Adult smoking rates continue to underscore health disparities

The latest data on tobacco use rates among U.S. adults show a decline overall — from 21.3 percent during 2013 and 2014 to 20.1 percent in 2015 — but many groups continue to use tobacco at higher rates than the rest of the population.

The findings, from a report on tobacco product use among adults in 2015 by the Centers for Disease Control and Prevention, reinforces the fact that tobacco continues to disproportionately affect certain populations. For example, the report found that:

• Tobacco use ranged from 9 percent among Asians to 26.6 percent among American Indians and Alaska Natives.
• The use of any tobacco product was higher among lesbian, gay or bisexual adults with overall use at 27.4 percent, compared with heterosexual adults at 20.1 percent.
• Tobacco use was higher among adults with an annual household income under $35,000, at 27.8 percent. Only 13.4 percent of adults with an income over $100,000 used a tobacco product.
• Tobacco use was most common among adults with serious psychological distress at 47.2 percent. Those without serious psychological distress used tobacco at a rate of 19.2 percent.

Cigarettes were the most commonly used product (15.1 percent), followed by e-cigarettes (3.5 percent); cigars, cigarillos or filtered little cigars (3.4 percent); smokeless tobacco, such as chewing tobacco, snuff, dip, snus and dissolvable tobacco (2.3 percent); and pipes, water pipes or hookahs (1.2 percent).

Groups with higher smoking rates, including racial/ethnic minorities, the LGBT community, low-income communities and people with mental health conditions, all have a history of being targeted by the tobacco industry. For example, tobacco companies have:

• sponsored activities linked with cultural traditions, including American Indian powwows.
• made efforts to appeal to LGBT consumers through targeted advertisements in LGBT press and local promotions like “LGBT bar nights.”
• handed out free cigarettes to children in housing projects, issued tobacco coupons with food stamps and explored giving away financial products like prepaid debit cards.
• given away cigarettes to psychiatric facilities, supported research that positions smoking cigarettes as a way to self-medicate and used stress relief themes in marketing.

The CDC recommends the use of targeted, population-level interventions — along with comprehensive state tobacco control programs and the regulation of tobacco products by the Food and Drug Administration — to combat all types of tobacco product use among the people who are most affected. These strategies include tobacco price increases, mass media campaigns, smoke-free policies and access to help for quitting tobacco.