Health United States 2020-2021

Tobacco use

Tobacco products encompass varieties of products including cigarettes, cigarette tobacco, roll-your-own tobacco, smokeless tobacco, electronic cigarettes, cigars, hookahs, pipe tobacco, nicotine gels, and dissolvables. Vapes, vaporizers, vape pens, hookah pens, e-cigarettes or e-cigs, and e-pipes are some of the many terms used to describe electronic nicotine delivery systems (ENDS). ENDS are battery-powered tobacco products that typically deliver nicotine in the form of an aerosol. Cigars include premium cigars, little filtered cigars, and cigarillos. Use of tobacco products is measured differently by the data systems used in Health, United States.

Monitoring the Future (MTF) Study

Collects information on the use of selected substances by using self-completed questionnaires in a school-based survey of secondary school students. Information on current cigarette smoking was obtained for 12th graders (starting in 1975) and for 8th and 10th graders (starting in 1991), based on the following question: “How frequently have you smoked cigarettes during the past 30 days?” Information on vaping use was obtained for 8th, 10th, and 12th graders (starting in 2015), based on the following question: “During the last 30 days, on how many days (if any), have you used electronic cigarettes (e-cigarettes)?” In 2017, questions on vaping were revised to include separate questions on vaping of nicotine, marijuana, and “just flavoring.” Students were first asked the screener question: “To ‘vape’ is to use a device such as a JUUL, vape-pen, e-cigarette, e-hookah, or e-vaporizer to inhale a vapor into the lungs. Have you ever vaped?” Students who reply “yes” are then asked additional questions about specific substances they have vaped over different time frames. They are first asked about nicotine with the question: “On how many DAYS (if any) have you vaped NICOTINE … in your lifetime … in the last 12 months … in the last 30 days?” They are also asked about vaping marijuana and vaping “just flavoring” in the same format.

National Health Interview Survey (NHIS)

Information about cigarette smoking is obtained for adults aged 18 and over. From 1965 through 1990, the basic cigarette smoking status questions consisted of two parts: (1) “Have you smoked at least 100 cigarettes during your entire life?” and (2) if yes, “Do you smoke cigarettes now?”

In 1991, a transition to a new measure of smoking status was initiated. For the first time, NHIS distinguished smokers who smoked daily from those who smoked less often than daily. Respondents were first asked, “Have you smoked at least 100 cigarettes in your entire life?” If yes, “Do you smoke cigarettes now?” To those who said “yes” to the question about current cigarette smoking, the question was asked, “Do you smoke cigarettes every day or some days?” For those who said “no” to the current smoking status question, the question was asked, “Do you smoke cigarettes ‘not at all’ or ‘some days’?” This additional follow-up resulted in the classification of people as “someday smokers” who would otherwise have been considered former smokers, because they initially said that they did not smoke now.

In 1992, the transition to the current set of questions occurred. The cigarette smoking questions were included on two separate questionnaires, each asked of a representative sample of the U.S. civilian noninstitutionalized adult population aged 18 and over. The Cancer Control questionnaire contained the same set of questions asked in 1991, while the Cancer Epidemiology questionnaire asked, “Have you smoked at least 100 cigarettes in your entire life?” and if the answer was yes, “Do you now smoke cigarettes every day, some days, or not at all?” The inclusion of both sets of questions in the same year allowed for evaluation of the impact of the question change on population prevalence. The revised current smoking status question was estimated to have resulted in an increase in smoking prevalence of about 1% due to capturing cigarette smoking among people who would otherwise have been classified as nonsmokers with the original question. The estimates for 1992 shown in Health, United States combined data collected using both the traditional and revised questions. Estimates for 1993 and beyond use the revised questions.

In 1993–1995, estimates of cigarette smoking prevalence were based on a half-sample of all respondents. Smoking data were not collected in 1996. Starting in 1997, smoking questions are asked of all Sample Adults. Starting in 2014, questions were added to NHIS on the use of e-cigarettes; however, estimates of e-cigarette use from NHIS are not presented in Health, United States. Data from the cigarette smoking questions used in Health, United States are available in the following files: Sample Adult (1997–2019), year 2000 objectives (year2000; 1993–1995), Cancer Control (canccntl; 1992), Cancer Epidemiology (cancepid; 1992), Health Promotion and Disease Prevention (hpdpsamp; 1985, 1990, 1991), Alcohol and Health Practices (alcoholh; 1983), Smoking (smokingx; 1979), Hypertension (hyperten; 1974), and Core (person; 1965). For more information on survey methodology and sample sizes for NHIS cigarette smoking data, see the NHIS Adult Tobacco Use Information website.

National Survey on Drug Use and Health (NSDUH)

Interviewers conduct in-person, computer-assisted interviews of a sample of children aged 12 years and over at their place of residence. Information on current cigarette smoking is obtained based on the following question: “Now think about the past 30 days, that is, from [DATE] up to and including today. During the past 30 days, have you smoked part or all of a cigarette?”

To measure current use of any tobacco products, respondents are asked about the use of each tobacco product on 1 or more days in the past 30 days, including smokeless tobacco (such as snuff, dip, chewing tobacco, or “snus”), cigars, and pipe tobacco. Any amount of use reported in the past 30 days was classified as recent use of that tobacco product. Electronic cigarette use is not considered in the definition of current cigarette smoking or any use of tobacco products.