Fewer People Are Smoking, But Nicotine Addiction Still Worries Experts

Find out which groups remain at high risk

The good news: Fewer Americans 18 and over are smoking cigarettes today. The bad: Smoking rates remain high in certain groups, and teenagers’ electronic cigarette use has reached epidemic proportions.

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The rate of smoking dropped from 20.9 percent in 2005 to 15.5 percent in 2015, according to the Centers for Disease Control and Prevention (CDC). That translates to about a 9 percent increase in quitting, with the greatest rise in quitting among 25- to 46-year-olds.

“We have seen smoking rates declining for a few years now in most developed countries,” says lung specialist Humberto Choi, MD. “But the U.S. decline is not homogenous across all states.

“For example, adult smoking rates are as high as 30 percent in the Midwest and South. And we see disproportionately higher smoking rates among certain groups.”

Which groups have the highest rate of smoking?

Of the 38 million Americans who continue to smoke, the National Health Interview Survey (NHIS), cited by the CDC, finds that rates are highest among those who:

  • Are male
  • Are 25-64 years old
  • Are under severe psychological distress
  • Are American Indians or Alaska natives
  • Have less education
  • Live below the poverty level
  • Are uninsured or on Medicaid

To discourage smoking in these groups, the CDC suggests strategies such as raising tobacco prices, comprehensive smoke-free laws, mass media anti-smoking campaigns and improved access to tobacco cessation counseling and medications.

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Is it better to smoke e-cigarettes?

The short answer is no. E-cigarettes contain nicotine and are addictive, says Dr. Choi, and experts are learning more and more about their health risks as time goes by.

“Overall, we have accomplished a lot over the last decades since we recognized the dangers of cigarette smoking. But on the other side, electronic cigarette use has achieved epidemic proportions,” he says.

He finds the trend toward increased e-cigarette use among teenagers and young adults especially discouraging.

Why are e-cigarettes risky for teens?

“Children and teenagers’ brains are still developing until they reach adulthood; many are now growing up addicted to nicotine,” explains Dr. Choi. “Therefore, they may experience the greatest mental and physical harm from smoking.”

Selling e-cigarettes to minors was banned in 2016 because of the special dangers that smoking and vaping or “juuling” pose for young people. But e-cigarette retailers and manufacturers continue to bombard teenagers with targeted ads.

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Between 2017 and 2018, e-cigarette use rose 78 percent among high school students and 48 percent among middle school students. “Something is definitely wrong,” he says. “We need to take more serious actions to reinforce the laws, including better vigilance and harsher punishment when they are broken.”

In November 2018, the U.S. Food and Drug Administration announced plans to ban the sale of sweet-flavored e-cigarette liquids, many flavored small cigars and menthol cigarettes. Time will tell if these measures work, says Dr. Choi.

Is smoking related to stress?

The NHIS also found that 40 percent of people use tobacco to cope with stress. “Smoking and vaping are used for quick stress relief — but the consequences are not worth it,” advises Dr. Choi.

You can find a wide variety of cheaper, healthier, more fulfilling and more effective ways to reduce stress, he says. But it’s not a one-size-fits-all solution.

“Sometimes you need to take a minute to think about what makes you happy, what makes you smile and what brings you joy,” he says. “Why not start by taking a walk and talking with a friend?​”

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