Tobacco Use Among U.S. Adults, 2017

This page summarizes a report in CDC's MMWR by CDC, the Food and Drug Administration (FDA) and the National Cancer Institute, using the 2017 National Health Interview Survey (NHIS).

Cigarette smoking harms nearly every organ of the body, causing heart disease, stroke and many cancers, and cigarette smoking and secondhand smoke kill an estimated 480,000 U.S. adults a year. Smoking has fallen a great deal, but tobacco products have diversified into a range of combustible, noncombustible and electronic products.

The survey

The NHIS is a yearly, nationally representative, in-person survey of the civilian noninstitutionalized population. Its 2017 adult sample included 26,742 people aged 18 and older, with a 53.0% response rate. It asked about five products: cigarettes; cigars, cigarillos and filtered little cigars; pipes, water pipes and hookahs; e-cigarettes; and smokeless tobacco (chewing tobacco, snuff, dip, snus or dissolvable tobacco). A current user used a product every day or some days; for cigarettes, current smokers also had to have smoked at least 100 in their lifetime.

Who used tobacco in 2017

Current cigarette smoking among U.S. adults, 1965–2017. Figure: CDC, National Health Interview Survey.

Cigarette smoking was the lowest measured since NHIS began tracking it in 1965, a 67% decline. From 2016 to 2017, use of any tobacco product, of combustible products, of two or more products, of cigarettes and of smokeless tobacco all declined.

Daily use among current 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.

Multiple products. 3.7% of adults (9.0 million, 19.0% of tobacco users) used two or more products: 84.1% of them two, 13.4% three, and 2.5% four or more. The most common pairings were cigarettes with e-cigarettes (30.1%) and cigarettes with cigars (29.2%).

Differences between groups

Use of any tobacco product was higher among:

Young adults reported the highest use of newer products such as e-cigarettes and pipes, the pipe use likely driven mostly by water pipes or hookahs. Differences between groups may reflect targeted advertising, differing views of tobacco's harm and social acceptability, prices, and access to help quitting.

What it means

• Combustible products are the main problem. Nearly nine in 10 tobacco users smoked a combustible product, and these cause the overwhelming share of tobacco death and disease.
• Multiple-product use raises the risk of nicotine addiction and dependence. E-cigarettes were common among these users. Adults report using e-cigarettes out of curiosity, for flavors, cost, consideration of others, convenience, to mimic cigarettes, and to try to quit. They might help smokers who switch completely, but evidence that they help people quit is inconclusive.
• Proven measures include higher tobacco prices, hard-hitting media campaigns, comprehensive smoke-free laws, barrier-free access to counseling and approved cessation medicines, and FDA regulation of tobacco products. Examples cited: CDC's National Tobacco Control Program and Tips From Former Smokers campaign, credited with about half a million lasting quits in 2012–2015; FDA's 2018 Every Try Counts campaign for adults 25–54 who recently tried to quit, and its plan to explore cutting nicotine in cigarettes to minimally or nonaddictive levels; and the National Cancer Institute's Smokefree.gov, the 1-800-QUIT-NOW quitline network and LiveHelp.

Limitations

• Answers were self-reported and not biochemically checked, though self-reported smoking correlates highly with serum cotinine.
• Gender identity was not asked.
• The results do not apply to military or institutionalized people.
• The 53.0% response rate may have introduced nonresponse bias.

Sources

• Wang TW, Asman K, Gentzke AS, et al. "Tobacco Product Use Among Adults — United States, 2017." MMWR 67(44). https://www.cdc.gov/mmwr/volumes/67/wr/mm6744a2.htm