5.6a Tobacco and Nicotine Use

Overall, about one in five U.S. adults (18.7%) use any tobacco product, including cigarettes, e-cigarettes, cigars, smokeless tobacco, and pipes (Cornelius et al., 2023). Cigarettes and e-cigarettes are the most common means of consuming tobacco. Smoking of tobacco cigarettes has declined significantly from its 1964 peak, “when an estimated 42% of U.S. adults were current smokers” (Centers for Disease Control and Prevention, 1994). Cigarette smoking declined by half, from 20.9% in 2005 to 11.6% in 2022 (Centers for Disease Control and Prevention, 2018; 2024c).

Photo 5.16

E-cigarette Use is Growing in Use, While Tobacco-Use Overall has Declined

As the known health risks of secondhand smoke to nonsmokers became too big to ignore, the rules, laws, and norms for acceptable behavior of smokers changed, leading many people to quit smoking and fewer people to start in the first place. Formal rules changed. For example, college campuses, hospitals, and other organizations banned smoking on their property. Many workplaces began charging higher health insurance premiums to employees who smoke.

Laws changed to ban indoor smoking in public places. Restaurants got rid of their smoking sections and businesses moved outdoor ashtrays several feet from their entrances. Laws also increased cigarette taxes, and in 2019, the United States increased the minimum age to buy tobacco from 18 to 21.

Informal norms as social approval for cigarette smoking declined. Still, new forms of tobacco use increased, like e-cigarettes and vaping. Most tobacco used by high school students is from e-cigarettes. However, users make up only 7.8% of high school students who have recently used electronic cigarettes, and the number using e-cigarettes has been declining in 2019 (Park-Lee et al., 2024; Birdsey et al., 2023). In contrast with the United States, 33 countries have banned the sale of e-cigarettes (Johnson, 2024).