Tobacco Product Use Among Adults — United States, 2020

MMWR Introduction

Although cigarette smoking* has declined over the past several decades, a diverse landscape of combustible and noncombustible tobacco products has emerged in the United States. To assess recent national estimates of commercial tobacco product use** among U.S. adults aged 18 years or older, the Centers for Disease Control and Prevention analyzed data from the 2020 National Health Interview Survey.

Continued monitoring of tobacco product use and tailored strategies and policies that reduce the effects of inequitable conditions could aid in reducing disparities in tobacco use.

MMWR Highlights

Percentage of adults aged 18 years or older who reported tobacco product use “every day” or “some days,” by tobacco product type, 2020

• Cigarettes: 12.5%.***
• Electronic cigarettes (e-cigarettes): 3.7%.
• Cigars, cigarillos, or filtered little cigars: 3.5%.
• Smokeless tobacco: 2.3%.
• Pipes, water pipes, or hookahs: 1.1%.
• Any combustible tobacco product: 15.2%.
• Used 2 or more tobacco products: 3.3%.

Percentage of adults aged 18 years or older who reported any tobacco product use “every day” or “some days,” 2020

• Overall current use of any tobacco product: 19.0%.
• By sex: 24.5% of men and 13.9% of women currently used any tobacco product.
• By age group: 22.9% of adults aged 25 to 44 years, 4% of adults aged 45 to 64 years, 17.6% of adults aged 18 to 24 years, and 11.8% of adults aged 65 years or older currently used any tobacco product.
• By race and ethnicity: 34.9% of non-Hispanic American Indian/Alaska Native adults, 29.1% of other, non-Hispanic adults, 21.1% of non-Hispanic White adults, 19.4% of non-Hispanic Black adults, 11.7% of Hispanic adults, and 11.5% of non-Hispanic Asian adults currently used any tobacco product.
• By U.S. region: 22.0% of adults in the Midwest, 21.1% of adults in the South, 16.6% of adults in the Northeast, and 15.0% of adults in the West currently used any tobacco product.
• By metropolitan statistical area: 27.3% of adults in rural areas and 17.7% of adults in urban areas currently used any tobacco product.
• By education level (adults aged 25 years or older): 40.5% of adults with a GED, 24.8% of adults without a high school diploma, 24.2% of adults with a high school diploma, 21.7% of adults with some college, but no degree, 19.4% of adults with an associate degree, 11.7% adults with a bachelor’s degree, and 8.6% of adults with a graduate degree currently used any tobacco product.
• By marital status: 6% who are divorced/separated/widowed, 21.4% who are single/never married/not living with a partner, and 17.5% who are married/living with partner currently used any tobacco product.
• By annual household income: 2% of adults with an annual household income of less than $35,000, 20.3% of adults with an annual household income of $35,000–$74,999, 18.4% of adults with an annual household income of $75,000–$99,999, and 13.7% of adults with an annual household income of more than $100,000 currently used any tobacco product.
• By sexual orientation: 25.1% of lesbian, gay, or bisexual adults and 18.8% of heterosexual/straight adults currently used any tobacco product.
• By health insurance coverage: 6% of adults with Medicaid, 27.3% of uninsured adults, 21.3% of adults with other public insurance, 16.4% of adults with private insurance, and 12.5% of adults with Medicare only (aged 65 years or older) currently used only tobacco product.
• By disability status: 25.4% of adults with a disability and 18.4% of adults without a disability currently used any tobacco product.
• By mental health condition: 29.6% among adults who regularly have feelings of anxiety and 17.7% of adults who do not regularly have feelings of anxiety currently used any tobacco product; 35.6% of adults who regularly have feelings of depression and 18.3% of adults who do not regularly have feelings of depression currently used any tobacco product.

*  Smoking and tobacco product use here refer to use of commercial tobacco products and not to tobacco used for medicinal and spiritual purposes by some American Indian communities.

** Any tobacco product use was defined as current use of at least one tobacco product (cigarettes; e-cigarettes; cigars, cigarillos, little cigars; smokeless tobacco; pipes, waterpipes, hookahs).

*** In this study, current cigarette smoking was defined as smoking 100 or more cigarettes during a person’s lifetime and smoking cigarettes “every day” or “some days” at the time of survey. For all other tobacco products, current use was defined as having smoked at least once during a person’s lifetime and reported use “every day” or “some days,” at the time of the survey.