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Background
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 daily smokers 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 never smokers, according to the Dose-Response Association of Low-Intensity and Nondaily Smoking With Mortality in the United States article, published in the journal JAMA Network Open.
Besides cigarettes, other tobacco products are also used by U.S. adults. According to 2019 NHIS data, reported that 8.7 million adults (3.7%) smoked cigars, 5.9 million adults (2.5%) used smokeless tobacco and 10.9 million (4.8%) used e-cigarettes.
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 smokers and nonsmokers. 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, 4.8 percent of U.S. adults (10.9 million people) were current e-cigarette users in 2019. E-cigarette use was higher among men than women (5.7% vs. 3.8%), among young adults (aged 18-24) than adults overall (9.2% vs. 4.1%), and among those who identify as lesbian, gay, or bisexual than heterosexual/straight (11.5% vs. 4.2%).
In 2019, the U.S. experienced an outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI). As of February 18, 2020, a total of 2,807 EVALI cases or deaths were reported to the Centers for Disease Control and Prevention (CDC). The U.S. Food and Drug Administration (FDA), CDC, and state health authorities have determined that tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products are linked to most EVALI cases. Vitamin E acetate is strongly linked to the EVALI outbreak; however, evidence is not sufficient to rule out the contribution of other chemicals of concern.
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, anus, 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 2021, almost 182,571 of the estimated 608,570 cancer-related deaths will be caused by cigarette smoking.
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, current smokers should quit, and former and never smokers should refrain from using cigarettes.
Measure
Any tobacco product: Percentage of adults aged 18 years and older who, at the time of the interview, currently used cigarettes; cigars, cigarillos, filtered little cigars; regular pipes, water pipes, hookah; e-cigarettes; and/or smokeless tobacco products.
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.
Combustible tobacco products: Percentage of adults aged 18 years and older who, at the time of the interview, currently used cigarettes; cigars, cigarillos, filtered little cigars; and/or regular pipes, water pipes, or hookah.
Healthy People 2030 Target
- Reduce to 16.2 percent the proportion of adults who are current users of any tobacco product.
- Reduce to 5 percent the proportion of adults who are current cigarette smokers.
- Reduce to 5 percent the proportion of adults who are combustible tobacco product users.
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, 1965–2020.
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 use the 2020 sample, which includes both new 2020 respondents and re-interviewed 2019 respondents.
Trends and Most Recent Estimates
By Type of Tobacco Product
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Cigarettes![]() |
12.6 | 12.1 - 13.2 |
Smokeless Tobacco![]() |
2.4 | 2.1 - 2.7 | |
Cigars![]() |
3.7 | 3.4 - 4.0 | |
E-Cigarettes![]() |
4.0 | 3.7 - 4.3 |
Cigarettes, Long Term Trends (1965+)
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Both Sexes![]() |
12.6 | 12.1 - 13.2 |
Male![]() |
14.3 | 13.5 - 15.2 | |
Female![]() |
11.1 | 10.4 - 11.8 |
Cigarettes
By Race/Ethnicity
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
All Races![]() |
12.6 | 12.1 - 13.2 |
Non-Hispanic White![]() |
13.7 | 13.1 - 14.5 | |
Non-Hispanic Black![]() |
14.5 | 12.8 - 16.5 | |
Hispanic![]() |
8.2 | 7.2 - 9.4 |
By Age
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Ages 18-24![]() |
7.0 | 5.7 - 8.6 |
Ages 25+![]() |
13.4 | 12.8 - 14.0 |
By Poverty Income Level
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
<200% of federal poverty level![]() |
20.0 | 18.8 - 21.3 |
>=200% of federal poverty level![]() |
10.0 | 9.4 - 10.6 |
By Education Level
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Less than High School![]() |
23.3 | 20.6 - 26.2 |
High School![]() |
19.9 | 18.6 - 21.3 | |
Greater than High School![]() |
9.0 | 8.5 - 9.6 |
By Smoking Frequency
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Nondaily Smoker![]() |
3.1 | 2.9 - 3.4 |
Daily Smoker![]() |
9.5 | 9.0 - 10.0 |
Smokeless Tobacco
By Sex
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Both Sexes![]() |
2.4 | 2.1 - 2.7 |
Male![]() |
4.6 | 4.1 - 5.1 | |
Female![]() |
0.3 | 0.2 - 0.5 |
By Race/Ethnicity
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
All Races![]() |
2.4 | 2.1 - 2.7 |
Non-Hispanic White![]() |
3.4 | 3.1 - 3.9 | |
Non-Hispanic Black![]() |
0.8 | 0.4 - 1.6 | |
Hispanic![]() |
0.4 | 0.2 - 0.7 |
By Age
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Ages 18-24![]() |
2.3 | 1.6 - 3.3 |
Ages 25+![]() |
2.4 | 2.1 - 2.7 |
By Poverty Income Level
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
<200% of federal poverty level![]() |
2.0 | 1.5 - 2.6 |
>=200% of federal poverty level![]() |
2.6 | 2.3 - 2.9 |
By Education Level
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Less than High School![]() |
