Smoking

Smoking in United States

United States

Smoking cigarettes harms health. As the leading cause of preventable death and disease in the United States, cigarette smoking is responsible for more than 480,000 deaths yearly. Smokers live 10 years less than non-smokers, on average. Currently, more than 16 million Americans live with a disease caused by smoking. 

Smoking damages nearly every organ and is associated with multiple types of cancer, heart disease, stroke, respiratory diseases such as chronic obstructive pulmonary disease and diabetes. Smoking can affect non-smokers as well. Exposure to secondhand smoke is responsible for 41,000 deaths among U.S. adults every year. The annual cost of smoking to the U.S. is around $132.5-$175.9 billion in medical expenses and $151 billion in lost productivity due to premature death. 

In recent years, there has been an increase in the popularity of e-cigarettes, especially among youth. E-cigarettes often contain nicotine and other cancer-causing chemicals and have been linked to lung injuries, hospitalizations and death. In October 2021, the U.S. Food and Drug Administration (FDA) authorized the marketing of certain electronic nicotine delivery system devices as a tool to help addicted adults smoke fewer cigarettes.

The prevalence of smoking in adults is higher among: 

• Men compared with women.
• Adults ages 45-64 compared with adults ages 65 and older and ages 18-44.
• American Indian/Alaska Native adults, who have a prevalence nearly 5 times higher than Asian adults.
• Adults with less than a high school education, who have a prevalence nearly 5 times higher than college graduates; the prevalence was significantly lower with each increase in education level.
• Adults with an income less than $25,000, who have a prevalence 3 times higher than those with an income of $75,000 or more; the prevalence was significantly lower with each increase in income level.
• Adults living in non-metropolitan areas compared with those living in metropolitan areas.

Additional populations with high prevalences of smoking include:

• Adults with a disability or self-reported limitation.
• Adults who report serious psychological distress, such as feelings of sadness, nervousness and worthlessness.
• Lesbian, gay and bisexual adults.
• Adults living in states with a high prevalence of e-cigarette use.

Quitting smoking can have profound benefits on current and long-term health at any age, even among heavy and lifelong smokers. A variety of interventions are effective for smoking prevention and cessation.

Over several decades, excise taxes and smoking bans have effectively prevented non-smokers from starting, increasing cessation and decreasing smoking-related health problems. Raising the legal tobacco purchase age is one way to decrease the number of teens who become smokers. In December 2019, the Federal Food, Drug and Cosmetic Act was changed to raise the legal tobacco age from 18 to 21. 

County Health Rankings & Roadmaps provides a list of evidence-based strategies to address health issues. Smokefree.gov provides free, accurate and evidence-based information as well as professional assistance to support the immediate and long-term needs of smokers trying to quit.

Healthy People 2030 has multiple goals regarding tobacco use, including reducing current use of cigarettes among adults to 5% and increasing successful quit attempts in adults who smoke to 10.2%.

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Hu, S. Sean, David M. Homa, Teresa Wang, Yessica Gomez, Kimp Walton, Hua Lu, and Linda Neff. “State-Specific Patterns of Cigarette Smoking, Smokeless Tobacco Use, and E-Cigarette Use Among Adults — United States, 2016.” Preventing Chronic Disease 16 (February 7, 2019): 180362. https://doi.org/10.5888/pcd16.180362.

Patnode, Carrie D., Jillian T. Henderson, Jamie H. Thompson, Caitlyn A. Senger, Stephen P. Fortmann, and Evelyn P. Whitlock. “Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force.” Annals of Internal Medicine 163, no. 8 (October 20, 2015): 608. https://doi.org/10.7326/M15-0171.

U.S. Department of Health and Human Services. “The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General.” Atlanta, GA: 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. https://pubmed.ncbi.nlm.nih.gov/24455788/.

Zulfiqar, Hassam, and Omar Rahman. “Vaping Associated Pulmonary Injury.” In StatPearls. Treasure Island (FL): StatPearls Publishing, 2022. http://www.ncbi.nlm.nih.gov/books/NBK560656/.