US Has Made Great Strides in Reducing Smoking, but Disparities Remain

WASHINGTON — Cigarette smoking among youth and adults in the United States has reached the lowest levels ever recorded, but marked racial and ethnic disparities linger in terms of tobacco use and secondhand smoke exposure, a report from the surgeon general has found.
As was true in the 1998 surgeon general’s report — the first to exclusively examine racial and ethnic disparities in tobacco use — the office’s latest report finds that Native American and Alaska Native people experience the highest prevalence of smoking of any racial and ethnic groups.
Even while overall youth tobacco product use declined between 2023 to 2024, use among Native American and Alaska Native youth has increased.
In addition, the authors found that people who identify as lesbian, gay, bisexual or transgender use tobacco products at substantially higher rates than those who identify as heterosexual or cisgender, respectively.
At the same time, they say their findings substantiate that menthol-flavored tobacco products increase the likelihood of tobacco initiation, addiction and sustained use, and that these products are target marketed to certain population groups including Blacks, Native Hawaiian and Pacific Islanders, women and people who identify as lesbian, gay or bisexual.
Not surprisingly given all of the above, disparities in exposure to secondhand tobacco smoke by race and by poverty level continue to persist.
“In 1964, the year of the first surgeon general’s report on smoking and health, nearly one in two U.S. adults smoked cigarettes. We’ve made remarkable progress since then,” U.S. Surgeon General Dr. Vivek Murthy writes in the report’s preface.
“Today, about one in nine adults smokes cigarettes. Sixty years later, the elimination of all tobacco-related disease and death for our nation is a bold yet attainable goal. [But] to reach this ambitious public health goal, we must first acknowledge that progress has not been even,” Murthy says.
“Today, as we show in this report, cigarette smoking among men and women living in poverty is more than twice as common compared to those not living in poverty,” he says. “American Indian and Alaska Native adults and youth have the highest prevalence of cigarette smoking by race and ethnicity in the United States, and among people who do not smoke, exposure to secondhand tobacco smoke remains disproportionately higher among Black people than among people in other racial and ethnic groups.”
On top of all this, “the gap in tobacco use between youth living in rural areas and those living in urban areas has widened since 1998,” Murthy says.
But, he asserts, “it doesn’t have to be this way.”
Despite the tobacco industry outspending tobacco control efforts by a factor of at least 12 to one annually, Murthy insists, “We have the change and the choice to free our society from tobacco industry influence and create a tobacco-free America for all.”
How does the surgeon general propose to achieve this?
First, he espouses equitable access to evidence-based strategies for reducing smoking and the tobacco industry’s influence on society.
These include cessation programs and quitlines; mass media campaigns; and retail, product and marketing regulations.
In addition, he lays out a number of “concrete steps” he believes the government and health community can support today.
These include imposing a product standard that would establish a maximum nicotine yield to reduce the addictiveness of cigarettes and other combusted tobacco products.
This step alone, he says, could prevent more than 33 million people from starting to smoke, avert more than 8 million deaths, and result in an adult smoking prevalence of under 2% by year 2100.
An additional product standard to prohibit the sale and marketing of menthol cigarettes could avert up to 654,000 deaths over the next four decades.
He notes that currently two states and nearly 200 communities across the United States prohibit the sale of menthol cigarettes and other flavored tobacco products, protecting about one-sixth of the population.
“And, in the boldest step yet, two communities, the cities of Beverly Hills and Manhattan Beach, both in California, have chosen to eliminate the sale of all commercial tobacco products,” Murthy writes.
“Importantly and appropriately,” he notes, “these strategies focus on product manufacturing, distribution, and sales — and do not include a prohibition on individual consumer possession or use.
“The time is now to accelerate a whole-of-society effort to reach the tobacco endgame: a world in which zero lives are harmed by or lost to tobacco use,” Murthy writes. “By driving down the appeal, availability, and addictiveness of tobacco products, we can make this more than just a possibility. We can make it a reality.”
Dan can be reached at [email protected] and @DanMcCue
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