In 2021, 11.5 percent of U.S. adults smoked cigarettes — the lowest rate recorded since 1965, and below the 12 percent goal Healthy People 2020 had set for the end of the decade. But nearly one adult in five still used some tobacco product, and e-cigarette use went the other way, rising from 3.7 percent to 4.5 percent in a year, largely because more adults aged 18 to 24 used them.
The numbers
CDC, the Food and Drug Administration and the National Cancer Institute analyzed the 2021 National Health Interview Survey, which reached 29,482 adults. "Tobacco" here means commercial tobacco, not the tobacco some American Indian communities use for medicinal and spiritual purposes.
| Current use, adults 18 and older, 2021 | Share | Adults |
|---|---|---|
| Any tobacco product | 18.7% | 46.0 million |
| Any combustible product (cigarettes, cigars, pipes) | 14.5% | 35.6 million |
| Two or more products | 3.4% | 8.3 million |
| Cigarettes | 11.5% | |
| E-cigarettes | 4.5% | |
| Cigars, cigarillos, filtered little cigars | 3.5% | |
| Smokeless tobacco | 2.1% | |
| Pipes, including hookah | 0.9% |
Of the people who used tobacco, 77.5 percent used a combustible product and 18.1 percent used two or more products. Among all adults who had ever smoked cigarettes, 66.5 percent had quit.
Young adults are the exception to the pattern: among 18- to 24-year-olds, 11.0 percent used e-cigarettes and 5.3 percent smoked cigarettes.
Using more than one product
The most common combinations among adults using two or more tobacco products, 2021. Credit: CDC, Morbidity and Mortality Weekly Report.
Among adults using two or more products, the most common combinations were cigarettes and e-cigarettes (31.4%), cigarettes and cigars (21.0%), cigarettes and smokeless tobacco (7.9%), e-cigarettes and cigars (7.0%), and cigarettes and pipes (3.7%). Another 29.0 percent used some other combination, including 14.0 percent who used three or more products.
Who uses tobacco most
| Group | Higher | Lower |
|---|---|---|
| Sex | men 24.1% | women 13.6% |
| Age | 25–44: 22.1%; 45–64: 21.1%; 18–24: 17.0% | 65 and older: 11.0% |
| Race and ethnicity | other races, non-Hispanic: 25.6%; White: 21.2% | Black: 18.1%; Hispanic: 12.4%; Asian: 8.6% |
| Region | Midwest 22.1%; South 19.7% | Northeast 16.2%; West 16.0% |
| Place | rural 26.2% | urban 17.5% |
| Education | GED certificate 39.0% | other levels 8.6%–24.4% |
| Marital status | divorced, separated or widowed 21.3%; single 20.1% | married or living with a partner 17.5% |
| Income | low 24.7% | middle 18.9%; high 14.8% |
| Sexual orientation | lesbian, gay or bisexual 27.4% | heterosexual 18.4% |
| Health insurance | uninsured 28.4%; Medicaid 28.1% | other public 21.6%; private 16.2%; Medicare only 10.7% |
| Disability | with 24.2% | without 18.2% |
| Serious psychological distress | with 37.6% | without 18.0% |
Estimates for American Indian and Alaska Native adults were not statistically reliable for 2021 and are not shown.
Smoking and depression
Cigarette smoking by race and ethnicity and history of diagnosed depression, 2019–2021. Credit: CDC, Morbidity and Mortality Weekly Report.
| Cigarette smoking | 2019 | 2020 | 2021 |
|---|---|---|---|
| Adults ever told they had depression | 22.9% | 20.5% | 19.4% |
| Adults never told they had depression | 12.3% | 10.9% | 9.9% |
Smoking fell in both groups — an important success — but stayed higher among people with diagnosed depression, and racial and ethnic differences were sharper among them. Those differences may reflect lived experience, including discrimination and heavy tobacco advertising in low-income neighborhoods and in areas with many Black or American Indian and Alaska Native residents, as well as unequal access to mental health care and help quitting.
What works
Smoke-free laws, media campaigns such as Tips From Former Smokers, and higher prices at the national, state and local levels likely helped bring smoking down. The authors call for more of the same — raising prices, enforcing comprehensive smoke-free policies, and running educational campaigns suited to each language and culture — together with FDA regulation of tobacco products, new approaches, and continued tracking of which products, and which combinations, people use.
Limits
- The survey covers only civilians living in households, not people in institutions or the military.
- Answers were self-reported, though self-reported smoking correlates with blood levels of cotinine.
- Because of the pandemic, the survey moved mostly to the telephone: 62.8 percent of 2021 interviews were at least partly by phone, against 34.3 percent in 2019, which may affect the 2020 and 2021 figures.
- The data are a snapshot and cannot show how individuals' use changed.
Sources
Based on "Tobacco Product Use Among Adults — United States, 2021," by Monica E. Cornelius and colleagues (CDC Office on Smoking and Health; FDA Center for Tobacco Products; National Cancer Institute), Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
许可协议： CC0 1.0（公有领域） · 改编自 www.cdc.gov
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