Adults & Smoking

National Prevalence and Trends

• According to the National Health Interview Survey, 20.6% of adults aged 18 and over were current smokers in
2008. In 2007, 19.8% of adults were current smokers. The increase in smoking rates is not statistically
1
significant.

Women:
1
• 18.3% of women are smokers, compared with over 23% of men.
• 20.6% of white American women, 17.8% of black women, 10.7% of Hispanic women, 4.7% of Asian American
1
women, and 22.4% of American Indian/Alaska Native women are smokers.
• In the U.S., smoking rates have historically been lower among women than men. However, as overall smoking
rates have decreased over the years, they have not dropped as quickly for women as for men. Since 1970,
2
smoking rates among women have declined by about 30%, compared to a 40% decline among men.
3, 4
• Between thirteen and twenty-two percent of women and girls in the United States smoke while pregnant.

Men:
1
• Adult men smoke at higher rates than adult women.
• American Indian/Alaska Native men have the highest rate of smoking at 42.3%, while Asian American and
Hispanic men have the lowest rate of smoking at 15.7% and 20.7%, respectively. 23.5% of white men and
1
25.6% of African American men are smokers.
• Daily smoking prevalence among men decreased continuously from 58% to 28% in the period from 1960 to
5
2000.

Lesbian, Gay, Bisexual & Transgender (LGBT):

1
• The latest research indicates a wide range of smoking prevalence for LGB adults, ranging from 25% to 44%
6-9
among the different subgroups.
• According to recent data from California and Washington state, the prevalence of smoking among bisexual men
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is almost 2 times that among heterosexual men. The prevalence of smoking among bisexual women is up to
8, 9
two and a half times the prevalence among heterosexual women.
• • The same data indicate the current smoking prevalence among lesbian women is 1.7 to 2.4 times higher than
7-9
the smoking prevalence among women in the general population.
• In California, smoking prevalence among WSW (women who have sex with women but do not self-identify as
8
lesbians) is over three and a half times higher than among women in the general population (43.6% VS.12.2%).
• Data indicate the average prevalence of smoking among gay or MSM (men who have sex with men but do not
6-9
self-identify as gay) is a little more than 30%, compared to 21% in their heterosexual counterparts.
• Several factors such as higher levels of social stress, frequent patronage of bars and clubs, higher rates of
alcohol and drug use, and direct targeting of LGB consumers by the tobacco industry may be related to higher
10
prevalence rates of tobacco use among some LGB groups.

Low SES:
1
• Increased tobacco use is strongly associated with low socio-economic status.
• The prevalence of current smoking is greatest among adults with working class jobs, low educational level, and
11
low income.
• In 2008, 32% of adults with incomes below the federal poverty level smoked, compared with 20% of those at or
1
above the poverty level.
o Thirty-one percent of men below the poverty line were smokers compared with 22% of men at or above
poverty level.

1
The limited studies available on this population do not include specific information on transgender individuals as a subgroup.
 o Thirty-two percent of women below the poverty line were smokers compared with 17% of women at or
above poverty level.
• In 2006, 18% of adults under 65 years of age with private health insurance coverage were current smokers,
12
compared to 35% of Medicaid recipients and 34% of the uninsured.
• Smoking rates also vary by education level. Among adults over age 25, those with General Education
Development (GED) diploma have the highest prevalence of current smoking (41%), followed by those with 9 to
11 years of education (36%). Those who had an undergraduate degree (11%) or graduate degree (6%) had the
1
lowest smoking prevalence.
• Lower education levels are associated with significantly higher rates of smoking during pregnancy. Nearly 24%
of women with 9-11 years of education smoked while pregnant compared with 15% of those with 12 years of
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education and 1.5% of those with 16 or more years of education.

