Cigarette Smoking Among US Adults Hit Record Low in 2020

Cigarette smoking is continuing to decline in the US. However, the populations using tobacco and the means by which they use tobacco are diversifying—pointing to the need for improved product use monitoring and strategies to reduce disparate impact of such use.

In a new report from the Centers for Disease Control and Prevention (CDC), investigators observed approximately 47.1 million American adults (19.0%) were current tobacco users of any kind in 2020. That number had again decreased from the year prior, as the leading use of tobacco in the US (smoking cigarettes) was prevalent among 12.5% of all US adults—the lowest prevalence since such data became available in 1965.

But another 17.3% of adults reported using ≥2 tobacco products the same year, as e-cigarette, cigar, smokeless tobacco, and pipe use was reported by millions.

Led by Monica E. Cornelius, PhD, of the Office on Smoking and Health at the National Center for Chronic Disease Prevention and Promotion at the CDC, investigators conducted a national assessment of 2020 National Health Interview Survey (NHIS) data to interpret the state of adult tobacco use.

They sought statistically significant differences—defined as P values <.05—in current cigarette smoking by each of urban-rural housing designation among each racial and ethnic group and changes from 2019 to 2020 in tobacco use prevalence, among other outcomes.

Americans using any tobacco product decreased from 2019 to 2020 (20.8% to 19.0%; P <.001), as did the rate of adults using ≥2 tobacco products. Among users, 79.6% reported using combustible products.

Use of any current tobacco product use was higher among men; adults aged <65 years old; non- Hispanic American Indian or Alaska Native adults; and non-Hispanic adults categorized as “Other” race in NHIS.

Additionally, use was higher among adults in rural areas; those whose highest education level was a GED certificate; those with below-average annual household income; lesbian, gay or bisexual adults; uninsured adults or those with Medicaid; adults with a disability; and adults with regular feelings of depression or anxiety.

Investigators suggested several factors may have influenced the lowered prevalence of overall tobacco use among US adults, including anti-tobacco media campaigns and policies.

They additionally pointed to the observed stark differences in sociodemographic factors among smoking US adults in 2020, such as that in rural areas.

“The tobacco industry has historically targeted rural and low-income areas with increased advertising, price promotions, and access to tobacco retailers, thereby contributing to an environment where tobacco use is viewed as normal,” they wrote. “Targeted marketing of menthol cigarettes to non-Hispanic Black and Hispanic racial and ethnic groups has also been documented.”

Cornelius and colleagues concluded that, while the downward trend of tobacco use among US adults is promising, further tobacco product use monitoring and tailored strategies to mitigate their impact should focus on reducing the disparities still prevalent among tobacco users.

“Equitable implementation of comprehensive commercial tobacco control interventions, including smoke-free policies for public places and access to cessation services, is essential for maintaining progress toward reducing tobacco-related morbidity and mortality in the United States,” they wrote.

The study, “Tobacco Product Use Among Adults – United States, 2020,” was published online in the Morbidity and Mortality Report.