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BRFSS Spotlight Series: Adult Smoking and E-Cigarette Use in the United States (Infographic)

Adult Smoking and E-Cigarette Use
In the first part of our BRFSS spotlight series, we analyzed newly available 2018 data for an existing measure, Adult Smoking, and a more complete set of existing data from 2017 (as data for 2018 was not available in a majority of states) for a brand new measure, Adult E-Cigarette Use.

According to the Centers for Disease Control and Prevention and the World Health Organization, smoking was the leading cause of preventable death in 2017, with cigarette smoking being responsible for approximately 480,000 deaths per year in the United States.¹ 

Lately, however, concerns around growth in tobacco use have shifted away from cigarette smoking—which has declined across the nation from a rate of 20.1 percent in 2011 to 15.5 percent in 2018—in response to the rise of vaping and e-cigarette use in recent years, especially among youth.²

Though vaping/e-cigarette use is thought to be less harmful compared to regular cigarettes,³ mounting concerns about the short- and long-term effects of such use have led researchers to conduct studies such as a recent analysis conducted by scholars at the University of California, San Francisco and published in the American Journal of Preventive Medicine, which finds growing evidence linking e-cigarette use and respiratory diseases.

As researchers continue to monitor individual and population-level trends in health behaviors, such as tobacco use, data from surveys such as the BRFSS will have an important impact in increasing our understanding of the consequences of smoking and e-cigarettes.

Adult Smoking (2018)
Smoking is defined as adults (age 18 and older) who have smoked 100 or more cigarettes in their lifetime and who currently report smoking “some days” or “every day.” Nationally, 15.5 percent of adults smoked some days or every day in 2018, which decreased significantly from a reported rate of 16.4 percent the previous year. Across the states (and the District of Columbia), smoking rates varied from a low of 9.0 percent in Utah to a high of 25.2 percent in West Virginia.

Eight states (Arkansas, Indiana, Kentucky, Louisiana, Mississippi, Ohio, Tennessee, and West Virginia) reported that more than one in every five adults smoked in 2018. In better news, data from eight states (Arizona, Florida, Louisiana, Maryland, New Mexico, New York, Vermont, and Washington) showed significant declines in adult smoking rates from 2017 to 2018, and no states experienced significant increases.

Smoking Patterns by Race/Ethnicity*
When looking at 2018 data across the nation by race/ethnicity, Black adults were 6.7 percent more likely to smoke than White adults (17.4 percent vs. 16.3 percent). Correspondingly, rates of smoking were higher among Black adults than among White adults in seven states (Connecticut, Illinois, Michigan, Minnesota, Nebraska, Pennsylvania, and Texas) as well as in D.C., and were only lower than the rate of White adults in four states (Florida, Georgia, Louisiana, and Rhode Island). The gap between smoking rates of Black and White adults was highest in D.C., where Black adults were more than two times more likely than White adults to smoke (21.8 percent vs. 6.9 percent).

Nationally, Hispanic/Latino adults were 23.6 percent less likely to report smoking compared to White adults (12.4 percent vs. 16.3 percent). Rates of smoking were higher among Hispanic/Latino adults than White adults in only six states (Colorado, Connecticut, Hawaii, Michigan, Utah, and Wyoming) and were lower than White adult smoking rates in 15 states. Hawaii was highest among states with a statistically significant gap, with Hispanic/Latino adults who were 83.7 percent more likely to smoke than White adults (21.4 percent vs. 11.6 percent).

For the adult smoking measure, we also analyzed national-level data for adults of Other/Multiple races, a category that includes those who identify as American Indian or Alaska Native, Asian, Native Hawaiian/Pacific Islander, Other race, or Multiracial.⁺ The national data showed that, overall, Other/Multiracial adults were 16.4 percent less likely to smoke than White adults (13.6 percent vs. 16.3 percent). Of this group, American Indian or Alaska Natives were most likely to report smoking at 29.1 percent, followed by Multiracial adults (23.5 percent), Native Hawaiian/Pacific Islanders (21.8 percent), adults reporting as “Other” (16.9 percent), and Asian adults having the lowest smoking rate at 7.7 percent. A high-level state analysis also revealed that Other/Multiracial adults had the highest rates of smoking in 26 states over White adults, Black adults, and Hispanic/Latino adults.

Adult E-Cigarette Use (2017)
E-Cigarette use is the newest measure that has been added to SHADAC’s State Health Compare web tool. The measure is defined as adults who currently report using e-cigarettes either “some days” or “every day.” Due to the fact that data are not available for all states in 2018, this analysis uses 2017 data in order to give a more complete picture of trends in e-cigarette use across the nation.

Nationally in 2017, 4.4 percent of adults used e-cigarettes—a rate that was statistically unchanged from 4.5 percent in 2016. Among the states, e-cigarette use ranged from a low of 2.5 percent in D.C. to a high of 7.1 percent in Oklahoma. Thirteen states (Arkansas, Arizona, Colorado, Indiana, Kentucky, Missouri, Nevada, Ohio, Oklahoma, Tennessee, Utah, West Virginia, and Wyoming) reported an e-cigarette use rate of more than one in every twenty adults in 2017. Just one state (Indiana) saw an increase in rates of e-cigarette use, while five states (Connecticut, Louisiana, Massachusetts, Nebraska, and Washington) saw decreases in rates of e-cigarette use.

Nationally, 3.2 percent of Black adults reported using e-cigarettes in 2017, a rate that was 36.5 percent less than White adults, who had an e-cigarette use rate of 5.0 percent. Hispanic/Latino adults reported e-cigarette use at 3.1 percent, a rate that was 38.2 percent less than White adults (5.0 percent), and Other/Multiracial adults’ reported e-cigarettes use that same year was 11.4 percent less than White adults (5.0 percent) at 4.4 percent.

As e-cigarette use becomes more of public health focus, and as more state and federal surveys field questions about this topic, SHADAC will continue to monitor available data for future analysis involving state-level trends in e-cigarette use.  

A brief on Adult Smoking and E-cigarette Use at the national and state levels is currently planned for release some time later this year, and will include a deeper analysis of these data.

Notes
All data are from SHADAC analysis of the Behavioral Risk Factor Surveillance System (BRFSS). All differences described in the post are statistically significant at the 95% confidence level unless otherwise specified.