If cigarette smoking keeps declining at the rate it has for the last decade, it could end altogether in the 2050s. For now, the Centers for Disease Control and Prevention (CDC) is aiming to reduce the prevalence to 12 percent of U.S. adults by 2020, and new data suggests they are making progress toward that goal.
According to the CDC’s latest Morbidity and Mortality Weekly Report (MMWR), cigarette smoking has declined from 20.9 percent of U.S. adults in 2005 to 16.8 percent in 2014. The drop was particularly dramatic from 2013 to 2014, when the prevalence fell by a full percent. The data for the report comes from the 2014 National Health Interview Survey (NHIS), which collected data from a nationally representative sample of over 35,000 U.S. adults.
Not only are fewer Americans smoking, many Americans are smoking less, as proved by a marked decline in the prevalence of people who smoke 20 to 29 cigarettes per day, and a near halving—from 12.7 percent to 6.9 percent—of those who smoke 30 or more per day. Daily smokers also lit up nearly three fewer cigarettes per day in 2014 than they did in 2005 (a drop from approximately 17 daily cigarettes to about 14).
But as of 2014, 40 million U.S. adults are still cigarette smokers, defined as people who have smoked 100 or more cigarettes in their lifetime and currently smoke “every day or some days.” It continues to be one of America’s costliest habits.
The new MMWR notes that tobacco smoking is still “the leading cause of preventable disease and death in the United States, resulting in approximately 480,000 premature deaths and more than $300 billion in direct health care expenditures and productivity losses each year.” For comparison, the CDC’s estimated cost of excessive alcohol consumption was $223.5 billion in 2006.
Alarming, too, is the fact that smoking is still proving to be more prevalent among certain populations of adults, many of whom already face significant social disadvantages. Adults who have less education, live below the poverty line, reside in the Midwest, have no insurance or rely on Medicaid, who are disabled, or who belong to a sexual minority (lesbian, gay, or bisexual), all reported a higher prevalence of cigarette smoking than the other groups in the annual survey.
The disparities, in many cases, are dramatic.
The poverty line amounts to a 10 percent difference in smoking prevalence, with over 26 percent of people living below it reporting that they are cigarette smokers, as opposed to over 15 percent of those at or above it. Education continues to be correlated with smoking prevalence, with 43 percent of GED recipients ages 25 and over smoking as opposed to less than 6 percent of those with a graduate degree.
At nearly 22 percent, people reporting a disability or another limitation fell 5 percent above the new national smoking average. And lesbian, gay, and bisexual adults out-smoked straight adults by over 7 percent (23.9 percent to 16.6 percent)—a statistic that the NHIS did not begin tracking until 2013.
Certain racial and ethnic groups, like Native Americans and multiracial adults, still have a particularly high smoking prevalence (close to 30 percent for both groups). Others, like Asians and Hispanics, have experienced rapid declines in smoking over the last decade and continue to smoke much less than whites and African Americans, whose rates of smoking tend to be close to one another. Regional differences are substantial, but slightly less stark, with Americans in the South and Midwest smoking more than their Western and Northeastern peers.
Uninsured and Medicaid-reliant adults had a prevalence of approximately 29 and 28 percent respectively, as compared to 13 percent for those with private health insurance. In the report, the CDC observes that uninsured and Medicaid-reliant adults might have less access to tobacco cessation coverage, which could account for some of this disparity.
Although none of these disparities are new, many of them are stubbornly persistent.
From 2005 to 2014, the rates of decline for several of these groups were lower than the country’s overall rate of decline of nearly 20 percent. For example, smoking among GED recipients only declined a mere half of 1 percent over that period but it fell by 26 percent among adults with undergraduate degrees. The prevalence of smoking also dropped 26 percent among people above the poverty line, but only by about 12 percent for those below it.
In other words, almost everyone in the country is smoking less than they were a decade ago, but poor people, and people with less education and/or insurance coverage, are bringing up the rear.
In some cases, stress and discrimination could help explain why smoking prevalence remains so high. This year, the CDC notes that “possible higher stress associated with disabilities” may help explain a high prevalence. And last year, the CDC noted that a higher prevalence of smoking among LGB adults could be partially attributed to “greater stress due to social stigma and discrimination, and targeted marketing toward this population by the tobacco industry.”
On its website, the CDC warns LGBT people, “If you are part of the LGBT communities, you likely have seen tobacco ads in magazines, newspapers, and websites directed at you. Tobacco companies are targeting your communities.”