Adult Tobacco Use

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In 2021, 11.7% of adults aged 18 and older reported current cigarette use.

Summary graph for Adult Tobacco Use, Click to see detailed view of graph

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Background

Cigarette smoking is the leading preventable cause of disease, disability, and death in the United States. Smoking causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon and rectum, as well as acute myeloid leukemia. Altogether, smoking causes approximately 30 percent of all U.S. cancer deaths each year. The American Cancer Society estimates that in 2022, almost 182,808 of the estimated 609,360 cancer-related deaths will be caused by cigarette smoking.

The prevalence of adult cigarette smoking in the U.S. has steadily declined since the first Surgeon General’s Report on the harms of smoking was published in 1964, when smoking prevalence was 42 percent. While the prevalence of daily smoking has dropped over time, and the average number of cigarettes smoked per day among those who smoke daily has decreased, nondaily smoking has remained relatively stable. Many studies show that there is no safe level of smoking. For example, individuals who smoke even a few cigarettes per month over their lifetime are at a higher risk of smoking-related death than those who have never smoked, according to research published in the journal JAMA Network Open.

Moreover, while the prevalence of cigarette smoking has declined overall, there remain notable disparities between different subpopulations defined by income, level of educational attainment, race and ethnicity, and other sociodemographic characteristics. For example, according to 2020 National Health Interview Survey (NHIS) data, 27.1% of American Indian or Alaska Native individuals reported current cigarette use, compared to only 13.3% among non-Hispanic White individuals. Another area where disparities remain is among people who smoke menthol cigarettes. Although the overall prevalence of menthol cigarette smoking has declined over time among US adults, menthol use among people who smoke has continued to increase over time. Young adults, women and non-Hispanic Black individuals are more likely to smoke menthol cigarettes compared to their respective counterparts.

Besides cigarettes, other tobacco products are also used by U.S. adults. According to 2020 NHIS data, 3.7% of U.S. adults (9.1 million) reported using electronic cigarettes (e-cigarettes), 3.5% (8.6 million) reported using cigars, and 2.3% (5.7 million) reported using smokeless tobacco.

A cigar is defined as a roll of tobacco wrapped in leaf tobacco or in a substance that contains tobacco (whereas a cigarette is defined as a roll of tobacco wrapped most often in paper or some other non-tobacco substance). There are three major types of cigars currently sold in the U.S. – large cigars, cigarillos, and little cigars. Cigarillos are short (3-4 inches), narrow cigars that contain approximately 3 grams of tobacco and typically do not include a filter. Little cigars are about the same size as a cigarette and often include a filter. The marketplace of cigar products in the U.S. has recently been characterized by increasing product diversity, and marketing of these products has been targeted to specific population groups, including urban Black adults. Cigars, especially little cigars and cigarillos, come in a variety of flavors, including menthol, fruit and alcohol flavors, such as grape and wine, which appeals to adolescents and young adults.

Like cigarette smoke, cigar smoke contains toxic and carcinogenic compounds that are harmful to both people who smoke and people exposed to secondhand smoke. Cigar smoking causes oral cavity cancers (cancers of the lip, tongue, mouth, and throat) and cancers of the larynx (voice box), esophagus, and lung. Gum disease and tooth loss are also linked to cigar smoking, and people who smoke cigars heavily or inhale deeply may further be at increased risk of developing coronary heart disease. Smoking cigars heavily also increases the risk for lung diseases, such as emphysema and chronic bronchitis, which can be risk factors for lung cancer.

Smokeless tobacco is also known as chewing tobacco, spit tobacco, snuff, dip, or snus. Snuff is a finely cut or powdered tobacco that is either placed between the cheek and gum, or sniffed through the nose, respectively. Some moist snuff and all snus come in tea bag-like pouches. Chewing tobacco is used by putting a wad (loose leaves, plug, or twist) of tobacco inside the cheek. The prevalence of smokeless tobacco use tends to be higher among men, compared with women, and residents of rural areas, compared with residents of urban areas.

Chewing tobacco and snuff contain at least 28 cancer-causing agents. Use of smokeless tobacco causes oral, esophageal, and pancreatic cancer. Smokeless tobacco also causes serious oral health problems, including gum disease, other non-cancerous oral lesions, and tooth loss, and increases the risk of heart disease.

E-cigarettes (also known as vapes or Electronic Nicotine Delivery Systems (ENDS)) are battery-powered devices that convert a liquid (“e-liquid”) into an aerosol. E-liquids typically contain nicotine, flavorings, vegetable glycerin, propylene glycol and other chemicals. In addition to nicotine, e-cigarette aerosol may contain heavy metals, volatile organic compounds, and fine and ultrafine particles that can be inhaled deeply into the lungs by both users and by-standers. 

