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Patterns of tobacco use

Nancy A Rigotti, MD
Section Editor
James K Stoller, MD, MS
Deputy Editor
H Nancy Sokol, MD


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 [1]. 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 [2].

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 [5]. Smoking cessation is associated with clear health benefits and should always be a major health care goal [6]. 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 [7].

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'.)


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 [9]. In 2012, an estimated 21.3 percent of United States adults used any tobacco product every day or some days [10]. The prevalence of emerging products such as electronic cigarettes is also increasing [10].

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 [11]. This gap has narrowed but not disappeared. In 2014, 18.8 percent of men and 14.8 percent of women smoked cigarettes [9].


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  1. World Health Organization Report on the Global Tobacco Epidemic, 2011: Warning about the dangers of tobacco. World Health Organization, Geneva 2011. http://whqlibdoc.who.int/publications/2011/9789240687813_eng.pdf (Accessed on September 27, 2011).
  2. Warren GW, Alberg AJ, Kraft AS, Cummings KM. The 2014 Surgeon General's report: "The health consequences of smoking--50 years of progress": a paradigm shift in cancer care. Cancer 2014; 120:1914.
  3. Centers for Disease Control and Prevention (CDC). Smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 2000-2004. MMWR Morb Mortal Wkly Rep 2008; 57:1226.
  4. Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults and trends in smoking cessation - United States, 2008. MMWR Morb Mortal Wkly Rep 2009; 58:1227.
  5. US Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Center for Disease Control, Washington 2004. CDC Publication No. 7829. Available at: www.cdc.gov/tobacco/sgr/sgr_2004/index.htm (Accessed on March 07, 2005).
  6. Health benefits of smoking cessation. A report of the Surgeon General. DHHS Publication No. (CDC) 90-8416, Department of Health and Human Services, Washington, DC 1990.
  7. Maciosek MV, Coffield AB, Edwards NM, et al. Priorities among effective clinical preventive services: results of a systematic review and analysis. Am J Prev Med 2006; 31:52.
  8. Centers for Disease Control and Prevention (CDC). Quitting smoking among adults--United States, 2001-2010. MMWR Morb Mortal Wkly Rep 2011; 60:1513.
  9. Jamal A, Homa DM, O'Connor E, et al. Current cigarette smoking among adults - United States, 2005-2014. MMWR Morb Mortal Wkly Rep 2015; 64:1233.
  10. Agaku IT, King BA, Husten CG, et al. Tobacco product use among adults--United States, 2012-2013. MMWR Morb Mortal Wkly Rep 2014; 63:542.
  11. Centers for Disease Control and Prevention (CDC). Vital signs: current cigarette smoking among adults aged ≥18 years--United States, 2005-2010. MMWR Morb Mortal Wkly Rep 2011; 60:1207.
  12. Turner L, Mermelstein R, Flay B. Individual and contextual influences on adolescent smoking. Ann N Y Acad Sci 2004; 1021:175.
  13. Centers for Disease Control and Prevention (CDC). Cigarette use among high school students--United States, 1991-2007. MMWR Morb Mortal Wkly Rep 2008; 57:686.
  14. DiFranza JR, Savageau JA, Fletcher K, et al. Symptoms of tobacco dependence after brief intermittent use: the Development and Assessment of Nicotine Dependence in Youth-2 study. Arch Pediatr Adolesc Med 2007; 161:704.
  15. Jarvis MJ. Why people smoke. BMJ 2004; 328:277.
  16. Carmelli D, Swan GE, Robinette D, Fabsitz R. Genetic influence on smoking--a study of male twins. N Engl J Med 1992; 327:829.
  17. Swan GE. Implications of genetic epidemiology for the prevention of tobacco use. Nicotine Tob Res 1999; 1 Suppl 1:S49.
  18. Primack BA, Sidani J, Agarwal AA, et al. Prevalence of and associations with waterpipe tobacco smoking among U.S. university students. Ann Behav Med 2008; 36:81.
  19. Akl EA, Gaddam S, Gunukula SK, et al. The effects of waterpipe tobacco smoking on health outcomes: a systematic review. Int J Epidemiol 2010; 39:834.
  20. Raad D, Gaddam S, Schunemann HJ, et al. Effects of water-pipe smoking on lung function: a systematic review and meta-analysis. Chest 2011; 139:764.
  21. Mazurek JM, Syamlal G, King BA, et al. Smokeless tobacco use among working adults - United States, 2005 and 2010. MMWR Morb Mortal Wkly Rep 2014; 63:477.
  22. Scientific Committee on Emerging and Newly Identified Health Risks. Health effects of smokeless tobacco products. Available at: ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_013.pdf (Accessed on October 17, 2011).