Burden of Tobacco Use in the U.S.

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

By Race/Ethnicity | By Sex | By Age | By Education | By Poverty 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 2015, an estimated 15.1% (36.5 million) U.S. adults were current* cigarette smokers. Of these, 75.7% (27.6 million) smoked every day, and 24.3% (8.9 million) smoked some days.³

By Race/Ethnicity³

Race/Ethnicity	Prevalence
American Indian/Alaska Natives (non-Hispanic)	21.9%
Asians (non-Hispanic)	7.0%
Blacks (non-Hispanic)	16.7%
Hispanics	10.1%
Multiple Races (non-Hispanic)	20.2%
Whites (non-Hispanic)	16.6%

 

By Sex³

Sex	Prevalence
Men	16.7%
Women	13.6%

 

By Age³

Age	Prevalence
18–24 years	13.0%
25–44 years	17.7%
45–64 years	17.0%
65 years and older	8.4%

 

By Education³

Education Level	Prevalence
Less than high school	24.2%
GED	34.1%
High school graduate	19.8%
Some college	18.5%
Associate degree	16.6%
Undergraduate degree	7.4%
Graduate degree	3.6%

 

By Poverty Status³

Income Status	Prevalence
Below poverty level	26.1%
At or above poverty level	13.9%

^{*Current cigarette smoking is defined as smoking 100 cigarettes or more during one’s lifetime and currently smoking every day or some days.}

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Current Cigarette Smoking Among Specific Populations—United States

American Indians/Alaska Natives | Asians | Blacks | Hispanics | Lesbian, Gay, Bisexual, and Transgender (LGBT) | Military | Pregnant or Planning for a Baby | People Living With HIV | Mental Health Conditions | Adults With Disabilities

American Indians/Alaska Natives (Non-Hispanic)

American Indians/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 2015:³
  • 21.9% of AI/AN adults in the United States smoked cigarettes, compared with 15.1% of U.S. adults overall.
  • The prevalence of cigarette smoking was about 1 in 5 (or 19.0%) among AI/AN men and about 1 in 4 (or 24.0%) among AI/AN women.
• From 2005 to 2015, current cigarette smoking prevalence decreased significantly among AI/AN adults.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 2015:³
  • 7.0% of non-Hispanic Asian adults in the United State smoked cigarettes, compared with 15.1% of U.S. adults overall.
  • Cigarette smoking prevalence was significantly higher among non-Hispanic Asian men (12.0%) than among non-Hispanic Asian women (2.6%).
• From 2005 to 2015, a decline in current smoking prevalence among non-Hispanic Asian adults occurred (from 13.3% in 2005 to 7.0% in 2015).³

Surveys conducted during 2010-2013 by the National Survey on Drug Use and Health reflect a more comprehensive representation of current smoking among Asian subpopulations:

• The percentage of respondents who reported smoking within the past 30 days by subpopulations surveyed were:⁶
  • Chinese – 7.6%
  • Asian Indian – 7.6%
  • Japanese – 10.2%
  • Filipino – 12.6%
  • Vietnamese – 16.3%
  • Korean – 20.0%
• Among women, cigarette smoking prevalence ranged from 2.9% among Chinese women to 20.4% among Koreans.⁶
• Among men, cigarette smoking prevalence ranged from 11.6% among Asian Indians to 24.4% among Vietnamese individuals.⁶

Blacks (Non-Hispanic)

Although cigarette smoking rates are lower among Black high school students than among U.S. high school students overall (5.7% compared with 9.3% in 2015), this difference is not sustained in adulthood.^3,7

• In 2015:³
  • 16.7% of non-Hispanic Black adults in the United States smoked cigarettes, compared with 15.1% of U.S. adults overall.
  • Smoking prevalence was significantly higher among non-Hispanic Black men (20.9%) than among non-Hispanic Black women (13.3%).
• From 2005 to 2015, current cigarette smoking prevalence decreased among non-Hispanic Blacks (from 21.5% in 2005 to 16.7% in 2015).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 that acculturation plays a role and that smoking prevalence is higher among Hispanics who were born in the United States.⁸

• In 2015:³
  • 10.1% of Hispanic adults in the United States smoked cigarettes, compared with 15.1% among U.S. adults overall.
  • Cigarette smoking prevalence was significantly higher among Hispanic men (13.1%) than among Hispanic women (7.1%).
• From 2005 to 2015, a decline in current smoking prevalence among Hispanics was noted (from 16.2% in 2005 to 10.1% in 2015).³

Surveys conducted during 2010-2013 by the National Survey on Drug Use and Health also reflect a more comprehensive representation of current smoking among Hispanic subpopulations:

• The percentage of respondents who reported smoking within the past 30 days by subpopulations surveyed were:⁶
  • Central or South American – 15.6%
  • Mexican – 19.1%
  • Cuban – 19.8%
  • Puerto Rican – 28.5%
• Among women, smoking prevalence ranged from 11.4% among Central or South Americans to 25.1% among Puerto Ricans.⁶
• Among men, smoking prevalence ranged from 19.8% among Central or South Americans to 32.1% 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 higher than among the total population.^3,9   This may be 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.¹⁰

