Patterns of tobacco use
- Nancy A Rigotti, MD
Nancy A Rigotti, MD
- Professor of Medicine
- Harvard Medical School
Cigarette smoking is the leading preventable cause of mortality, responsible for nearly six million deaths worldwide and 480,000 deaths in the United States annually [1,2]. If present trends continue, this toll is projected to rise to over eight million deaths per year by 2030, with 80 percent of those deaths occurring in the developing world where tobacco use is increasing . Up to one-half of all tobacco users can be expected to die from a tobacco-related disease. The economic burden of tobacco use in the United States is estimated to be $289 to 332.5 billion per year, which includes $132.5 to 175.9 billion in health care costs and an additional $151 billion in productivity losses .
The most important causes of smoking-related mortality are atherosclerotic cardiovascular disease (CVD), lung cancer, and chronic obstructive pulmonary disease (COPD) [3,4]. Tobacco use also increases the risk of many other acute and chronic diseases, including cancers at many sites other than the lung. An estimated 30 percent of cancers in the United States are tobacco-related . Smoking cessation is associated with clear health benefits and should always be a major health care goal . Screening all patients for tobacco use and providing all smokers a brief smoking cessation intervention is one of the three most cost-saving clinical preventive services .
The prevalence and patterns of tobacco use in the United States are reviewed here. An overview of smoking cessation management, including behavioral and pharmacologic methods to help patients stop smoking, is reviewed separately. (See "Overview of smoking cessation management in adults", section on 'Difficulty quitting'.)
UNITED STATES PREVALENCE AND TOBACCO USE PATTERNS
Prevalence — The prevalence of smoking cigarettes among United States adults declined from 42.4 percent in 1965 to 20.9 percent in 2005 to 16.8 percent in 2014 [8,9]. Not all smokers are daily smokers; 77 percent of smokers smoke every day, while 23 percent smoke less frequently than daily . In 2012, an estimated 21.3 percent of United States adults used any tobacco product every day or some days . The prevalence of emerging products such as electronic cigarettes is also increasing .
A large gender gap in cigarette smoking existed in the 1960s, when over 50 percent of men and only about 25 percent of women smoked . This gap has narrowed but not disappeared. In 2014, 18.8 percent of men and 14.8 percent of women smoked cigarettes .
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