E-cigarette use among adults may potentially reduce the health risks associated with conventional cigarette smoking if users switch completely to e-cigarettes. However, a large percentage of U.S. adults who use e-cigarettes also smoke conventional cigarettes and are at continued risk for exposure to their toxic and carcinogenic compounds, and subsequent smoking-related morbidity and mortality. Furthermore, almost a quarter of those who use e-cigarettes report never having smoked, and the majority of this group is 18-24 years old. As noted above, overall, 3.7 percent of U.S. adults reported current e-cigarette use in 2020. E-cigarette use was higher among men than women (4.6% vs. 2.8%), among young adults (aged 18-24) than other age groups (9.4% vs. 3.7%), and among those who identify as lesbian, gay, or bisexual than heterosexual/straight (8.7% vs. 3.5%).

Presently, the COVID-19 pandemic poses a major threat to public health in the U.S. and across the world. Current and former cigarette smoking can increase an individual’s risk of severe illness from COVID-19. To reduce the chance of severe illness, people who currently smoke should quit, and people who used to smoke or have never smoked should refrain from using cigarettes.

Measure

Cigarettes: Percentage of adults aged 18 years and older who had smoked at least 100 cigarettes in their lifetime and, at the time of the interview, smoked cigarettes every day or some days.

Smokeless Tobacco: Percentage of adults aged 18 years and older who used smokeless tobacco at least once in their lifetime and, at the time of the interview, used smokeless tobacco every day or some days.

Cigars: Percentage of adults aged 18 years and older who smoked cigars at least once in their lifetime and, at the time of the interview, smoked cigars every day or some days.

E-cigarettes: Percentage of adults aged 18 years and older who used e-cigarettes at least once in their lifetime and, at the time of the interview, used e-cigarettes every day or some days.

Healthy People 2030 Target

  • Reduce to 6.1 percent the proportion of adults who currently smoke cigarettes.

Healthy People 2030 is a set of goals set forth by the Department of Health and Human Services.
Note: Goals are indicated as blue line on Detailed Trend Graphs.

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 1965–2021.

In 2019 the NHIS questionnaire was redesigned to increase relevance, enhance data quality, and minimize respondent burden. In addition, the COVID-19 pandemic created challenges conducting in-person interviews for the 2020 NHIS, requiring changes to field procedures to conduct most surveys by telephone, which impacted survey response rates. For details related to the potential impacts of these issues, please refer to Potential Impact of NHIS Redesign and COVID-19 on the Cancer Trends Progress Report.

In 2020, NHIS data collection shifted from being conducted in person to being conducted primarily over the telephone, and response rates subsequently declined. To augment data from the 2020 sample, followback interviews were conducted with 2019 NHIS participants. Estimates presented here for 2020 use this sample, which includes both new 2020 respondents and re-interviewed 2019 respondents.

Trends and Most Recent EstimatesHelp with navigating the graphs and data tables

By Type of Tobacco Product

Percentage of adults aged 18 years and older who reported current tobacco product use by type of tobacco product used, 1991-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current tobacco product use by type of tobacco product used, 1991-2021 CigarettesClick to see the detailed trend graph for Cigarettes 11.7 11.2 - 12.2
Smokeless TobaccoClick to see the detailed trend graph for Smokeless Tobacco 2.2 2.0 - 2.4
CigarsClick to see the detailed trend graph for Cigars 3.7 3.4 - 4.0
E-CigarettesClick to see the detailed trend graph for E-Cigarettes 4.9 4.6 - 5.3

Cigarettes, Long Term Trends (1965+)

Percentage of adults aged 18 years and older who reported current cigarette use by sex, 1965-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current cigarette use by sex, 1965-2021 Both SexesClick to see the detailed trend graph for Both Sexes 11.7 11.2 - 12.2
MaleClick to see the detailed trend graph for Male 13.3 12.6 - 14.1
FemaleClick to see the detailed trend graph for Female 10.1 9.5 - 10.7

