Burden of Cigarette Use in the U.S.
Cigarette smoking remains the leading cause of preventable disease and death in the United States.
Cigarette smoking kills more than 480,000 Americans each year.1 Cigarette smoking cost the United States more than $600 billion in 2018, including more than $240 billion in healthcare spending and nearly $372 billion in lost productivity.1,2,3,4
In 2020, an estimated 12.5% (30.8 million) of U.S. adults currently smoked cigarettes. Current cigarette smoking was defined as smoking ≥100 cigarettes during a lifetime and now smoking cigarettes either every day or some days.5
Percentage of persons aged ≥18 years who reported cigarette use “every day” or “some days” at time of survey and reported smoking at least 100 cigarettes during their lifetime.5
|By Age Group (yrs)||Percentage|
|American Indian/Alaska Native, non-Hispanic||27.1%|
|By U.S. Census Region||Percentage|
|By Education (adults aged ≥25 yrs)||Percentage|
|0–12 yrs (no diploma)||21.5%|
|High school diploma||17.6%|
|Some college, no degree||14.4%|
|Associate degree (academic or technical/vocational)||12.7%|
|Undergraduate degree (bachelor’s)||5.6%|
|Graduate degree (Master’s, doctoral or professional)||3.5%|
|By Marital Status||Percentage|
|Married/Living with partner||10.9%|
|Single/Never married/Not living with partner||13.0%|
|By Annual Household Income||Percentage|
|By Sexual Orientation||Percentage|
|By Health Insurance Coverage||Percentage|
|Medicare only (aged ≥65 yrs)||10.2%|
|Other public insurance||14.8%|
|Has a Disability||Percentage|
|Regularly Having Feelings of Anxiety††††||Percentage|
|Regularly Having Feelings of Depression††††||Percentage|
††††Measures of anxiety and depression are based on questions from The Washington Group Short Set on Functioning – Enhanced.
American Indians/Alaska Natives (AI/ANs) have a higher prevalence of current smoking than most other racial/ethnic groups in the United States.5 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.6 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 2020, 27.1% of AI/AN adults in the United States smoked cigarettes, while 12.5% of U.S. adults overall smoked cigarettes.5
Asian Americans represent a wide variety of languages, dialects, and cultures.7 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.7 Many Asian Americans emigrate from countries where smoking prevalence is 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.6
- In 2020, 8.0% of non-Hispanic Asian adults in the United States smoked cigarettes, while 12.5% of U.S. adults overall smoked cigarettes.5
Among Asian adult subpopulations in the U.S., current smoking prevalence is higher among Korean and Vietnamese respondents compared with Filipino, Japanese, Asian Indian, and Chinese respondents.7 Among women, smoking prevalence is highest among Koreans and lowest among Chinese. Among men, smoking prevalence is highest among Vietnamese and lowest among Asian Indians.7
Although prevalence of cigarette smoking is lower among non-Hispanic Black high school students than it is among U.S. high school students overall (6.4% compared with 11.2% in 20218, respectively), smoking prevalence among non-Hispanic Black adults is similar to that of the overall adult population.5,8
- In 2020, 14.4% of non-Hispanic Black adults in the United States smoked cigarettes, while 12.5% of U.S. adults overall smoked cigarettes.5
- Current smoking prevalence among non-Hispanic Black adults has been decreasing. In 2005, 21.5% of non-Hispanic Black adults reported current smoking.1,23
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.5,7
- In 2020, 8.0% of Hispanic adults in the United States smoked cigarettes, while 12.5% of U.S. adults overall smoked cigarettes.5
- Current smoking prevalence among Hispanic adults has been decreasing. In 2005, 16.2% of Hispanic adults reported current smoking.1,23
Among Hispanic adult subpopulations in the U.S., current smoking prevalence is higher among Puerto Rican adults compared with Cuban, Mexican, and Central or South American adults.7 Among both men and women, smoking prevalence is highest among Puerto Ricans, and lowest among Central or South Americans.7
Smoking prevalence among lesbian, gay, bisexual, and transgender (LGBT) individuals in the United States is higher than among heterosexual/straight individuals.5,10 This may be in part due to the aggressive marketing of tobacco products to this community. LGBT individuals also are likely to have risk factors for smoking that include daily stress related to prejudice and stigma that they can face.11
