Tobacco Product Use Among Adults — United States, 2020

Abstract

Although cigarette smoking has declined over the past several decades, a diverse landscape of combustible and noncombustible tobacco products has emerged in the United States (1-4). To assess recent national estimates of commercial tobacco product use among U.S. adults aged 18 years, CDC analyzed data from the 2020 National Health Interview Survey (NHIS). In 2020, an estimated 47.1 million U.S. adults (19.0%) reported currently using any commercial tobacco product, including cigarettes (12.5%), e-cigarettes (3.7%), cigars (3.5%), smokeless tobacco (2.3%), and pipes* (1.1%). From 2019 to 2020, the prevalence of overall tobacco product use, combustible tobacco product use, cigarettes, e-cigarettes, and use of two or more tobacco products decreased. Among those who reported current tobacco product use, 79.6% reported using combustible products (e.g., cigarettes, cigars, or pipes), and 17.3% reported using two or more tobacco products. The prevalence of any current commercial tobacco product use was higher among the following groups: 1) men; 2) adults aged <65 years; 3) non-Hispanic American Indian or Alaska Native (AI/AN) adults and non-Hispanic adults categorized as of "Other" race ; 4) adults in rural (nonmetropolitan) areas; * The use of regular pipe, water pipe, or hookahs was assessed together using a single question. Interviewers could read the following sentences if necessary: "A hookah is a type of water pipe. It is sometimes called a 'narghile' (NAR-ge-lee) pipe. Do not include electronic hookahs or e-hookahs"; "Do not include electronic pipes or e-pipes"; "Do not include pipes filled with substances other than tobacco." Categories are not mutually exclusive. Current use of two or more tobacco products was defined as use either every day or some days of at least two or more of the following tobacco products: cigarettes (100 or more cigarettes during lifetime); cigars, cigarillos, or filtered little cigars; pipes, water pipes, or hookahs; e-cigarettes; or smokeless tobacco products. Hispanic persons could be of any race. All other groups were non-Hispanic. The following four non-Hispanic single-race categories were available for sample adults in the 2020 NHIS public use files: 1) White; 2) Black or African American; 3) Asian; and 4) AI/AN. Exclusive from these groups, the "non-Hispanic, Other" category includes those adults who were categorized as "non-Hispanic AI/AN and any other group" or "other single and multiple races." 5) those whose highest level of educational attainment was a general educational development certificate (GED); 6) those with an annual household income <$35,000; 7) lesbian, gay, or bisexual adults; 8) uninsured adults or those with Medicaid; 9) adults living with a disability; and 10) those who regularly had feelings of anxiety or depression. Continued monitoring of tobacco product use and tailored strategies and policies that reduce the effects of inequitable conditions could aid in reducing disparities in tobacco use (1,4).