Cigarettes

By Race/Ethnicity
Percentage of adults aged 18 years and older who reported current cigarette use by race/ethnicity, 1991-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current cigarette use by race/ethnicity, 1991-2021 All Races/EthnicitiesClick to see the detailed trend graph for All Races/Ethnicities 11.7 11.2 - 12.2
Non-Hispanic WhiteClick to see the detailed trend graph for Non-Hispanic White 13.3 12.6 - 14.0
Non-Hispanic BlackClick to see the detailed trend graph for Non-Hispanic Black 11.7 10.3 - 13.2
HispanicClick to see the detailed trend graph for Hispanic 7.8 7.0 - 8.8
By Age
Percentage of adults aged 18 years and older who reported current cigarette use by age, 1991-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current cigarette use by age, 1991-2021 Ages 18-24Click to see the detailed trend graph for Ages 18-24 5.3 4.3 - 6.5
Ages 25+Click to see the detailed trend graph for Ages 25+ 12.6 12.1 - 13.2
By Poverty Income Level
Percentage of adults aged 18 years and older who reported current cigarette use by poverty income level, 1997-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current cigarette use by poverty income level, 1997-2021 <200% of federal poverty levelClick to see the detailed trend graph for <200% of federal poverty level 19.2 18.1 - 20.4
>=200% of federal poverty levelClick to see the detailed trend graph for >=200% of federal poverty level 9.0 8.5 - 9.5
By Education Level
Percentage of adults aged 25 years and older who reported current cigarette use by highest level of education obtained, 1991-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 25 years and older who reported current cigarette use by highest level of education obtained, 1991-2021 Less than High SchoolClick to see the detailed trend graph for Less than High School 21.1 18.9 - 23.4
High SchoolClick to see the detailed trend graph for High School 19.2 18.0 - 20.5
Greater than High SchoolClick to see the detailed trend graph for Greater than High School 8.8 8.3 - 9.3
By Smoking Frequency
Percentage of adults aged 18 years and older who reported current cigarette use by smoking frequency, 1991-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current cigarette use by smoking frequency, 1991-2021 Nondaily SmokingClick to see the detailed trend graph for Nondaily Smoking 2.9 2.6 - 3.1
Daily SmokingClick to see the detailed trend graph for Daily Smoking 8.8 8.4 - 9.3

Smokeless Tobacco

By Sex
Percentage of adults aged 18 years and older who reported current smokeless tobacco use by sex, 1993-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current smokeless tobacco use by sex, 1993-2021 Both SexesClick to see the detailed trend graph for Both Sexes 2.2 2.0 - 2.4
MaleClick to see the detailed trend graph for Male 4.2 3.8 - 4.7
FemaleClick to see the detailed trend graph for Female 0.3 0.2 - 0.4
By Race/Ethnicity
Percentage of adults aged 18 years and older who reported current smokeless tobacco use by race/ethnicity, 1993-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current smokeless tobacco use by race/ethnicity, 1993-2021 All Races/EthnicitiesClick to see the detailed trend graph for All Races/Ethnicities 2.2 2.0 - 2.4
Non-Hispanic WhiteClick to see the detailed trend graph for Non-Hispanic White 3.1 2.8 - 3.5
Non-Hispanic BlackClick to see the detailed trend graph for Non-Hispanic Black 0.8 0.5 - 1.3
HispanicClick to see the detailed trend graph for Hispanic 0.8 0.5 - 1.2
By Age
Percentage of adults aged 18 years and older who reported current smokeless tobacco use by age, 1993-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current smokeless tobacco use by age, 1993-2021 Ages 18-24Click to see the detailed trend graph for Ages 18-24 1.4 0.9 - 2.1
Ages 25+Click to see the detailed trend graph for Ages 25+ 2.3 2.1 - 2.6
By Poverty Income Level
Percentage of adults aged 18 years and older who reported current smokeless tobacco use by poverty income level, 2000-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current smokeless tobacco use by poverty income level, 2000-2021 <200% of federal poverty levelClick to see the detailed trend graph for <200% of federal poverty level 2.0 1.7 - 2.5
>=200% of federal poverty levelClick to see the detailed trend graph for >=200% of federal poverty level 2.2 2.0 - 2.5
By Education Level
Percentage of adults aged 25 years and older who reported current smokeless tobacco use by highest level of education obtained, 1993-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 25 years and older who reported current smokeless tobacco use by highest level of education obtained, 1993-2021 Less than High SchoolClick to see the detailed trend graph for Less than High School 1.6 1.1 - 2.4
High SchoolClick to see the detailed trend graph for High School 3.4 2.9 - 4.0
Greater than High SchoolClick to see the detailed trend graph for Greater than High School 1.9 1.7 - 2.2

