Study: After decades of anti-smoking campaigns, 1 in 4 Americans still use tobacco

Anti-smoking campaigns have been credited with sharply reducing the percentage of Americans who smoke traditional cigarettes, but new products like 'e-cigarettes' present a fresh challenge, public health experts say.

First Look

Fifty-three years after the US Surgeon General’s report on smoking launched countless anti-tobacco laws and campaigns, new challenges have emerged in the fight against nicotine use, according to a new study that tracks use of not just traditional cigarettes, but a dozen tobacco products.

More than 1 in 4 American adults and nearly 1 in 10 youths still use tobacco, according to findings from the Population Assessment of Tobacco and Habits (PATH) Study released on Wednesday. The findings come from the first wave of the study, a collaboration between the National Institutes of Health's National Institute on Drug Abuse, the US Food and Drug Administration's Center for Tobacco Products, survey corporation Westat, and the Roswell Park Cancer Institute.

Americans could be forgiven for thinking that the war on tobacco had been won. In 2015, US smoking rates hit an all-time low of 15.1 percent. Since the Surgeon General first raised alarms about smoking's health risks, in 1964, the drop in smoking has saved an estimated 8 million lives, adding 157 million years to lives that otherwise could have been cut short by tobacco. But as traditional cigarettes get stubbed out, e-cigarettes are taking their place.

"The [PATH] study documents that tobacco use is about much more than just cigarettes," Wilson M. Compton, a co-author of the study and the deputy director of the National Institute on Drug Abuse, said in a statement. "Both youth and adults use a remarkably broad variety of tobacco products."

The study, published online ahead of its publication in the New England Journal of Medicine, looked beyond cigarette use. Researchers asked 32,320 adults and 13,651 teenagers about their use of 12 types of tobacco products, including cigarettes, e-cigarettes, cigars, pipe tobacco, and hookah.

They found that 27.6 percent of adults and 8.9 percent of youth had used at least one of these products during the past 30 days. Among those who used more than one, cigarettes and e-cigarettes were the most common combination.

Even as use of the former has dropped, e-cigarettes, which heat a nicotine solution for inhalation, have become popular in recent years. High school students' use of the devices grew from 1.5 percent in 2011 to 16 percent in 2016.

Public health experts see this trend as cause for concern. In December, US Surgeon General Vivek Murthy told the Associated Press, "My concern is e-cigarettes have the potential to create a whole new generation of kids who are addicted to nicotine. If that leads to the use of other tobacco-related products, then we are going to be moving backward instead of forward."

E-cigarettes do not produce smoke, but they still contain nicotine. Although they are often marketed as safer alternatives to traditional smoking, "The health consequences of repeated exposure to these chemicals are not yet clear," as the National Institute on Drug Abuse cautions.

But many laws that restrict tobacco advertising do not yet cover e-cigarettes, as The Christian Science Monitor reported in December. As new products become increasingly popular with middle-school and high-school students, companies are spending millions to market to them: according to one study, nearly 7 in 10 American teenagers saw an e-cigarette advertisement in 2014. In January, the Centers for Disease Control and Prevention cautioned that companies are using images that evoke sex and rebellion, similar to past eras' ads that got many of yesterday's teens hooked on traditional tobacco products.

The current lack of research or laws related to e-cigarettes poses a new challenge, public health experts say. But five decades of close cooperation among researchers, governments, and public-health advocates, has been credited with bringing down traditional smoking rates – and the new PATH study may help lay out the next steps against tobacco use. 

"The findings from the PATH Study will help inform the FDA's efforts to regulate tobacco products in such a way that reduces harm and protects public health," David Ashley, the director of the FDA Center for Tobacco Products' Office of Science, said in a statement.