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Cigarette Smoking in the United States

Current Cigarette Smoking Among U.S. Adults Aged 18 Years and Older

By Race/Ethnicity | By Sex | By Age | By Education | By Income Status

Tobacco use remains the single largest preventable cause of death and disease in the United States. Cigarette smoking kills more than 480,000 Americans each year, with more than 41,000 of these deaths from exposure to secondhand smoke.1 In addition, smoking-related illness in the United States costs more than $300 billion a year, including nearly $170 billion in direct medical care for adults and $156 billion in lost productivity.1, 2

In 2013, an estimated 17.8% (42.1 million) U.S. adults were current cigarette smokers.3 Of these, 76.9% (32.4 million) smoked every day, and 23.1% (9.7 million) smoked some days.3

By Race/Ethnicity3

Race/EthnicityPrevalence
American Indian/Alaska Natives (non-Hispanic)26.1%
Asians (non-Hispanic)9.6%
Blacks (non-Hispanic)18.3%
Hispanics12.1%
Multiple Races (non-Hispanic)26.8%
Whites (non-Hispanic)19.4%


By Sex3

SexPrevalence
Men20.5%
Women15.3%


By Age3

AgePrevalence
18–24 years18.7%
25–44 years20.1%
45–64 years19.9%
65 years and older  8.8%


By Education3

Education LevelPrevalence
Less than high school24.2%
GED41.4%
High school graduate22.0%
Some college20.9%
Associate degree17.8%
Undergraduate degree  9.1%
Postgraduate degree  5.6%


By Poverty Status3

Income StatusPrevalence
Below poverty level29.2%
At or above poverty level16.2%

 

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Current Cigarette Smoking Among Specific Populations—United States

American Indian/Alaska Natives | Asians | Blacks | Hispanics | Lesbian, Gay, Bisexual, and Transgender (LGBT) | Military | People Living With HIV | Pregnant or Planning a Baby

American Indian/Alaska Natives (Non-Hispanic)

American Indian/Alaska Natives (AI/ANs) have a higher prevalence of current smoking than most other racial/ethnic groups in the United States.3 Factors that may affect smoking prevalence include sacred tobacco’s ceremonial, religious, and medicinal roles in Native culture, which may affect attitudes, beliefs, and behaviors toward commercial tobacco use.4 Also, tobacco sold on tribal lands is typically not subject to state and national taxes, which reduces costs. Lower prices are connected with increased smoking rates.1

  • In 2013:
    • 26.1% of AI/AN adults in the United States smoked cigarettes, compared with 17.8% of U.S. adults overall.3
    • The prevalence of current cigarette smoking was higher among AI/AN men (32.1%) than among AI/AN women (22.0%).3
  • From 2005 to 2013, current cigarette smoking prevalence decreased among AI/AN adults (from 32.0% in 2005 to 26.1% in 2013).3

Asians (Non-Hispanic)

Asian Americans represent a wide variety of languages, dialects, and cultures.5 While non-Hispanic Asian adults have the lowest current cigarette smoking prevalence of any racial/ethnic group in the United States, there are significant differences in smoking prevalence among subgroups in this population.6 Many Asian Americans emigrate from countries where smoking rates are high and smoking among men is the social norm. However, research also shows an association between cigarette smoking and acculturation among Asian Americans, with those having higher English-language proficiency and those living in the United States longer being less likely to smoke.4,5

  • In 2013:
    • 9.6% of non-Hispanic Asian adults in the United State smoked cigarettes, compared with 17.8% of U.S. adults overall.3
    • Cigarette smoking prevalence was significantly higher among non-Hispanic Asian men (15.1%) than among non-Hispanic Asian women (4.8%).3
  • From 2005 to 2013, a decline in current smoking prevalence among non-Hispanic Asian adults occurred (from 13.3% in 2005 to 9.6% in 2013).3

Estimates reflecting a more comprehensive representation of current smoking among Asian subpopulations were published in Preventing Chronic Disease in July 2008.6 These estimates, based on four waves of the National Survey on Drug Use and Health conducted between 2002 and 2005, show that:

  • The percentage of respondents who reported smoking within the past 30 days by subpopulations surveyed were:6
    • Chinese - 8.8%
    • Asian Indian - 11.9%
    • Japanese - 12.1%
    • Filipino - 16.7%
    • Vietnamese - 21.5%
    • Korean - 26.6%
  • Among women, cigarette smoking prevalence ranged from 3.5% among Asian Indians to 20.1% among Koreans.6
  • Among men, cigarette smoking prevalence ranged from 13.9% among Chinese individuals to 37.4% among Koreans.6

Blacks (Non-Hispanic)

Although cigarette smoking rates are lower among Black youth than among U.S. youth overall (9.0% compared with 12.7% in 2013), this difference is not sustained in adulthood.3,7

