state of smoking and health in the united states

This page was last edited on: March 26, 2024 at 3:33 pm

smoking rate

15.5% (2022)

TOBACCO USE RATE

23% (2022)

TOBACCO USE AND TRENDS

In 2022, an estimated 62.9 million adults aged 15 years and older in the US are tobacco product users. This positions the US the 4^th globally and the 1^st in the WHO Americas Region in terms of number of tobacco product users.
In 2021, about 18.7% or 46 million US adults age 18 and older reported currently using tobacco products, where:
- 11.5% or 28.3 million adult cigarette users (13.1% men and 10% women). Current cigarette smoking is the lowest at 5.3% among people aged 18-24 years old.
- 2.1% or 5.2 million ( 4.2% men and 0.2% women) are current smokeless tobacco users.
It is estimated that demand for cigarettes per capita reduced by 37.2% from 50/pack in 2010 to 31.4/pack in 2022 (Euromonitor)-last accessed in December 2023.

DUAL USERS:

In 2021, among adults aged 18 years and older, 1.3% were dual cigarette and e-cigarette users, where:
- 10.2% smoked cigarettes only and
- 3.2% used e-cigarettes only.
- Dual use of cigarettes and e-cigarettes was similar for those 18-24 and 25-44 age groups (1.8%), and lowest 0.8% for those aged 45 and over.
In 2021, 7.9% of adults reported using two or more tobacco products and reported currently smoking cigarettes and smokeless tobacco.
In 2023, 2.5% of middle school and 3.9% of high school students reported current use of multiple tobacco products.

YOUTH TOBACCO USE:

In 2023 [2] 6.6% of middle school and 12.6% of high school students reported current use of a tobacco product.
1.1% of middle school and 1.9% of high school students are current cigarette users.
0.7% of middle school and 1.5% of high school students are current smokeless tobacco users.

Nicotine Alternatives

In 2021, 4.5% of adults (18+ age population) currently use e-cigarettes; 5.1% male and 4% female.

- E-cigarette use is the highest (11%) among the 18-24 years old age group followed by 6.5% among the 25-44 age group and it is the lowest (2%) among adults aged 45 and over.
- Current e-cigarette use is higher among white adults (5.2%), followed by Hispanic or Latino adults (3.3%), Asian adults (2.9%) and African American adults (2.4%).

In 2023, 4.6% middle school students (5.6% girls and 3.5% boys) and 10% high school students (12.2% girls and 8% boys) are current e-cigarette users.
0.8% of middle school (0.8% girls) and 1% of high school students (0.7% girls and 1.4% boys) are current heated tobacco products users.

HEALTH AND ECONOMIC BURDEN FROM TOBACCO USE

Tobacco was the 1st highest risk factor driving the most death and disability combined in 2019. It was estimated that tobacco use accounted for 549,585 deaths or 31% of all deaths in the country.
- Of tobacco deaths, 528 thousand or 96% were attributed to smoking, 36 thousand or 6.5% were secondhand smoking.
The leading causes of most deaths in the US include Ischemic Heart Disease (IHD) ranking 1^st, Lung Cancer ranking 2^nd, COPD ranking 3^rd, and Stroke ranking 4th, where tobacco was responsible for:
- 115 thousand or 22% of total IHD deaths, 113 thousand or 81% of all COPD deaths, 26 thousand or 17% of all Stroke deaths, and 149 thousand or 88% of all lung cancer deaths in 2019.
Tobacco use causes an estimated loss of 15 million disability-adjusted life years (DALYs) – 28% of total DALYs where tobacco accounts for the loss of 2.6 million DALYs for IHD, 3 million DALYs for COPD, 793 thousand DALYs for Stroke and 3 million DALYs for tracheal, bronchus, and lung cancer.
Smoking-related illnesses in the United States cost more than USD 300 billion each year where $225 billion for direct medical care for adults and more than $156 billion in lost productivity where $5.6 billion accounts for secondhand smoke exposure.

REGULATORY ENVIRONMENT

The U.S. has not signed the WHO Framework Convention on Tobacco Control (WHO FCTC). However, it has a strong tobacco policy environment.
In May 2016, the US Food and Drug Administration extended its authority to regulate cigars, pipe tobacco, hookah tobacco, heated tobacco, and e-vapor products, deeming them to be subject to the Federal Food, Drug, and Cosmetic Act. All manufacturers will need to file a PMTA (Pre-Market Tobacco Application).
Tobacco control is primarily implemented by state-level regulations. As of March 2023:
- The sale of e-cigarettes to underage persons has been prohibited in all 50 States, the District of Columbia (DC), Guam, the Northern Mariana Islands, Palau, Puerto Rico, and the US Virgin Islands.
- 34 states also require a retail license to sell e-cigarettes over the counter.
- Comprehensive smoke-free indoor air laws are passed by 17 states where the laws prohibit smoking and the use of e-cigarettes in indoor areas of private worksites, restaurants, and bars.
- Multiple states have banned flavored e-cigarettes, including Massachusetts, New York, New Jersey, and Rhode Island

TAXATION POLICY

In 2023, all 50 states and some cities levy excise tax on cigarettes, varying from US$0.170/pack in Missouri to US$4.35/pack in Connecticut and New York. In addition to states, cigarettes are subject to federal excise tax and state sales taxes.
On average total tax rate on retail prices of a pack of cigarettes was 30.96% in 2023 where the median excise value was $2.79 and the median retail price was $9.00/pack.
E-cigarettes are subject to various excise tax rates by 30 states and the District of Colombia as of July 2023. The base and the rates vary. As of 2023, 9 states impose ad valorem on wholesale price, while 7 states and DC impose on ml of liquid, and the rest impose a mixture of excises based on open or closed systems.
Heated Tobacco Products are subject to a Federal excise tax of $1.01/pack of HTPs where its share (20.31%) of the median retail price is $5,00/pack of 20 sticks in 2023.

TOBACCO PRODUCTION AND DIVERSIFICATION

In 2022, United States of America was the 5^th largest unmanufactured tobacco producer globally, produced approximately 202.9 thousand tons of unmanufactured tobacco. This accounts for about 3.5% of the global production of 5.8 million tons. Compared to 2010, when the United States of America produced 325.8 thousand tons, there has been a reduction of 37.7%.
The United States of America utilized an estimated 81.7 thousand hectares of land to harvest tobacco in 2022, which is a notable reduction of 40.2% compared to 2010. (FAOSTAT)

As research findings become available that are inclusive of additional gender identities, the Foundation will update the information presented.

[1] Source: World Health Organization: Non-age-standardized estimates of current tobacco use, tobacco smoking and cigarette smoking (Tobacco control: Monitor) and The World Bank’s Population Estimates and Projections.

Explanation: This estimate is calculated by applying the WHO’s estimated percentage of tobacco smokers for 2023 to the World Bank’s projected population figures of the same year for 15 years and older. These figures should be used with caution, as they do not account for the 95% credible interval around the estimate.

[2] reported using tobacco products and e-cigarettes in the past 30 days