Tobacco Product Use Among Adults - United States, 2021

Abstract

Commercial cigarette smoking among U.S. adults has declined during the preceding 5 decades (1,2); however, tobacco product use remains the leading cause of preventable disease and death in the United States, and some populations continue to be disproportionately affected by tobacco use (1,2). To assess recent national estimates of commercial tobacco use among U.S. persons aged ≥18 years, CDC, the Food and Drug Administration (FDA), and the National Cancer Institute analyzed 2021 National Health Interview Survey (NHIS) data. In 2021, an estimated 46 million U.S. adults (18.7%) reported currently using any tobacco product, including cigarettes (11.5%), e-cigarettes (4.5%), cigars (3.5%), smokeless tobacco (2.1%), and pipes (including hookah)* (0.9%).^† Among those who used tobacco products, 77.5% reported using combustible products (cigarettes, cigars, or pipes), and 18.1% reported using two or more tobacco products.^§ The prevalence of current use of any tobacco product use was higher among the following groups: men; persons aged <65 years; persons of non-Hispanic other races; non-Hispanic White (White) persons^¶; residents of rural (nonmetropolitan) areas; financially disadvantaged (income-to-poverty ratio = 0-1.99); lesbian, gay, or bisexual (LGB) persons; those uninsured or enrolled in Medicaid; adults whose highest level of education was a general educational development (GED) certificate; who had a disability; and who had serious psychological distress. Continued surveillance of tobacco product use, implementation of evidence-based tobacco control strategies (e.g., hard-hitting media campaigns, smoke-free policies, and tobacco price increases), conducting linguistically and culturally appropriate educational campaigns, and FDA regulation of tobacco products will aid in reducing tobacco-related disease, death, and disparities among U.S. adults (3,4).

FIGURE 1

Percentage of persons aged ≥18 years who reported use of two or more tobacco products, by the top five product combinations — United States, 2021^,, Abbreviation: e-cigarettes = electronic cigarettes. * Smoking and tobacco product use refers to use of commercial tobacco products and not to tobacco used for medicinal and spiritual purposes by some American Indian communities. ^† Current smokeless tobacco product use was defined as using chewing tobacco, snuff, dip, snus, or dissolvable tobacco at least once during a person’s lifetime and now using at least one of these products “every day” or “some days.” ^§ “All other combinations” refers to use of other combinations of two or more products.

FIGURE 2

Prevalence of cigarette smoking among persons aged ≥18 years, by race and ethnicity and depression diagnosis history — United States, 2019–2021^,,, Abbreviations: AI/AN = American Indian or Alaska Native; NCHS = National Center for Health Statistics; NH = non-Hispanic. * With 95% CIs indicated by error bars. ^† Smoking and tobacco product use refers to use of commercial tobacco products and not to tobacco used for medicinal and spiritual purposes by some American Indian communities. ^§ Depression was defined using the question, “Have you ever been told by a doctor or other health professional that you had … any type of depression?” Those responding “Yes” were classified as having ever had depression in their lifetime. Those responding “No” were classified as never having had depression in their lifetime. ^¶ Among adults who ever had diagnosed depression, statistically significant (p<0.05) trends during 2019–2021 were observed for the following groups: all races; Black or African American, NH; White, NH; and Hispanic adults. **Among adults who never had diagnosed depression, statistically significant (p<0.05) trends during 2019–2021 were observed for the following groups: all races; Black or African American, NH; White, NH; and Hispanic adults. ^†† Among adults who ever had diagnosed depression, estimates were statistically unreliable for AI/AN, NH; and Asian, NH adults during 2019–2021 and are not presented based on NCHS data presentation standards (https://www.cdc.gov/nchs/data/series/sr_02/sr02_175.pdf). SAS MACRO used to suppress criteria check. https://support.sas.com/resources/papers/proceedings19/3659-2019.pdf ^§§ Among adults who never had diagnosed depression, estimates were statistically unreliable for AI/AN, NH adults in 2019 and 2021 and are not presented based on NCHS data presentation standards (https://www.cdc.gov/nchs/data/series/sr_02/sr02_175.pdf). SAS MACRO used to suppress criteria check. https://support.sas.com/resources/papers/proceedings19/3659-2019.pdf