  • In 2013:
    • 18.3% of non-Hispanic Black adults in the United States smoked cigarettes, which is similar to U.S. adults overall (17.8%).3
    • Smoking prevalence was significantly higher among non-Hispanic Black men (21.8%) than among non-Hispanic Black women (15.4%).3
  • From 2005 to 2013, current cigarette smoking prevalence decreased among non-Hispanic Blacks (from 21.5% in 2005 to 18.3% in 2013).3

Hispanics

The prevalence of cigarette smoking among Hispanics is generally lower than the prevalence among other racial/ethnic groups in the United States, with the exception of non-Hispanic Asians. However, smoking prevalence among Hispanic men is significantly higher than among Hispanic women, and there are significant differences in smoking prevalence among subgroups in this population.3,6  Research also shows acculturation plays a role and smoking prevalence is higher among Hispanics who were born in the United States.8         

  • In 2013:
    • 12.1% of Hispanic adults in the United States smoked cigarettes, compared with 17.8% among U.S. adults overall.3
    • Cigarette smoking prevalence was significantly higher among Hispanic men (17.3%) than among Hispanic women (7.0%).3
  • From 2005 to 2013, a decline in current smoking prevalence among Hispanics was noted (from 16.2% in 2005 to 12.1% in 2013).3

Estimates reflecting a more comprehensive representation of current smoking among Hispanic subpopulations were published in Preventing Chronic Disease in July 2008.6 These estimates, based on four waves of the National Surveys on Drug Use and Health conducted between 2002 and 2005, show that:

  • The percentage of respondents who reported smoking within the past 30 days by subpopulations surveyed were:6
    • Central or South American - 20.2%
    • Mexican - 23.8%
    • Cuban - 25.2%
    • Puerto Rican - 31.5%
  • Among women, smoking prevalence ranged from 14.7% among Central or South Americans to 28.0% among Puerto Ricans.6
  • Among men, smoking prevalence ranged from 25.3% among Central or South Americans to 35.6% among Puerto Ricans.6

Lesbian, Gay, Bisexual, and Transgender (LGBT)

Smoking prevalence among lesbian, gay, bisexual, and transgender (LGBT) individuals in the United States is much higher than among the total population.3,9  This is in part due to the aggressive marketing of tobacco products to this community. LGBT individuals are also likely to have risk factors for smoking that include daily stress related to prejudice and stigma that they may face.3

  • In 2013, the prevalence of current cigarette smoking among lesbian, gay, and bisexual individuals was 26.6%, compared with 17.6% among heterosexual/straight individuals.3

Military Service Members and Veterans

In the United States, cigarette smoking prevalence is higher among people currently serving in the military than among the civilian population.10,11 Cigarette smoking prevalence is even higher among military personnel who have been deployed.10

  • Male veterans aged 25–64 years were more likely to be current smokers than nonveterans (29% versus 24%).
  • Among men aged 45–54 years, 36% of veterans reported being current smokers, compared with 24% of nonveterans.

Current Smoking* Among Men Aged 25 to 64 Years, by Age Group and Veteran Status—National Health Interview Survey (NHIS), United States, 2007 to 2010§

Figure showing that the rate of smoking is higher among male adults who are military veterans.

Footnotes:

  • * Current smoking is defined as having smoked at least 100 cigarettes in their lifetime and now smoke every day or some days.
  • † In NHIS, veterans identify themselves by responding "Yes" to the question "Have you ever been honorably discharged from active duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard?" During 2007–2010, veterans accounted for 15% of the male population aged 25 to 64 years, ranging from 6% among men aged 25–34 years to 34% for those aged 55–64 years.
  • § Estimates are based on household interviews of a sample of the civilian, noninstitutionalized U.S. population and are derived from the NHIS sample adult component.
  • ¶ 95% confidence interval.


 

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Women Who Are Pregnant or Plan to Become Pregnant

In the United States, modest decreases in cigarette smoking during pregnancy and after delivery occurred between 2000 and 2010, according to a study of 39 states and New York City.12

In 2010, data from 27 sites, representing 52% of live births, showed that among women with recent live births:12

  • About 23% reported smoking in the 3 months prior to pregnancy.
  • Almost 11% reported smoking during pregnancy.
  • More than half (54.3%) reported that they quit smoking by the last 3 months of pregnancy.
  • Almost 16% reported smoking after delivery.

