Fewer Americans Than Ever Smoke, but Vaping Poses a Growing Threat: CDC

Fewer Americans Than Ever Smoke, but Vaping Poses a Growing Threat: CDC

Cigarette smoking has reached an all-time low in the United States, but experts say the rise of vaping puts a damper on what otherwise would be a tremendous public health achievement.

Just under 14% of American adults smoked cigarettes in 2018, a dramatic decline from the 42% adult smoking rate in 1965, according to researchers with the U.S. Centers for Disease Control and Prevention.

Further, all signs seem to show that the popularity of cigarette smoking continues to decline:

  • About 55% of adult smokers tried to quit in 2018, up from nearly 53% in 2009.
  • About 7.5% of smokers said they successfully quit in 2018, up from 6.3% in 2009.
  • The "quit ratio" of smokers who permanently kicked the habit increased from about 52% in 2009 to about 62% in 2018.

But 1 in 5 adults are still using some form of tobacco, and the boom in vaping threatens to undermine progress against cigarette smoking, experts said.

"It's a good news/bad news thing," said Dr. David Hill, a national board member for the American Lung Association. "We've made tremendous strides over decades in decreasing combustible cigarette use, but when you look at this report and they talk about e-cigarette use, it's very concerning."

Other tobacco products used by adults include cigars (3.9%); e-cigarettes (3.2%); smokeless tobacco (2.4%), and pipes or hookahs (1%), according to the CDC's Morbidity and Mortality Weekly Report, published Nov. 14.

E-cigarette use among adults saw a modest increase, up from 2.8% in 2017 to 3.2% in 2018, researchers said.

But 21% of U.S. high school students had vaped within the past month in 2018, and they are expected to cause an uptick in adult tobacco use rates as they enter young adulthood, researchers said.
One sign this is happening: The rate of e-cigarette use among 18- to 24-year-olds increased more than among adults overall, rising from 5.2% in 2017 to 7.6% in 2018.

"Youth is the age when people experiment, and this is a new thing," said Dr. Emanuela Taioli, director of the Institute for Translational Epidemiology at the Icahn School of Medicine at Mount Sinai in New York City. "Many of them don't know it contains nicotine, and that's how they get addicted. Nicotine is the most powerful addictive product existing on the market."

Beyond nicotine addiction, vaping also includes its own set of health hazards, noted Dr. Len Horovitz, a pulmonary specialist with Lenox Hill Hospital in New York City.

More than 2,000 cases of severe lung illness have been linked to vaping, and the CDC reported last week that one oily chemical - vitamin E acetate - has been found in fluid samples from the lungs of 29 vapers hospitalized in 10 states.

But the CDC has not ruled out the possibility that other compounds or ingredients might be contributing to the wave of vaping-related lung illness.

"Cigarette smoking has decreased in recent years, but vaping has had a dramatic increase with a variety of devices and the inclusion of substances besides nicotine, some known and unknown," Horovitz said. "Recent vaping illnesses and deaths have brought to light chemical substances such as vitamin E acetate, diacetyl, formaldehyde and cyanide."

Meanwhile, Taioli chalks up the successes against cigarette smoking to anti-tobacco advertising, tobacco taxes, increases in the legal age for buying cigarettes, and state and local smoking bans.
"The cities with the highest and most restrictive smoking bans are the ones with the lowest smoking rates," she said.

People who want to quit shouldn't rely on an e-cigarette to help, according to Hill of the lung association.

"Essentially, we don't have a lot of evidence that electronic cigarettes are a smoking cessation product," Hill said. "It's really a switching product, where people are going from combustible cigarettes to e-cigarettes, and for youth it's an entry product."

Experts said smokers should instead reach out to their health care provider for support and help, including prescriptions for proven nicotine replacements.

"Many patients express that they wish they did not have access to tobacco products," said Christine Fardellone, a certified tobacco treatment specialist at Northwell Health's Center for Tobacco Control in Great Neck, N.Y.

"Their lives are often filled with illness, regret, financial problems and the difficult experience of trying to quit tobacco use. Health care professionals must continue to work to reduce the public health burden of tobacco-related illness," she said.

Sources: David Hill, M.D., national board member, American Lung Association; Emanuela Taioli, M.D., Ph.D., director, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York City; Len Horovitz, M.D., pulmonary specialist, Lenox Hill Hospital, New York City; Christine Fardellone, D.N.P., certified tobacco treatment specialist, Northwell Health, Center for Tobacco Control, Great Neck, N.Y.; Morbidity and Mortality Weekly Report, Nov. 14, 2019.

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