Background: Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States, causing approximately 443,000 premature deaths annually.
Methods: The 2009 National Health Interview Survey and the 2009 Behavioral Risk Factor Surveillance System were used to estimate national and state adult smoking prevalence, respectively. Cigarette smokers were defined as adults aged ≥18 years who reported having smoked ≥100 cigarettes in their lifetime and now smoke every day or some days.
Results: In 2009, 20.6% of U.S. adults aged ≥18 years were current cigarette smokers. Men (23.5%) were more likely than women (17.9%) to be current smokers. The prevalence of smoking was 31.1% among persons below the federal poverty level. For adults aged ≥25 years, the prevalence of smoking was 28.5% among persons with less than a high school diploma, compared with 5.6% among those with a graduate degree. Regional differences were observed, with the West having the lowest prevalence (16.4%) and higher prevalences being observed in the South (21.8%) and Midwest (23.1%). From 2005 to 2009, the proportion of U.S. adults who were current cigarette smokers did not change (20.9% in 2005 and 20.6% in 2009).
Conclusions: Previous declines in smoking prevalence in the United States have stalled during the past 5 years; the burden of cigarette smoking continues to be high, especially in persons living below the federal poverty level and with low educational attainment. Sustained, adequately funded, comprehensive tobacco control programs could reduce adult smoking.
Implications for public health practice: To further reduce disease and death from cigarette smoking, declines in cigarette smoking among adults must accelerate. The Patient Protection and Affordable Care Act is expected to expand access to evidence-based smoking-cessation services and treatments; this likely will result in additional use of these services and reductions of current smoking and its adverse effects among U.S. adults. Population-based prevention strategies such as tobacco taxes, media campaigns, and smoke-free policies, in concert with clinical cessation interventions, can help adults quit and prevent the uptake of tobacco use, furthering the reduction in the current prevalence of tobacco use in the United States across age groups.