Tobacco

Tobacco use is the single most preventable cause of disease, disability, and death in the United States, yet more deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.1, 2

In 2009, an estimated 20.6% of all American adults age 18 and older—46.6 million people—smoked,3 and every day another 850 young people age 12 to 17 began smoking on a daily basis.4 As a result of widespread tobacco use, approximately 443,000 Americans die from tobacco-related illnesses, such as cancer and heart disease, each year. An estimated 49,000 of these deaths are the result of secondhand smoke exposure.1 For every person who dies from tobacco use, another 20 suffer from at least one serious tobacco-related illness.5

Tobacco use poses a heavy burden on the U.S. economy and medical care system. Each year, cigarette smoking costs more than $193 billion in medical care costs, while secondhand smoke costs an additional $10 million.1, 6 Tobacco use is thus one of the Nation’s deadliest and most costly public health challenges.

The Tobacco Use Leading Health Indicators are:

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• Adults who are current cigarette smokers (TU-1.1)
• Adolescents who smoked cigarettes in the past 30 days (TU-2.2)

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Health Impact of Tobacco Use

Tobacco use in any form—even occasional smoking—causes serious diseases and health problems, including:

• Several forms of cancer, including cancers of the lung, bladder, kidney, pancreas, mouth, and throat
• Heart disease and stroke
• Lung diseases, including emphysema, bronchitis, and chronic obstructive pulmonary disease (COPD)
• Pregnancy complications, including preterm birth, low birth weight, and birth defects
• Gum disease
• Vision problems

Secondhand smoke from cigarettes and cigars also causes heart disease and lung cancer in adults and a number of health problems in infants and children, including:

• Asthma
• Respiratory infections
• Ear infections
• Sudden infant death syndrome (SIDS)

Smokeless tobacco causes a number of serious oral health problems, including cancer of the mouth and gums, periodontal disease, and tooth loss.

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Tobacco Use Across the Life Stages

Preventing tobacco use and helping people who use tobacco quit can improve the health and quality of life for Americans of all ages. People who stop smoking greatly reduce their risk of disease and premature death. Benefits are greater for people who stop at earlier ages, but quitting tobacco use is beneficial at any age.

Children

• Secondhand smoke can trigger an asthma attack in a child who previously had not exhibited symptoms of asthma. Children with asthma who are around secondhand smoke have more severe and frequent asthma attacks.7
• Infants and children younger than 6 who are regularly exposed to secondhand smoke are at increased risk of lower respiratory tract infections, such as pneumonia and bronchitis.7
• Children who regularly breathe secondhand smoke are at increased risk for middle ear infections.7
• Infants who are exposed to secondhand smoke after birth are at greater risk of sudden infant death syndrome (SIDS).7

Adolescents

• Each day in the United States, approximately 3,450 young people age 12 to 17 smoke their first cigarette.4
• Adolescents who use smokeless tobacco are more likely than those who do not use smokeless tobacco to smoke cigarettes as adults.8, 9, 10 Smoking during adolescence is associated with other health risks, including high-risk sexual behavior and alcohol and substance use.8, 11

Adults

• The risk of developing lung cancer is approximately 23 times higher among men who smoke and 13 times higher among women who smoke compared with people who have never smoked. Smoking causes an estimated 90% of all lung cancer deaths in men and 80% of all lung cancer deaths in women.12
• Men and women who smoke are 2 to 4 times more likely to develop coronary heart disease than people who do not smoke.12
• People who are exposed to secondhand smoke increase their heart disease risk by 25% to 30% and their lung cancer risk by 20% to 30%.7
• Smoking during pregnancy causes health problems for both women and infants, including pregnancy complications, premature birth, low birth weight, stillbirth, and sudden infant death syndrome (SIDS). Approximately 1 in 8 women in the United States smoke during pregnancy.
• People who smoke die approximately 13 to 14 years earlier than people who do not smoke.13

Determinants of Tobacco Use

A broad range of social, environmental, psychological, and genetic factors have been associated with tobacco use, including gender, race and ethnicity, age, income level, educational attainment, and geographic location. Motivation to begin and to continue smoking is strongly influenced by the social environment, although genetic factors are also known to play a role. Smoke-free protections, tobacco prices and taxes, and the implementation of effective tobacco prevention programs all influence tobacco use.

Among adolescents and young adults, in particular, tobacco use is influenced by:

• The use of tobacco and approval of tobacco use by peers or siblings
• Smoking by parents or guardians
• Accessibility of tobacco products
• Exposure to tobacco use promotional campaigns
• Low self-image or self-esteem

Understanding and addressing these factors is key to reducing the number of Americans who use tobacco or are exposed to secondhand smoke.