Latino:
• 15.8% of all Hispanic adults smoke, but there are substantial differences in smoking rates by gender; 20.7% of
1
Hispanic men smoke, while 10.7% of Hispanic women smoke.
• Hispanic smokers are more likely than white smokers to attempt cessation, but less likely to receive cessation
14
advice from physicians or to use nicotine replacement therapy.
15
• 43% of Hispanics who have ever smoked have quit.
• Several studies have found wide variations between smoking prevalence rates among Hispanic subgroups,
16
ranging from 11 percent to 27 percent.

African American:
• 21.3% of all adult African Americans smoke. 25.6% of African American men smoke and 17.8% of African
1
American women smoke.
15
• 37% of all African Americans who ever smoked have quit, the lowest quit rate among racial/ethnic groups.

Asian American:
• About ten percent (9.9%) of all adult Asian Americans smoke. There are substantial differences in smoking rates
1
by gender: 15.7% of Asian American men and 4.7% of Asian American women smoke.
• The overall smoking rate among Asian American adults is lower than the rates among all other racial and ethnic
1
groups.
15
• 45% of Asian Americans who have ever smoked have quit, the second highest quit rate after white Americans.

Native American:
• In 2008, thirty-six percent (32.4%) of adult American Indians and Alaska Natives smoked. When broken down
by gender, 42.3% of American Indian/Alaska Native men smoked, while 22.4% of American Indian/Alaska
1
Native women smoked.
1
• Smoking rates among American Indian and Alaska Native adults are the highest of any racial/ethnic group.
15
• 41% of American Indians who ever smoked have quit.

Health Impact:
Mortality
• Tobacco-related disease is the leading preventable cause of death in the U.S. causing over 400,000 deaths per
17
year (over 260,000 among men and over 170,000 among women).

Cardiovascular Disease
• It is estimated that as many as 30% of deaths in the U.S. from cardiovascular disease are a result of tobacco
18
use.
19
• The risk of having a heart attack increases with the number of cigarettes smoked.
• 128,000 Americans die each year of smoking-related cardiovascular disease (49,000 women and 79,000 men).
17
 Lung Cancer
4, 20
• Cigarette smoking causes the majority of lung cancer cases.
• 47,000 women and 79,000 men die each year from smoking-related cancers of the trachea, lung, and
17
bronchus.
21
• Lung cancer death rates are highest for those in the lowest income brackets.

Other Health Effects

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• Smoking increases the risk of stroke.
• In addition to lung cancer, tobacco use increases the risk of developing cancers of the oral cavity, pharynx,
20
esophagus, pancreas, larynx, cervix, urinary bladder, and kidney.
4
• Women who smoke increase their risk of infertility, ectopic pregnancy, spontaneous abortion, and still birth.

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questionnaire. National Center for Health Statistics 1965-1999.
3. Nishimura BK, Adams EK, Melvin CL, Tucker PJ, Merritt RK, Rivera CC. State Prenatal Smoking. Atlanta (GA): Centers for Disease Control
and Prevention; 2002 Spring.
4. U.S. Department of Health and Human Services. Women and Smoking: A report of the Surgeon General: U.S. Department of Health and
Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on
Smoking and Health; 2001.
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Population and the General Population in California. Am J Pub Health 2007;97:1496-1502.
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2007(235):1-153.
13. National Center for Health Statistics. Health, United States, 2006 with chartbook on trends in the health of Americans; 2006.
14. Levinson AH, Perez-Stable EJ, Espinoza P, Flores ET, Byers TE. Latinos report less use of pharmaceutical aids when trying to quit
smoking. American Journal of Preventive Medicine 2004;26(2):105-111.
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2008;57(45):1226-1228.
18. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993;270(18):2207-12.
19. Prescott E, Hippe M, Schnohr P, Hein HO, Vestbo J. Smoking and risk of myocardial infarction in women and men: longitudinal population
study. BMJ 1998;316(7137):1043-1047.
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Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.
21. Singh GK, Miller BA, Hankey BF. Changing area socioeconomic patterns in U.S. cancer mortality, 1950-1998: Part II--Lung and colorectal
cancers. J Natl Cancer Inst 2002;94(12):916-925.