2.5 | 1.7 - 3.6 |
High School![]() |
3.5 | 2.9 - 4.3 | |
Greater than High School![]() |
1.9 | 1.6 - 2.2 |
Cigars
By Sex
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Both Sexes![]() |
3.7 | 3.4 - 4.0 |
Male![]() |
6.5 | 6.0 - 7.2 | |
Female![]() |
0.9 | 0.7 - 1.2 |
By Race/Ethnicity
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
All Races![]() |
3.7 | 3.4 - 4.0 |
Non-Hispanic White![]() |
4.2 | 3.8 - 4.7 | |
Non-Hispanic Black![]() |
4.6 | 3.8 - 5.6 | |
Hispanic![]() |
2.2 | 1.7 - 2.7 |
By Age
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Ages 18-24![]() |
4.0 | 3.1 - 5.2 |
Ages 25+![]() |
3.6 | 3.3 - 3.9 |
By Poverty Income Level
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
<200% of federal poverty level![]() |
3.1 | 2.7 - 3.7 |
>=200% of federal poverty level![]() |
3.9 | 3.5 - 4.3 |
By Education Level
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Less than High School![]() |
4.0 | 2.7 - 5.7 |
High School![]() |
3.6 | 3.0 - 4.2 | |
Greater than High School![]() |
3.6 | 3.3 - 4.0 |
E-Cigarettes
By Sex
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Both Sexes![]() |
4.0 | 3.7 - 4.3 |
Male![]() |
4.9 | 4.5 - 5.5 | |
Female![]() |
3.0 | 2.6 - 3.5 |
By Race/Ethnicity
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
All Races![]() |
4.0 | 3.7 - 4.3 |
Non-Hispanic White![]() |
5.0 | 4.5 - 5.5 | |
Non-Hispanic Black![]() |
1.6 | 1.1 - 2.3 | |
Hispanic![]() |
2.4 | 1.9 - 3.0 |
By Age
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Ages 18-24![]() |
9.3 | 7.7 - 11.2 |
Ages 25+![]() |
3.2 | 2.9 - 3.5 |
By Sex and Age
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
---|---|---|---|
Percent of adults | 95% Confidence Interval | ||
![]() ![]() |
Males, Ages 18-24![]() |
12.1 | 9.6 - 15.1 |
Males, Ages 25+![]() |
3.9 | 3.5 - 4.3 | |
Females, Ages 18-24![]() |
6.5 | 4.7 - 9.0 | |
Females, Ages 25+![]() |
2.5 | 2.2 - 2.9 |
Additional Information on Adult Tobacco Use
- Tobacco. National Cancer Institute.
- Tobacco and Cancer. American Cancer Society.
- Smoking and Tobacco Use. Centers for Disease Control and Prevention.
- Smoking and Increased Risk of Severe Illness from COVID-19. Centers for Disease Control and Prevention.
- Tobacco Products. U.S. Food and Drug Administration.
Quitting Resources
- Cigarette Smoking: Health Risks and How to Quit (PDQ®)–Patient Version. National Cancer Institute.
- Smokefree.gov. National Cancer Institute.
- Where To Get Help When You Decide To Quit Smoking. National Cancer Institute.
- How to Quit Smoking or Smokeless Tobacco. American Cancer Society.
- What You Need To Know About Quitting Smoking: Advice from the Surgeon General. Centers for Disease Control and Prevention.
- North American Quitline Consortium.
- Cigarette Smoking: Health Risks and How to Quit (PDQ®)–Health Professional Version. National Cancer Institute.
- Tobacco Control Evidence-Based Programs Listing. National Cancer Institute.
- Treating Tobacco Use and Dependence: 2008 Update – Clinical Practice Guidelines. Agency for Healthcare Research and Quality.
- Best Practices for Comprehensive Tobacco Control Programs—2014. Centers for Disease Control and Prevention.
- Best Practices: Putting Evidence into Practice. Centers for Disease Control and Prevention.
- Smoking and Tobacco Use – Healthcare Provider Resources. Centers for Disease Control and Prevention.
- Smoking Cessation – The Role of Healthcare Professionals and Health Systems. Centers for Disease Control and Prevention.
- Surgeon General’s Reports on Smoking and Tobacco Use. Centers for Disease Control and Prevention.
- Tobacco Use. Million Hearts.
- Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions. U.S. Preventive Services Task Force.
- Tobacco Product Use Among Adults — United States, 2019. Cornelius ME, Wang TW, Jamal A, Loretan CG, Neff LJ. MMWR 2020;69(46);1736–1742.
- State-specific patterns of cigarette smoking, smokeless tobacco use, and e-cigarette use among adults—United States, 2016. Hu SS, Homa DM, Wang T et al. Prev Chronic Dis 2019;16:180362.
- Association of long-term, low-intensity smoking with all-cause and cause-specific mortality in the National Institutes of Health-AARP Diet and Health Study. Inoue-Choi M, Liao LM, Reyes-Guzman C et al. JAMA Intern Med. 2017;177(1):87-95.
- Dose-Response Association of Low-Intensity and Nondaily Smoking With Mortality in the United States. Inoue-Choi M, Christensen CH, Rostron BL, et al. JAMA Netw Open. 2020; 3(6):e206436.
- Demographic Characteristics, Cigarette Smoking, and e-Cigarette Use Among US Adults. Mayer M, Reyes-Guzman C, Grana R, et al. 2020; 3(10):e2020694.
- Not Quite the Rule, But No Longer the Exception: Multiple Tobacco Product Use and Implications for Treatment, Research, and Regulation. Pacek LR, Villanti AC, Mcclernon FJ. 2020;22(11):2114-2117.
- 2018-2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) Data Brief. National Cancer Institute.
- State Cancer Profiles. National Cancer Institute.
- Cancer Facts and Figures. American Cancer Society.
- Behavioral Risk Factor Surveillance System Prevalence and Trends Data. Centers for Disease Control and Prevention.
- Current Cigarette Smoking Among Adults in the United States. Centers for Disease Control and Prevention.
- Reports and Detailed Tables From the 2019 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration.