Tobacco Product Use Among Adults — United States, 2017

1Cigarette smoking harms nearly every organ of the body and causes adverse health consequences, including heart disease, stroke, and multiple types of cancer. Although cigarette smoking among U.S. adults has declined considerably, tobacco products have evolved in recent years to include various combustible, noncombustible, and electronic products. To assess recent national estimates of tobacco product use among U.S. adults aged ≥18 years, CDC, the Food and Drug Administration (FDA), and the National Institutes of Health’s National Cancer Institute analyzed data from the 2017 National Health Interview Survey (NHIS). In 2017, an estimated 47.4 million U.S. adults (19.3%) currently used any tobacco product, including cigarettes (14.0%; 34.3 million); cigars, cigarillos, or filtered little cigars (3.8%; 9.3 million); electronic cigarettes (e-cigarettes) (2.8%; 6.9 million); smokeless tobacco (2.1%; 5.1 million); and pipes, water pipes, or hookahs (1.0%; 2.6 million). Among current tobacco product users, 86.7% (41.1 million) smoked combustible tobacco products, and 19.0% (9.0 million) used ≥2 tobacco products. By univariate analyses, the prevalence of current use of any tobacco product was higher among males than among females; adults aged <65 years than among those aged ≥65 years; non-Hispanic American Indian/Alaska Natives, whites, blacks, or multiracial adults than among Hispanics or non-Hispanic Asians; adults who lived in the South or Midwest than among those in the West or Northeast; adults who had a general educational development certificate (GED) than among those with other levels of education; adults who earned an annual household income of <$35,000 than among those with those with higher income; lesbian, gay, or bisexual adults than among heterosexual/straight adults; and adults who were divorced/separated/widowed or single/never married/not living with a partner than among those who were married/living with a partner. Prevalence was also higher among those who were uninsured, insured by Medicaid, or had some other public insurance than among those with private insurance or Medicare only; those who had a disability/limitation than among those who did not; and those who had serious psychological distress than among those who did not. Full implementation of evidence-based tobacco control interventions that address the diversity of tobacco products used by U.S. adults, in coordination with regulation of tobacco product manufacturing, marketing, and sales, can reduce tobacco-related disease and death in the United States.

2NHIS is an annual, nationally representative, in-person survey of the noninstitutionalized U.S. civilian population. The 2017 Sample Adult component included 26,742 adults aged ≥18 years; the response rate was 53.0%. Data were weighted to adjust for differences in selection probability and nonresponse and to provide nationally representative estimates. Five tobacco products were assessed: cigarettes; cigars (cigars, cigarillos, or filtered little cigars); pipes (regular pipes, water pipes, or hookahs)*; e-cigarettes; and smokeless tobacco (chewing tobacco, snuff, dip, snus, or dissolvable tobacco). Current cigarette smokers were those who reported having smoked ≥100 cigarettes during their lifetime and smoked every day or some days at the time of survey. Current users of all other tobacco products were those who reported their use every day or some days at the time of survey. Prevalence estimates for current use of any tobacco product, any combustible tobacco product (cigarettes, cigars, or pipes), and use of ≥2 tobacco products† were calculated. Estimates were calculated overall and separately by sex, age, race/ethnicity, U.S. region,§ education, marital status, annual household income, sexual orientation,¶ health insurance coverage,** disability,†† and presence of serious psychological distress.§§ T-tests were performed to assess overall differences in tobacco use between 2016 and 2017, with statistical significance defined as p<0.05.¶¶

3Among U.S. adults in 2017, 19.3% (estimated 47.4 million) currently used any tobacco product and 16.7% (41.1 million; 86.7% of current tobacco users) used any combustible tobacco product (Table). Cigarettes were the most commonly used tobacco product (14.0%; 34.3 million), with the prevalence of cigarette smoking in 2017 being the lowest measured among U.S. adults since NHIS data collection for this measure began in 1965 (Figure 1). Prevalence estimates of other tobacco products in 2017 were as follows: cigars (3.8%; 9.3 million); e-cigarettes (2.8%; 6.9 million); smokeless tobacco (2.1%; 5.1 million); and pipes (1.0%; 2.6 million). During 2016–2017, declines occurred in current use of any tobacco product; any combustible tobacco product; ≥2 tobacco products; cigarettes; and smokeless tobacco (all p<0.05). Among current tobacco product users, the proportion who were daily users was 75.0% for cigarettes, 58.2% for smokeless tobacco, 40.5% for e-cigarettes, 12.4% for cigars, and 10.6% for pipes.

4Overall, 3.7% of U.S. adults (9.0 million; 19.0% of current tobacco product users) used ≥2 tobacco products. Among multiple tobacco product users, 84.1% used two products, 13.4% used three products, and 2.5% used four or more products. The most prevalent tobacco product combinations were cigarettes and e-cigarettes (30.1%), followed by cigarettes and cigars (29.2%) (Figure 2).