Cigars

By Sex
Percentage of adults aged 18 years and older who reported current cigar use by sex, 1998-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current cigar use by sex, 1998-2021 Both SexesClick to see the detailed trend graph for Both Sexes 3.7 3.4 - 4.0
MaleClick to see the detailed trend graph for Male 6.3 5.8 - 6.9
FemaleClick to see the detailed trend graph for Female 1.1 0.9 - 1.3
By Race/Ethnicity
Percentage of adults aged 18 years and older who reported current cigar use by race/ethnicity, 1998-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current cigar use by race/ethnicity, 1998-2021 All Races/EthnicitiesClick to see the detailed trend graph for All Races/Ethnicities 3.7 3.4 - 4.0
Non-Hispanic WhiteClick to see the detailed trend graph for Non-Hispanic White 4.0 3.6 - 4.4
Non-Hispanic BlackClick to see the detailed trend graph for Non-Hispanic Black 5.3 4.2 - 6.5
HispanicClick to see the detailed trend graph for Hispanic 2.3 1.9 - 2.9
By Age
Percentage of adults aged 18 years and older who reported current cigar use by age, 1998-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current cigar use by age, 1998-2021 Ages 18-24Click to see the detailed trend graph for Ages 18-24 3.0 2.2 - 4.1
Ages 25+Click to see the detailed trend graph for Ages 25+ 3.7 3.5 - 4.1
By Poverty Income Level
Percentage of adults aged 18 years and older who reported current cigar use by poverty income level, 1998-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current cigar use by poverty income level, 1998-2021 <200% of federal poverty levelClick to see the detailed trend graph for <200% of federal poverty level 3.7 3.1 - 4.3
>=200% of federal poverty levelClick to see the detailed trend graph for >=200% of federal poverty level 3.7 3.3 - 4.0
By Education Level
Percentage of adults aged 25 years and older who reported current cigar use by highest level of education obtained, 1998-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 25 years and older who reported current cigar use by highest level of education obtained, 1998-2021 Less than High SchoolClick to see the detailed trend graph for Less than High School 3.1 2.2 - 4.3
High SchoolClick to see the detailed trend graph for High School 3.9 3.3 - 4.7
Greater than High SchoolClick to see the detailed trend graph for Greater than High School 3.8 3.4 - 4.2

E-Cigarettes

By Sex
Percentage of adults aged 18 years and older who reported current e-cigarette use by sex, 2014-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current e-cigarette use by sex, 2014-2021 Both SexesClick to see the detailed trend graph for Both Sexes 4.9 4.6 - 5.3
MaleClick to see the detailed trend graph for Male 5.4 5.0 - 5.9
FemaleClick to see the detailed trend graph for Female 4.4 3.9 - 4.8
By Race/Ethnicity
Percentage of adults aged 18 years and older who reported current e-cigarette use by race/ethnicity, 2014-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current e-cigarette use by race/ethnicity, 2014-2021 All Races/EthnicitiesClick to see the detailed trend graph for All Races/Ethnicities 4.9 4.6 - 5.3
Non-Hispanic WhiteClick to see the detailed trend graph for Non-Hispanic White 6.1 5.6 - 6.7
Non-Hispanic BlackClick to see the detailed trend graph for Non-Hispanic Black 2.5 1.9 - 3.3
HispanicClick to see the detailed trend graph for Hispanic 3.0 2.5 - 3.6
By Age
Percentage of adults aged 18 years and older who reported current e-cigarette use by age, 2014-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current e-cigarette use by age, 2014-2021 Ages 18-24Click to see the detailed trend graph for Ages 18-24 10.9 9.3 - 12.6
Ages 25+Click to see the detailed trend graph for Ages 25+ 4.0 3.7 - 4.3
By Sex and Age
Percentage of adults aged 18 years and older who reported current e-cigarette use by sex and age, 2014-2021
Overview Graph Detailed Trend Graphs Most Recent Estimates (2021)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults aged 18 years and older who reported current e-cigarette use by sex and age, 2014-2021 Males, Ages 18-24Click to see the detailed trend graph for Males, Ages 18-24 11.5 9.3 - 14.3
Males, Ages 25+Click to see the detailed trend graph for Males, Ages 25+ 4.5 4.1 - 5.0
Females, Ages 18-24Click to see the detailed trend graph for Females, Ages 18-24 10.2 8.1 - 12.7
Females, Ages 25+Click to see the detailed trend graph for Females, Ages 25+ 3.5 3.1 - 3.9

Additional Information on Adult Tobacco Use

Quitting Resources

Year Range

1965-2021

Recent Summary Trend Year Range

2017-2021

Summary Tables

Smoking

Recent Summary Trend

Falling

Desired Direction

Falling