Among racial and ethnic groups, smoking during pregnancy was highest among American Indians/Alaska Natives (26.0%) and lowest among Asians/Pacific Islanders (2.1%).12

The highest prevalence of smoking after delivery was reported in women aged 20–24 years (25.5%), American Indians/Alaska Natives (40.1%), those who had less than 12 years of education (24.5%), and those who had Medicaid coverage during pregnancy or delivery (24.3%).12

 

Smoking Status—Women With Recent Live Births, 2010Prevalence12
Smoked before pregnancy23.2%
Smoked during pregnancy10.7%
Quit smoking during pregnancy54.3%
Smoked after delivery15.9%

                                                                        * Pregnancy Risk Assessment Monitoring System 2010, 27 sites

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People Living With HIV

Cigarette smoking prevalence is much higher among people who are living with HIV in the United States than among the total population.13,14 Advances in science mean that HIV is now a chronic, manageable disease. Many people with HIV lead healthy, happy lives. However, smoking has serious health effects on people with HIV, including higher risks for cancer; chronic obstructive pulmonary disease (COPD); heart disease; stroke; and HIV-related infections, including bacterial pneumonia.13

Among all adults, 17.8% smoked cigarettes in 2013.3 Smoking prevalence is estimated to be at least two times higher among adults living with HIV than in the general population.13,14

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Facts About Secondhand Smoke

  • During 2011–2012, an estimated 58 million nonsmokers in the United States breathed other peoples' tobacco smoke.15
  • Secondhand smoke exposure among nonsmokers decreased from 52.5% during 1999–2000 to 25.3% during 2011–2012.15
  • During 2011–2012, secondhand smoke exposure was highest among:15
    • Children aged 3–11 years (40.6%)
    • Non-Hispanic Blacks (46.8%)
    • People living below the poverty level (43.2%)
    • People living in rental housing (36.8%)
  • Each year, more than 41,000 nonsmoking adults die from exposure to secondhand smoke:1
    • Nearly 34,000 from coronary heart disease
    • About 7,300 from lung cancer

Nonsmokers who are exposed to secondhand smoke at home or work increase their lung cancer risk by 20–30%.16

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References

  1. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: 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, 2014 [accessed 2015 Mar 26].

  2. Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek TF. Annual Healthcare Spending Attributable to Cigarette Smoking: An Update. American Journal of Preventive Medicine. 2014;doi:10.1016/j.amepre.2014.10.012 [accessed 2015 Mar 26].
  3. Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults—United States, 2005–2013. Morbidity and Mortality Weekly Report 2014;63(47):1108–12 [accessed 2015 Mar 26].
  4. U.S. Department of Health and Human Services. Tobacco Use Among U.S. Racial/Ethnic Minority Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, Hispanics: A Report of the Surgeon General. Atlanta, Georgia: 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, 1998 [accessed 2015 Mar 26].
  5. Centers for Disease Control and Prevention. Office of Minority Health and Health Equity. Asian American Populations [last updated 2013 Jul 2; accessed 2015 Mar 26].
  6. Caraballo RS, Yee SL, Gfroerer J, Mirza S. Adult Tobacco Use Among Racial and Ethnic Groups Living in the United States 2002–2005 [PDF - 447KB]. Preventing Chronic Disease: Public Health Research, Practice, and Policy 2008;5(3):1–6 [accessed 2015 Mar 26].
  7. Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students—United States, 2013. Morbidity and Mortality Weekly Report 2014;63(45):1021–6 [accessed 2015 Mar 26].
  8. Kaplan RC, Bandiwala SI, Barnhart JM, Castañeda SF, Gellman MD, et al. Smoking Among U.S. Hispanic/Latino Adults: The Hispanic Community Health Study/Study of Latinos. American Journal of Preventive Medicine 2014;46(5):496–506 [cited 2015 Mar 26].
  9. King BA, Dube SR, Tynan MA. Current Tobacco Use Among Adults in the United States: Findings From the National Adult Tobacco Survey. American Journal of Public Health 2012;102(11):e93–e100 [accessed 2015 Mar 26].
  10. IOM (Institute of Medicine). 2009. Combating Tobacco Use in Military and Veteran Populations. Washington: The National Academies Press [accessed 2015 Mar 26].
  11. Centers for Disease Control and Prevention. Quick Stats: Current Smoking Among Men Aged 25–64 Years, by Age Group and Veteran Status—National Health Interview Survey (NHIS), United States, 2007–2010 [PDF - 863KB]. Morbidity and Mortality Weekly Report 2012;61(45):929 [accessed 2015 Mar 26].
  12. Centers for Disease Control and Prevention. Trends in Smoking Before, During, and After Pregnancy—Pregnancy Risk Assessment Monitoring System, United States, 40 Sites, 2000–2010. Morbidity and Mortality Weekly Report 2013;62(SS06)1–19 [accessed 2015 Mar 26].
  13. U.S. Department of Health and Human Services. AIDS.gov: HIV and Smoking  [last updated 2014 Aug 12; accessed 2015 Mar 26].
  14. U.S. Department of Health and Human Services, Health Resources and Services Administration. Guide for HIV/AIDS Clinical Care, 2014 Edition [accessed 2015 Mar 26].
  15. Centers for Disease Control and Prevention. Vital Signs: Disparities in Nonsmokers' Exposure to Secondhand Smoke—United States, 1999–2012. Morbidity and Mortality Weekly Report 2015;64(04):103–8 [accessed 2015 Mar 26].
  16. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006 [accessed 2015 Mar 26].

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