10.6: Tobacco Use
Probably one of the most recognizable public health movements has been the fight against the use of tobacco products. Since the first Surgeon General’s report on the harmful effects of smoking in 1964, the public perception and acceptance of smoking has strongly soured. The rate of current cigarette smokers in the U.S. in 2021 was estimated to be 11.5% (28.3 million Americans), demonstrating this downward trend over time: from an estimated 42% of Americans who smoked in 1965, and even 25.3% in 1990 (CDCTobaccoFree, 2023b, National Center for Health Statistics, 2021). For teens, there has been a significant decline in cigarette smoking since the 1990s - in 1997, 24.6% of high school seniors reported smoking daily (Pampel & Aguilar, 2007), whereas in 2023 current use was at about 6.6% for middle schoolers and 12.6% for high schoolers. Among those kids who currently smoke though, e-cigarettes are the most common product used. Smoking during the teen years is particularly concerning due to the addictive nature of nicotine. Nearly 90% of adult smokers began smoking before age 18 (CDCTobaccoFree, 2023c).
Who are these holdout smokers? Men tend to smoke more than women, while smoking rates are lowest for Asian and Hispanic groups compared to non-Hispanic White and non-Hispanic Black populations. Perhaps most telling is the correlation of tobacco use and education or income levels. The highest smoking rates are found for folks with a GED (30.7%) or no high school diploma (20.1%), and progressively decline with higher educational attainment - only 3.2% of those with a graduate degree smoke. Similarly, smoking rates decline along lines of income, with highest rates for low income (18.3%) versus middle income (12.3%) and high income (6.7%) (CDCTobaccoFree, 2023b). Perhaps there are factors associated with socioeconomic status and education level which influence a person’s likelihood of smoking, and the ease with which they can quit. Stress, social norms, and access to smoking cessation support are all influenced by these other social determinants.
The burden of tobacco products on society cannot be overstated. Smoking is the top leading preventable cause of death, and is considered responsible for over 480,000 deaths each year. Smoking increases the risk of cardiovascular disease, stroke, diabetes, cancers (particularly lung cancer - but also others), asthma, chronic obstructive pulmonary disease (COPD), and more. In 2018 it is estimated that smoking cost the U.S. over $600 billion, including both healthcare costs and lost productivity (CDCTobaccoFree, 2023b). Yet, the tobacco industry still spends billions of dollars to advertise their products. Targeted marketing is often aimed at women and specific racial/ethnic communities. And in spite of decades of restrictive legislation on this advertising to protect children, these advertisements still have an effect on youth perceptions of smoking (CDCTobaccoFree, 2023a).