• In 2015, the prevalence of current cigarette smoking among lesbian, gay, and bisexual individuals was 20.6%, compared with 14.9% among heterosexual/straight individuals.³
• In 2013, the prevalence of current cigarette smoking among transgender adults was 35.5% compared with 20.7% among adults whose gender identity corresponds with their birth sex (cisgender).¹¹

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.^12,13 Cigarette smoking prevalence is even higher among military personnel who have been deployed.¹²

• In 2011, 24.0% of all active-duty military personnel reported currently smoking cigarettes, compared with 19.0% of civilians.¹⁴
• During 2007–2010, male veterans aged 25–64 years were more likely to be current smokers than nonveterans (29.0% versus 24.0%).¹²

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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.¹⁵

In 2010, data from 27 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 (54.3%) 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 American Indians/Alaska Natives (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%), 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%).¹⁵

 

Smoking Status—Women With Recent Live Births, 2010	Prevalence*15
Smoked before pregnancy	23.2%†
Smoked during pregnancy	10.7%
Smoked after delivery	15.9%

* Pregnancy Risk Assessment Monitoring System 2010, 27 sites
† Among those who smoked before pregnancy, 54.3% quit smoking during pregnancy. 

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People Living With HIV

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, 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.¹⁶

• In 2009, among adults with HIV, 42.4% were current cigarette smokers.¹⁸
• Factors associated with higher smoking prevalence among adults with HIV include:¹⁸
  • Age: Persons aged 40–49 years are more likely to smoke than those aged 18–29 years.
  • Race/ethnicity: Non-Hispanic Whites and 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.

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People With Mental Health Conditions

Nationally, nearly 1 in 5 adults (or 45.7 million adults) have some form of mental health condition, and 36% of these people smoke cigarettes. In comparison, 21% of adults without mental health conditions smoke cigarettes. (Mental health conditions is defined here as diagnosable mental, behavioral, or emotional conditions and does not include developmental and substance use disorders.)¹⁹

Following are other key facts: ¹⁹

• 31% of all cigarettes are smoked by adults with a mental health condition.
• 40% of men and 34% of women with a mental health condition smoke.
• 48% of people with a mental health condition who live below the poverty level smoke, compared with 33% of those with a mental health condition who live above the poverty level.

Adults With Disabilities

Adults with disabilities are more likely to be cigarette smokers than those without disabilities. This might be because a smoker’s disability is the result of smoking or because of possible higher stress associated with disabilities.³

• In 2015, the prevalence of current cigarette smoking among adults with disabilities was 21.5% compared with 13.8% among adults with no disability.³

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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 2017 Jun 20].
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 2015;48(3):326–33 [accessed 2017 Jun 20].
3. Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults—United States, 2005–2015. Morbidity and Mortality Weekly Report 2016;65(44):1205–11 [accessed 2017 Jun 20].
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 2017 Jun 20].
5. Centers for Disease Control and Prevention. Office of Minority Health and Health Equity. Asian American Populations [last updated 2013 Jul 2; accessed 2017 Jun 20].
6. Centers for Disease Control and Prevention. Disparities in Adult Cigarette Smoking–United States, 2002-2005 and 2010-2013. Morbidity and Mortality Weekly Report 2016:65(30): 753-8 [accessed 2017 Jun 20].
7. Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students—United States, 2011–2015. Morbidity and Mortality Weekly Report 2016;65(14):361–7 [accessed 2017 Jun 20].
8. 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 [cited 2017 Jun 20].
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 2017 Jun 20].
10. 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 2017 Jun 20].
11. Buchting FO, Emory KT, Scout, Kim Y, Fagan P, Vera LE, Emery S. Transgender Use of Cigarettes, Cigars, and E-Cigarettes in a National Study. American Journal of Preventive Medicine 2017; doi: 10.1016/j.amepre.2016.11.022[accessed 2017 Jun 20].
12. Institute of Medicine. Combating Tobacco in Military and Veteran Populations. Washington: The National Academies Press, 2009 [accessed 2017 Jun 20].
13. 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 2017 Jun 20].
14. Barlas FM, Higgins WB, Pflieger JC, Diecker K. 2011 Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel [PDF—3.60MB]. U.S. Department of Defense, TRICARE Management Activity, Defense Health Cost Assessment and Program Evaluation, and the United States Coast Guard 2013 [accessed 2017 Jun 20].
15. 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 2017 Jun 20].
16. U.S. Department of Health and Human Services. AIDS.gov: HIV and Smoking  [last updated 2014 Aug 12; accessed 2017 Jun 20].
17. U.S. Department of Health and Human Services, Health Resources and Services Administration. Guide for HIV/AIDS Clinical Care, 2014 [accessed 2017 Jun 20].
18. 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 [cited 2017 Jun 20].
19. Centers for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years with Mental Illness—United States, 2009–2011. Morbidity and Mortality Weekly Report 2013;62(05):81–7 [accessed 2017 Jun 20].

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