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Disparities in Tobacco Use

Disparities in tobacco use persist. For example in 2008:

• The rate of current smoking among adults varied among race and ethnicity groups. The lowest rates were seen among people who identified as Asian (9.7%, age adjusted) and as Hispanic or Latino (14.9%, age adjusted). The age adjusted prevalence observed for other race and ethnicity groups were as follows:
• Non-Hispanic black: 20.7%
• Non-Hispanic white: 22.6%
• Native Hawaiian or Other Pacific Islander: 22.6%
• American Indian or Alaska Native: 23.7%
• More men were current smokers than women (22.8% and 18.5%, age adjusted, respectively).
• Among adults age 25 and over, prevalence of current smoking was lower among groups with higher education, with the lowest rates seen among those who have completed an advanced degree beyond college (5.5%, age adjusted).
• Prevalence of current smoking was lower among groups with higher family income levels. Prevalence of current smoking for adults in families living below the poverty threshold (<100%) was more than 2½ times the prevalence for adults in families living at 600% or more above the poverty limit (31.9% versus 11.8%, age adjusted, respectively).

In 2009:

• For students in grades 9 to 12, the prevalence of smoking cigarettes in the past 30 days varied among race and ethnicity groups. The lowest rates were seen for those who identified as Asian (9.1%) and non-Hispanic black (9.5%). The rates observed for other race and ethnicity groups were as follows:
• Hispanic or Latino: 18.0%
• Native Hawaiian or Other Pacific Islander: 20.8%
• Non-Hispanic white: 22.5%
• American Indian or Alaska Native: 25.8%
• Students who were obese had a higher prevalence of smoking cigarettes in the past 30 days than students who were not obese (22.1% and 18.8%, respectively).

About the Disparities Data

All disparities described are statistically significant at the 0.05 level of significance.

Notes for Cigarette Smoking among Adults (TU-1.1):

• Data are available annually and come from the National Health Interview Survey, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics.
• People are considered as current smokers if they report that they smoked at least 100 cigarettes in their lifetime and now report smoking cigarettes every day or some days.
• See the Health Indicators Warehouse for all age adjustment information for this indicator.

Notes for Cigarette Smoking among Adolescents (TU-2.2):

• Data are available biennially and come from the Youth Risk Behavior Surveillance System, CDC, National Center for Chronic Disease Prevention and Health Promotion.
• Students are classified as using cigarettes if they report smoking one or more cigarettes in the 30 days preceding the survey.

References

1Centers for Disease Control and Prevention. Annual smoking—attributable mortality, years of potential life lost, and productivity losses—United States, 2000–2004. MMWR. 2008;57(45):1226–1228. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm

2Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States. JAMA. 2004;291(10):1238–1245.

3Centers for Disease Control and Prevention. Vital signs: current cigarette smoking among adults aged ≥ 18 years—United States, 2009. MMWR. 2010;59(35):1135–1140. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5935a3.htm?s_cid=mm5935a3_w

4Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Results From the 2009 National Survey on Drug Use and Health: National Findings. Rockville, MD: 2010. Available from http://www.oas.samhsa.gov/NSDUH/2k9NSDUH/tabs/Cover.pdf [PDF - 93KB]

5Centers for Disease Control and Prevention. Cigarette smoking—attributable morbidity—United States, 2000. MMWR. 2003;52(35):842–844. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5235a4.htm

6Behan DF, Eriksen MP, Lin Y. Economic Effects of Environmental Tobacco Smoke Report. Schaumburg, IL: Society of Actuaries; 2005. Available from http://www.soa.org/files/pdf/ETSReportFinalDraft(Final%203).pdf [PDF - 546KB]

7Office of the Surgeon General, U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General: Secondhand Smoke: What It Means To You. Washington, DC: 2006. Available from http://www.surgeongeneral.gov/library/reports/secondhandsmoke/index.html

8Office of the Surgeon General, U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Washington, DC: 1994. Available from http://www.cdc.gov/tobacco/data_statistics/sgr/1994/index.htm

9Campaign for Tobacco-Free Kids. The Path to Smoking Addiction Starts at Very Young Ages. Washington, DC: 2009. Available from http://www.tobaccofreekids.org/research/factsheets/pdf/0127.pdf [PDF - 93KB]

10Centers for Disease Control and Prevention. Tobacco use among middle and high school students—United States, 2000–2009. MMWR. 2010;59(33):1063–1068. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5933a2.htm

11Campaign for Tobacco-Free Kids. How Parents Can Protect Their Kids from Becoming Addicted Smokers. Washington, DC: 2009. Available from http://www.tobaccofreekids.org/research/factsheets/pdf/0152.pdf [PDF - 198KB]

12Office of the Surgeon General, U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Washington, DC: 2004. Available from http://www.cdc.gov/tobacco/data_statistics/sgr/2004/index.htm

13Centers for Disease Control and Prevention. Annual smoking—attributable mortality, years of potential life lost, and productivity losses—United States, 1995–1999. MMWR. 2002;51(14):300–303. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5114a2.htm

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