- In 2020, the prevalence of current cigarette smoking among lesbian, gay, and bisexual adults was 16.1%, compared with 12.3% among adult heterosexual/straight adults.5
In the United States, cigarette smoking prevalence is higher among people currently serving in the military than among the civilian population.12,13 Cigarette smoking prevalence is even higher among military personnel who have been deployed.12
- Among military veterans, 29.2% of veterans reported current tobacco product use.14
- Cigarettes were the most commonly used tobacco product among veterans, at 21.6%.14
The high prevalence of tobacco use among military and veteran personnel has a significant financial impact. During 2010, the Veterans Health Administration (VHA) spent an estimated $2.7 billion on smoking-related ambulatory care, prescription drugs, hospitalization, and home health care.14
Overall, there have been slight decreases in cigarette smoking during pregnancy and after delivery between 2000 and 2010, but for the majority of states, smoking prevalence before, during, or after pregnancy did not change over time, according to a study using Pregnancy Risk Assessment and Monitoring Survey (PRAMS) data.15
In 2010, data from 27 PRAMS sites, representing 52% of live births, showed that among women with recent live births:15
- About 23% reported smoking in the 3 months prior to pregnancy.
- More than half of these smokers (54%) reported that they quit smoking by the last 3 months of pregnancy.
- Almost 11% reported smoking during the last 3 months of pregnancy.
- Almost 16% reported smoking after delivery.
Among racial and ethnic groups, smoking during pregnancy was highest among AI/ANs (26.0%) and lowest among Asians/Pacific Islanders (2.1%).15
The highest prevalence of smoking after delivery was reported in women aged 20–24 years (25.5%), AI/ANs (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%).15
The cigarette smoking rates of women who smoked before, during and after pregnancy15
|Smoking Status—Women With Recent Live Births, 2010||Prevalence*|
|Smoked before pregnancy||23.2%†|
|Smoked during pregnancy||10.7%|
|Smoked after delivery||15.9%|
Cigarette smoking prevalence is estimated to be at least two times higher among adults living with HIV than in the general population.16,17,18 Advances in science mean that HIV is now a chronic, manageable disease. Many people with HIV lead healthy 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.16
- In 2014, among adults with HIV in medical care, 33.6% were current cigarette smokers.19
- Factors associated with higher smoking prevalence among adults with HIV include:18
- Race/ethnicity: Non-Hispanic Whites and non-Hispanic Blacks are more likely to smoke than Hispanics and Latinos.
- Education: Persons who only achieved a high school education or less are more likely to smoke than those with more than a high school education.
- Poverty level: Persons living below the poverty level are more likely to smoke than those living at or above the poverty level.
Approximately 1 in 4 (or 25%) of adults in the U.S. have some form of mental illness or substance use disorder, and these adults consume almost 40% of all cigarettes smoked by adults overall.20
- In 2019, 27.2% of U.S. adults with any mental illness reported smoking cigarettes during the past month compared to 15.8% of adults with no mental illness.21
The Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health (NSDUH) defines mental illness as any diagnosable mental, behavioral, or emotional disorder and defines substance use disorder as dependence or abuse of alcohol or illicit drugs.22
Adults who have disabilities have a higher prevalence of cigarette smoking than adults without disabilities. It is not known if the disability is a result of smoking or if the person began smoking after the onset of the disability.5
- In 2020, the prevalence of current cigarette smoking among adults with disabilities was 19.8% compared with 11.8% among adults with no disability.5
- 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 2019 Feb 1].
- Xu X, Shrestha SS, Trivers KF, Neff L, Armour BS, King BA. U.S. Healthcare Spending Attributable to Cigarette Smoking in 2014. Preventive Medicine. https://doi.org/10.1016/j.ypmed.2021.106529. [accessed 2021 May 17].
