The number of American adults currently using tobacco products slightly decreased in 2020 compared to 2019, however 19% continue tobacco use, the CDC reports. According to the CDC, an estimated 47.1 million American adults reported current (every day or some days) use in 2020, including 30.8 million who smoked cigarettes. That number is down 1.8 percentage points from 2019 (19% vs 20.8%).

The CDC assessed recent national estimates of tobacco product use among adults 18 years old or older using data from the 2020 National Health Interview Survey. The survey assessed use of five products: cigarettes, cigars (cigars, cigarillos, or filtered little cigars), pipes (regular pipes, water pipes, or hookahs), e-cigarettes, and smokeless tobacco.

According to the data, cigarettes remained the most commonly used product (12.5%), followed by e-cigarettes (3.7%), cigars (3.5%), smokeless tobacco (2.3%), and pipes (1.1%).

“We have made significant progress in preventing and reducing tobacco product use in this country by using proven strategies and implementing effective policies,” said Karen Hacker, MD, MPH, Director of CDC’s National Center for Chronic Disease Prevention and Health Promotion. “Despite significant declines in adult tobacco use, our work is far from over. We must continue to address tobacco-related health disparities and inequities to ensure everyone has the opportunity to be as healthy as possible.”

Combustible Tobacco Use Remains High

This study shows that adult cigarette smoking declined to the lowest prevalence recorded since it was 42% in 1965. Although the percentage of adults who smoked cigarettes declined—from 14.0% in 2019 to 12.5% in 2020— nearly 31 million U.S. adults reported smoking cigarettes in 2020. More than three-fourths of adults who currently use tobacco products use combustible products (e.g., cigarettes, cigars, pipes), which are the predominant cause of tobacco-related disease, disability, and death in the United States.

The percentage of U.S. adults using other tobacco products also decreased from 2019 to 2020, including: use of e-cigarettes from 4.5% to 3.7%; use of combustible products from 16.7% to 15.2%; and use of two or more products from 3.9% to 3.3%.

Factors that may have contributed to the decline in cigarette smoking and other tobacco use include high-impact anti-tobacco media campaigns (e.g., CDC’s Tips From Former Smokers), smokefree policies, and policies limiting the availability of specific types of products, such as flavored products.

Disparities in Use

In 2020, there continued to be marked differences in any current tobacco product use among different groups of U.S. adults. These groups included:

  • Males (5%).
  • Adults 25-44 years old (9%).
  • Non-Hispanic American Indian/Alaska Native adults (34.9%) and non-Hispanic adults categorized as other race (1%).
  • Adults living in rural (nonmetropolitan) areas (3%).
  • Adults whose highest level of educational attainment was General Educational Development (GED) certificate (40.5%).
  • Adults with annual household income of less than $35,000 (25.2%).
  • Adults identifying as lesbian, gay, or bisexual (1%).
  • Uninsured adults (27.3%) and those insured by Medicaid (6%).
  • Adults living with a disability (4%).
  • Adults who regularly had feelings of anxiety (29.6%) or depression (6%).

Curbing Use

The implementation of comprehensive, evidence-based, population-level interventions, in coordination with regulation of tobacco products, can reduce the burden of tobacco-related disease, disability, and death in the United States. These strategies include implementation of tobacco price increases, comprehensive smoke-free policies, high-impact antitobacco media campaigns, and barrier-free access to cessation services. Continued monitoring and tailored strategies and policies that reach populations with high rates of tobacco use, could further aid in reducing disparities.