5By univariate analyses, the prevalence of any current tobacco product use was higher among males (24.8%) than among females (14.2%); those aged 25–44 years (22.5%), 45–64 years (21.3%), or 18–24 years (18.3%) than among those aged ≥65 years (11.0%); non-Hispanic American Indian/Alaska Natives (29.8%), multiracial adults (27.4%), whites (21.4%), or blacks (20.1%) than among Hispanics (12.7%) or non-Hispanic Asians (8.9%); those who lived in the Midwest (23.5%) or the South (20.8%) than among those who lived in the West (15.9%) or Northeast (15.6%); those who had a GED (42.6%) than among those with other levels of education; those who were divorced/separated/widowed (23.1%) or single/never married/not living with a partner (21.0%) than among those married/living with a partner (17.6%); those who had annual household income of <$35,000 (26.0%) than among those with higher income; and lesbian, gay, or bisexual adults (27.3%) than among heterosexual/straight adults (19.0%). Prevalence was also higher among those who were uninsured (31.0%), insured by Medicaid (28.2%) or had some other public insurance (26.8%) than among those with private insurance (16.2%) or Medicare only (11.0%); those who had a disability/limitation (25.0%) than among those who did not (18.8%); and those who had serious psychological distress (40.8%) than among those who did not (18.5%).

6Considerable progress has been made in reducing cigarette smoking among U.S. adults over the past half century: an estimated 14.0% of U.S. adults (34.3 million) were current cigarette smokers in 2017, representing a 67% decline since 1965. However, in 2017, nearly nine in 10 (41.1 million) adult tobacco product users reported using a combustible tobacco product, with cigarettes being the product most commonly used. The burden of death and disease from tobacco use in the United States is caused overwhelmingly by cigarettes and other combustible products, and an estimated 480,000 U.S. adults die from cigarette smoking and secondhand smoke exposure each year. Therefore, continued efforts to reduce all forms of combustible tobacco smoking, including cigarettes, among U.S. adults are especially important.

7U.S. adults also report using various noncigarette tobacco products. In 2017, approximately one in five adults (47.4 million) currently used any tobacco product, and 19.0% of these adults reported multiple tobacco product use. Multiple tobacco product users are at increased risk for nicotine addiction and dependence. E-cigarettes were commonly used among multiple tobacco product users. Primary reasons for e-cigarette use among adults include curiosity, flavoring, cost, consideration of others, convenience, and simulation of cigarettes, as well as to attempt to quit smoking. However, although e-cigarettes could benefit adult smokers if used as a complete substitute for combustible tobacco smoking, evidence of the effectiveness of e-cigarettes as a cessation aid is inconclusive.

8Demographic variations in tobacco product use were observed. For example, young adults reported the highest use of emerging products such as e-cigarettes and pipes; the higher prevalence of overall pipe use among young adults is likely primarily driven by water pipe or hookah use. Differences in tobacco product use across population groups might be related to multiple factors, including targeted advertising, differing perceptions regarding the relative harm or social acceptability of tobacco use, and differences in tobacco product prices and levels of access to cessation resources.

9The findings in this report are subject to at least four limitations. First, the potential for recall bias exists because responses were self-reported and not biochemically validated. However, self-reported smoking status correlates highly with serum cotinine levels. Second, the questionnaire did not assess gender identity; including transgender persons could affect overall tobacco use estimates among the sexual and gender minorities considered in this report. Third, NHIS estimates are not generalizable to persons in the military or institutionalized populations. Finally, the NHIS Sample Adult component’s response rate of 53.0% might have resulted in nonresponse bias.

10Full implementation of comprehensive tobacco control programs at the national, state, and local levels, including tobacco price increases, high-impact anti-tobacco mass media campaigns, comprehensive smoke-free laws,*** and barrier-free access to tobacco cessation counseling and approved medications, along with FDA regulation of tobacco products, can accelerate progress toward reducing tobacco-related death and disease in the United States. Given the increasing diversity of available tobacco products, coordinated efforts are key to implementing proven strategies while also exploring promising new strategies. For example, CDC supports the National Tobacco Control Program, and the Tips From Former Smokers campaign, which led to approximately half a million sustained quits among U.S. adult smokers during 2012–2015. FDA launched the Every Try Counts campaign in 2018, which targets adults aged 25–54 years who have attempted to quit smoking in the last year but were unsuccessful. The campaign also complements FDA’s recently announced plan to explore reducing nicotine content in cigarettes to minimally or nonaddictive levels. The National Cancer Institute supports research to improve tobacco dependence treatment and provides resources to help smokers quit, including Smokefree.gov; the toll-free national quitline network (1-800-QUIT-NOW); and LiveHelp online. These coordinated strategies, in combination with state and local level tobacco prevention and control strategies that address the diversity of tobacco products, can reduce tobacco related disease and death in the United States.

11Although cigarette smoking among U.S. adults has declined considerably, tobacco products have evolved in recent years to include various combustible, non-combustible, and electronic products.

12In 2017, an estimated 47.4 million U.S. adults (19.3%) currently used any tobacco product. Among current tobacco product users, 86.7% (41.1 million) smoked combustible tobacco products, and 19.0% (9.0 million) used two or more tobacco products.

13Implementation of evidence-based tobacco control interventions that address the diversity of tobacco products used by U.S. adults, in coordination with regulation of tobacco product manufacturing, marketing, and sales, can reduce tobacco-related disease and death in the United States.