Smoking declined by 20 percent in US, yet uninsured adults smoke at twice the rate of the insured

The number of U.S. adults who smoke cigarettes declined by nearly 20%—from 20.9% (45.1 million) in 2005 to 16.8% (40.0 million) in 2014. Between 2013 and 2014 alone, smoking dropped by a full percentage point, according a November 13, 2015 study in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR).

“Smoking kills half a million Americans each year and costs more than $300 billion,” said CDC Director Tom Frieden, MD, MPH. “This report shows real progress helping American smokers quit and that more progress is possible.”

The study also reported that 27.9% of uninsured adults and 29.1% of Medicaid recipients currently smoke. That’s more than double the rates of adults with private insurance, at 12.9%, and those on Medicare, at 12.5%. Similarly, Americans living below the poverty level had a higher smoking prevalence (26.3%) than those at or above it (15.2%).

To create this report, CDC researchers analyzed data from the 2014 National Health Interview Survey (NHIS), a nationally representative, in-person survey of 36,697 American adults.

In terms of smoking frequency, the number of adults who smoked on a daily basis decreased from 36.4 million (80.8% of all smokers) to 30.7 million (76.8%), while the number of adults who reported smoking “some days” increased from 8.7 million (19.2%) to 9.3 million (23.2%).

Of all age groups, young adults (ages 18-24) showed the greatest decrease in cigarette smoking; however, recent reports suggest that use of other tobacco products—including e-cigarettes and hookahs—is increasingly common among teens and young adults. “The extent to which emerging tobacco products, such as e-cigarettes, might have contributed to the observed decline in cigarette smoking in recent years is uncertain,” largely because data on these products has been collected only since 2014, the authors wrote.

Among adults older than 25, smoking was highest among people with a General Education Development (GED) certificate (43.0%), and lowest among those with a graduate degree (5.4%). Among racial and ethnic groups, smoking was highest among American Indian/Alaska Natives (29.2%) and multiracial adults (27.9%), and lowest among Asians (9.5%). By region, prevalence was highest in the Midwest (20.7%) and lowest in the West (13.1%).

“These findings underscore the importance of ensuring that proven strategies to prevent and reduce tobacco use reach the entire population, particularly vulnerable groups,” said Brian King, PhD, Deputy Director for Research Translation, CDC Office on Smoking and Health. “Comprehensive smoke-free laws, higher prices for tobacco products, high-impact mass media campaigns, and barrier-free access to quitting help are all important. They work to reduce the enormous health and financial burden of tobacco use and secondhand smoke exposure among Americans.”

On a related note, the Great American Smokeout takes place November 19, 2015.