US smoking rate sees faster decline

The number of American adults who smoke cigarettes hit an all-time low in 2015, the biggest one-year drop in more than 20 years, according to new estimates from the Centers for Disease Control and Prevention (CDC) released in May.

In 1964, the surgeon general released a landmark report that declared smoking harmful to health. Since then, that percentage has declined steadily – in recent years by around one percentage point per year. But from 2014 to 2015, the rate dropped nearly two percentage points, from 16.8 percent to 15.1 percent.

Experts say the record low represents huge progress, and although they have not pinned down the reason for the sharper-than-usual fall last year, they know the winning combination: raising the price of cigarettes, smoke-free laws, and graphic advertisements. The decline in cigarette use is encouraging, they say, but with tens of millions of Americans still smoking and some demographics disproportionately affected, the job is not yet done. The rise of so-called e-cigarette use, particularly among youths, poses a challenge to the inroads made on traditional smoking. 

“Within the last year we’ve had a lot of progress at both the state, local, and federal level in terms of implementing smoke-free laws, raising the price of tobacco, and running hard-hitting mass-media campaigns,” says Brian King, deputy director for research translation for the CDC’s Office on Smoking and Health. 

Since the 1964 surgeon general’s report, the federal government and many state governments, hospitals, and public-health institutions have built a collective crusade against smoking. In 2014, that effort was estimated to have saved some 8 million lives, or 157 million years of life. Smoking is still considered the leading cause of preventable illness in the United States, however, with CDC figures attributing 480,000 deaths a year to the habit. Smoking-related disease is estimated to cost the country $300 billion per year.

One leading way of tackling the problem, research shows, is to hike the price of cigarettes via tax increases. This is a way of pricing out many of the most vulnerable, highest smoking demographic groups – mainly youths, lower-income people, and some minorities. The federal government currently taxes cigarettes at $1.01 per pack, after President Obama increased the tax by 62 cents in 2009.

It’s not the only factor, but typically the higher a state’s tax the lower the smoking rate, according to the CDC. The states with the 10 largest excise taxes on cigarettes all have around or less than the national average of percentage of smokers. Kentucky and West Virginia, by comparison, have the highest smoking rates (above 25 percent) and are among the 10 lowest taxing states.

Indeed, many states with the lowest taxes also have the weakest smoke-free laws. Smoke-free laws have been shown to give smokers a greater chance of quitting in the future by reducing the number of opportunities they have to smoke as well as the exposure of others to secondhand smoke.

In West Virginia, for example, less than a third of the population lives somewhere with smoke-free restaurant laws. On the other hand, in Utah, which has the lowest smoking rate in the US (around 10 percent), workplaces, restaurants, and bars are covered. 

The discrepancy is not just between states, but also demographic groups. Men, youth, American Indians, lower-income people, and the lesbian, gay, and bisexual communities have among the highest rates.

A pillar of the strategy in convincing these groups to quit is through TV advertising, the most prominent being the CDC’s “Tips” campaign. It features real people, often bearing the obvious signs of a serious health condition stemming from their smoking habit. Even as authorities keep working to drive smoking numbers down via proven methods, a new front is opening up, forcing them to educate the public, particularly parents, to challenge nicotine addiction at its root. 

“[A] lot of products ... have entered the market, including e-cigarettes, and so although we’re seeing declines in cigarette smoking it’s important to note that the use of some other tobacco products is either staying the same or increasing,” Dr. King says.

The use of e-cigarettes, especially among youths, spiked in recent years – it tripled among middle and high school students from 2013 to 2014. Furthermore, the actual use of tobacco products among this group did not diminish at all. The CDC warns parents that any nicotine use is bad for teenagers because their brains are still developing. 

Early research has shown an increase in young people trying e-cigarettes or other “vaping” products increases the likelihood they will take up cigarettes later. (For adults who are smokers, there is emerging evidence that a complete transition to
e-cigarettes can help them quit.)

Despite this new challenge, King calls the record low in cigarette use a “public health win,” but says there is much more to do. “The good news on that front is we know what works,” he says, “and we just need to implement those interventions.”