The new data come from the 2017 National Health Interview Survey (NHIS), which the CDC and U.S. Food and Drug Administration (FDA) have used to track adult cigarette use since 1965. The agencies published their latest findings on cigarette and tobacco use in Morbidity and Mortality Weekly Report (November 9, 2018).
"This new all-time low in cigarette smoking among U.S. adults is a tremendous public health accomplishment -- and it demonstrates the importance of continued proven strategies to reduce smoking," stated CDC Director Robert Redfield, MD, in a press release. "Despite this progress, work remains to reduce the harmful health effects of tobacco use."
Changing tobacco use trends
Cigarette smoking is the top cause of death and disease in the U.S., and it is associated with numerous oral health diseases, including oral cancer and gum disease. To track cigarette smoking and tobacco use, the CDC, FDA, and other federal agencies use the NHIS, a nationally representative survey of U.S. adults.
The 2017 NHIS survey included nearly 27,000 adults at least 18 years old. Researchers defined current cigarette smokers as adults who smoked 100 cigarettes or more during their lifetime and who reported smoking every day or on some days. They defined current tobacco users as those who reported using any tobacco product, including electronic cigarettes (e-cigarettes), everyday or on some days..
About 47 million U.S. adults used a tobacco product in 2017. Cigarettes were the most commonly used tobacco product among these adults, and 14% of all U.S. adults smoked cigarettes in 2017. Comparatively, 15.5% of U.S. adults smoked cigarettes in 2016, and 42% did so in 1965.
“This new all-time low in cigarette smoking among U.S. adults is a tremendous public health accomplishment.”
— Robert Redfield, MD
The CDC attributed the recent decline in cigarette use to a notable decrease in smoking among young adults. About 10% of adults age 18 to 24 years smoked cigarettes in 2017, a decline from 13% in 2016. However, young adults more frequently used e-cigarettes and pipes, such as a hookah.
The researchers also found disparities in cigarette use by education, income, and psychological distress. People who used tobacco products were more likely to be uninsured or insured by Medicaid, have an annual household income of less than $35,000, and have earned a GED certificate. Furthermore, adults who reported serious psychological distress were more than twice as likely to use tobacco products as those who did not identify with being mentally distressed.
"For more than half a century, cigarette smoking has been the leading cause of cancer mortality in the United States," stated Norman Sharpless, MD, director of the National Cancer Institute at the National Institutes of Health. "The persistent disparities in adult smoking prevalence described in this report emphasize the need for further research to accelerate reductions in tobacco use among all Americans."
Coordinated prevention efforts needed
The report authors noted several limitations to their findings, including that smoking status was not validated by biochemical testing and that the 53% response rate may have resulted in nonresponse bias. In addition, the survey did not assess how gender identity may affect tobacco use.
Federal agencies must implement both proven and novel strategies to prevent the use of new types of tobacco products on the market, the authors noted. The FDA already has proposed stricter regulations on e-cigarette sales to teenagers.
"The continued drop in adult smoking rates to historic lows is encouraging, and the FDA is committed to accelerating declines in smoking and shifting the trajectory of tobacco-related disease and death through our comprehensive approach to tobacco and nicotine regulation," stated FDA Commissioner Scott Gottlieb, MD. "We've taken new steps to ultimately render combustible cigarettes minimally or nonaddictive. ... At the same time, we're also working to protect kids from the dangers of tobacco product use, including e-cigarettes."
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