- Shrestha SS, Ghimire R, Wang X, Trivers KF, Homa DM, Armour BS. Cost of Cigarette Smoking Attributable Productivity Losses, United States, 2018. Am J Prev Med 2022.
- Max W, Sung HY, Shi Y. Deaths from secondhand smoke exposure in the United States: economic implications. American Journal of Public Health 2012;102(11): 2173–80.
- Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco Product Use Among Adults — United States, 2020. MMWR Morb Mortal Wkly Rep 2022; 71:397–405.
- 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 2019 Feb 1].
- Martell BN, Garrett BE, Caraballo RS. Disparities in Adult Cigarette Smoking—United States, 2002–2005 and 2010–2013. Morbidity and Mortality Weekly Report 2016; 65:753–758. DOI: https://www.cdc.gov/mmwr/volumes/65/wr/mm6530a1.htm [accessed 2019 Feb 1].
- Gentzke AS, Wang TW, Cornelius M, Park-Lee E, Ren C, Sawdey MD, Cullen KA, Loretan C, Jamal A, Homa DM. Tobacco Product Use and Associated Factors Among Middle and High School Students – National Youth Tobacco Survey, United States, 2021. Morbidity and Mortality Weekly Report, 2022; 71(No. SS-5):1–29.
- Kaplan RC, Bandiwala SI, Barnhart JM, Castañeda SF, Gellman MD, Lee DJ, Pérez-Stable EJ, Talavera GA, Youngblood ME, Giachello 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 [accessed 2019 Feb 1].
- 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 2019 Feb 1].
- Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults—United States, 2005–2013. Morbidity and Mortality Weekly Report 2014;69(47):1108–12 [accessed 2019 Feb 1].
- Institute of Medicine. Combating Tobacco in Military and Veteran Populations. Washington: The National Academies Press, 2009 [accessed 2019 Feb 1].
- 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, 2007–201 [PDF – 863KB]. Morbidity and Mortality Weekly Report 2012;61(45):929 [accessed 2019 Feb 1].
- Odani S, Agaku IT, Graffunder CM, Tynan MA, Armour BS. Tobacco Product Use Among Military Veterans — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2018;67:7–12. DOI: http://dx.doi.org/10.15585/mmwr.mm6701a2 [accessed 2018 Dec 19].
- 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 2019 Feb 1].
- U.S. Department of Health and Human Services. AIDS.gov: HIV and Smoking [last updated 2018 Nov 8; accessed 2019 Feb 1].
- U.S. Department of Health and Human Services, Health Resources and Services Administration. Guide for HIV/AIDS Clinical Care, 2014 [accessed 2019 Feb 1].
- Mdodo R, Frazier EL, Dube SR, Mattson CL, Sutton MY, Brooks JT, Skarbinski J. Cigarette Smoking Prevalence Among Adults With HIV Compared With the General Adult Population in the United States: Cross-Sectional Surveys. Annals of Internal Medicine 2015;162:335–44 [accessed 2019 Feb 1].
- Frazier, EL, Sutton, MY, Brooks, JT, Shouse, RL, Weiser, J. Trends in cigarette smoking among adults with HIV compared with the general adult population, United States – 2009–2014. Preventative Medicine. 2018;111:231-234. https://doi.org/10.1016/j.ypmed.2018.03.007 [accessed 2019 February 25].
- Centers for Disease Control and Prevention. Tobacco Use Among Adults with Mental Illness and Substance Use Disorders. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. [updated 2019 Jan 7; last accessed 2019 Feb 7].
- Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2018 and 2019. Published: September 11, 2020. 2019 NSDUH Detailed Tables [accessed 2020, Nov 10].
- Lipari R, Van Horn S. Smoking and Mental Illness Among Adults in the United States. The CBHSQ Report: March 30, 2017. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration [accessed 2019 Feb 7].
- National Institutes of Health, National Cancer Institute. Cancer Trends Progress Report, Adult Tobacco Use. July 2021. https://progressreport.cancer.gov/prevention/adult_smoking