than two thirds of adults aged 26 or older (68.9 percent) who were current tobacco users smoked only cigarettes in the past month.

"Among adults who were current users of tobacco products, 25.9 percent of those aged 18 to 25 and 18.7 percent of those aged 26 or older did not smoke cigarettes. In contrast, among adolescents who were current tobacco users, 36.1 percent used tobacco products other than cigarettes but did not smoke cigarettes. In addition, 26.5 percent of adolescents and 23.8 percent of young adults aged 18 to 25 who were current tobacco users smoked cigarettes and used other tobacco products. Among adults aged 26 or older who were current tobacco users, about 1 in 8 (12.4 percent) were current cigarette smokers and current users of other tobacco products."

Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
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2. Estimated Annual Number of Deaths Caused by Tobacco Use in the US - Mortality Data

"The 2014 Surgeon General's report estimates that cigarette smoking causes more than 480,000 deaths each year in the United States.1 This widely cited estimate of the mortality burden of smoking may be an underestimate, because it considers deaths only from the 21 diseases that have been formally established as caused by smoking (12 types of cancer, 6 categories of cardiovascular disease, diabetes, chronic obstructive pulmonary disease [COPD], and pneumonia including influenza). Associations between smoking and the 30 most common causes of death in the United Kingdom in the Million Women Study suggest that the excess mortality observed among current smokers cannot be fully explained by these 21 diseases.2

Brian D. Carter, M.P.H., Christian C. Abnet, Ph.D., et al., "Smoking and Mortality — Beyond Established Causes," New England Journal of Medicine, Feb 12, 2015;372:631-40. DOI: 10.1056/NEJMsa1407211.
http://www.nejm.org/doi/full/1...

3. Alternative Estimate of Total Number of Deaths In the US Caused By Tobacco Use

"Our results suggest that the Surgeon General's recent estimate of smoking-attributable mortality may have been an underestimate. The Surgeon General's estimate, which took into account only the 21 diseases formally established as caused by smoking, was that approximately 437,000 deaths among adults are caused each year by active smoking (not including secondhand smoke). However, the Surgeon General’s report presents an alternative estimate of 556,000 deaths among adults on the basis of the excess mortality from all causes. The difference between these two estimates is nearly 120,000 deaths.1 If, as suggested by the results in our cohort, at least half of this difference is due to associations of smoking with diseases that are causal but are not yet formally established as such, then at least 60,000 additional deaths each year among U.S. men and women may be caused by cigarette smoking."

Brian D. Carter, M.P.H., Christian C. Abnet, Ph.D., et al., "Smoking and Mortality - Beyond Established Causes," New England Journal of Medicine, Feb 12, 2015;372:631-40. DOI: 10.1056/NEJMsa1407211.
http://www.nejm.org/doi/full/1...

4. Composition of Cigarette Smoke

"Cigarette smoke is a complex mixture of chemical compounds that are bound to aerosol particles or are free in the gas phase. Chemical compounds in tobacco can be distilled into smoke or can react to form other constituents that are then distilled to smoke. Researchers have estimated that cigarette smoke has 7,357 chemical compounds from many different classes (Rodgman and Perfetti 2009). In assessing the nature of tobacco smoke, scientists must consider chemical composition, concentrations of components, particle size, and particle charge (Dube and Green 1982). These characteristics vary with the cigarette design and the chemical nature of the product."

US Department of Health and Human Services. "How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General." Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010, p. 29.
http://www.cdc.gov/tobacco/dat...

5. Prevalence of Daily Cigarette Use In the US By Age

"Among the 47.0 million current cigarette smokers aged 12 or older in 2018, 27.3 million were daily cigarette smokers. The 27.3 million daily smokers correspond to 58.2 percent of current cigarette smokers (Figure 4). Thus, nearly three fifths of current cigarette smokers in 2018 smoked cigarettes daily. The percentage of current smokers in 2018 who smoked cigarettes daily was lower than the percentages in most years from 2002 to 2012, but it was similar to the percentages in 2013 to 2017 (2018 DT 7.26).

"Among the 27.3 million daily smokers aged 12 or older in 2018, 10.8 million smoked 16 or more cigarettes per day (i.e., approximately one pack or more per day). Stated another way, about 2 out of 5 daily smokers (39.6 percent) smoked a pack or more of cigarettes per day (Figures 4 and 5). The percentage of daily smokers who smoked one or more packs of cigarettes per day was lower in 2018 than in 2002 to 2011, but it was similar to the percentages in 2012 to 2017.

"Aged 12 to 17
"In 2018, about 99,000 adolescents aged 12 to 17 smoked cigarettes every day in the past month. This number corresponds to about 1 in 7 adolescent current smokers (14.7 percent) (2018 DT 7.27). The 2018 percentage was lower than the percentages in most years from 2002 to 2014, but it was similar to the percentages in 2015 to 2017. The percentage of adolescent daily smokers who smoked one or more packs of cigarettes per day was not reported for 2018 due to low precision.12

"Aged 18 to 25
"About 2.4 million young adults aged 18 to 25 in 2018 were daily cigarette smokers in the past month, or 37.4 percent of young adults who were current cigarette smokers (2018 DT 7.29). Thus, nearly 2 in 5 young adults in 2018 who were current cigarette users smoked cigarettes daily. The percentage of young adult current smokers in 2018 who smoked cigarettes daily was lower than the percentages in 2002 to 2015, but it was similar to the percentages in 2016 and 2017. The percentage of young adult daily smokers in 2018 who smoked one or more packs of cigarettes per day (23.4 percent) was lower than the percentages in 2002 to 2010, but it was similar to the percentages in 2011 to 2017 (Figure 5).

"Aged 26 or Older
"In 2018, about 24.8 million adults aged 26 or older smoked cigarettes every day in the past month, which corresponds to 62.3 percent of the current smokers in this age group (2018 DT 7.30). The percentage of current smokers in this age group in 2018 who smoked cigarettes every day was lower than the percentages in 2002 to 2013, but it was similar to the percentages in 2014 to 2017. Despite the decline since 2002, when nearly 70 percent of current smokers aged 26 or older were daily smokers, about three fifths of current smokers in this age group in 2018 were daily smokers. Among daily smokers aged 26 or older, the percentage in 2018 who smoked one or more packs of cigarettes per day (41.4 percent) was lower than in 2002 to 2013. However, the percentage was stable from 2014 to 2018 (Figure 5)."

Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
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