Tobacco Product Use Among Adults - United States, 2020

Abstract

Although cigarette smoking has declined over the past several decades, a diverse landscape of combustible and noncombustible tobacco products has emerged in the United States (1-4). To assess recent national estimates of commercial tobacco product use among U.S. adults aged ≥18 years, CDC analyzed data from the 2020 National Health Interview Survey (NHIS). In 2020, an estimated 47.1 million U.S. adults (19.0%) reported currently using any commercial tobacco product, including cigarettes (12.5%), e-cigarettes (3.7%), cigars (3.5%), smokeless tobacco (2.3%), and pipes* (1.1%).^† From 2019 to 2020, the prevalence of overall tobacco product use, combustible tobacco product use, cigarettes, e-cigarettes, and use of two or more tobacco products decreased. Among those who reported current tobacco product use, 79.6% reported using combustible products (e.g., cigarettes, cigars, or pipes), and 17.3% reported using two or more tobacco products.^§ The prevalence of any current commercial tobacco product use was higher among the following groups: 1) men; 2) adults aged <65 years; 3) non-Hispanic American Indian or Alaska Native (AI/AN) adults and non-Hispanic adults categorized as of "Other" race^¶; 4) adults in rural (nonmetropolitan) areas; 5) those whose highest level of educational attainment was a general educational development certificate (GED); 6) those with an annual household income <$35,000; 7) lesbian, gay, or bisexual adults; 8) uninsured adults or those with Medicaid; 9) adults living with a disability; and 10) those who regularly had feelings of anxiety or depression. Continued monitoring of tobacco product use and tailored strategies and policies that reduce the effects of inequitable conditions could aid in reducing disparities in tobacco use (1,4).

FIGURE 1

Prevalence of current cigarette smoking among U.S. adults, by urban-rural designation and race and ethnicity — United States, 2020 Abbreviation: AI/AN = American Indian or Alaska Native. * Smoking and tobacco use here refer to use of commercial tobacco products and not to tobacco used for medicinal and spiritual purposes by some American Indian communities. ^† Urban = large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan; rural = nonmetropolitan. https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf ^§ Hispanic adults could be of any race. All other groups were non-Hispanic. The following four non-Hispanic single-race categories were available for sample adults in the 2020 National Health Interview Survey public use files: 1) White, 2) Black or African American, 3) Asian, and 4) AI/AN. Exclusive from these groups, the “non-Hispanic, Other” category in this report includes those adults who were categorized as “non-Hispanic AI/AN and any other group” or “other single and multiple races.” The only multiracial categories available were “non-Hispanic AI/AN and any other group” and “other single and multiple races.” https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2020/srvydesc-508.pdf ^¶ p<0.05 for differences in urban-rural cigarette smoking prevalence for the following race/ethnicity groups: non-Hispanic Asian, non-Hispanic Black, non-Hispanic White, Hispanic.

FIGURE 2

Percentage of adults aged ≥18 years who reported smoking cigarettes every day, by average number of cigarettes smoked per day — United States, 2005–2020^†§ * Smoking and tobacco use here refer to use of commercial tobacco products and not to tobacco used for medicinal and spiritual purposes by some American Indian communities. ^† Linear trends were adjusted for sex, age, race, and ethnicity. During 2005–2020, prevalence of adults who smoked daily and smoked 1–9 cigarettes per day and 10–19 cigarettes per day significantly increased (p<0.05); prevalence of adults who smoked daily and smoked 20–29 cigarettes per day and ≥30 cigarettes per day significantly deceased (p<0.05). ^§ Changes in weighting and design methodology for the 2019 National Health Interview Survey could affect comparisons of weighted survey estimates over time; preliminary evaluation showed that the estimate of current cigarette smoking was affected by methodological changes, which might have shifted the estimate upward by 0.5 percentage points. In addition, changes in the 2020 National Health Interview Survey administration from in-person to primarily telephone-based might affect estimates. Under- and overrepresentation of certain groups exists. How this might bias the measured prevalence of current cigarette smoking is uncertain. For these reasons, observed trends should be interpreted cautiously. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2019/srvydesc-508.pdf and https://www.cdc.gov/nchs/data/nhis/earlyrelease/EarlyRelease202009-508.pdf