US Tobacco Use Declines, But Smoking-Related Health Disparities Remain

• U.S. Surgeon General Dr. Vivek Murthy issued a new advisory highlighting health disparities in tobacco use despite the fact that cigarette smoking has declined in recent decades.
• The report found unequal progress in smoking cessation among racial and ethnic groups and across various sociodemographics.
• Quitting smoking can have short- and long-term benefits on human health.
• There are many resources available to help with smoking cessation, such as the American Cancer Society’s Great American Smokeout and 1-800-QUIT-NOW.

Cigarette smoking is the leading cause of preventable disease, disability, and death in the United States.

While cigarette smoking has declined more than 70% in the U.S. since 1965, a new advisory from U.S. Surgeon General Dr. Vivek Murthy highlights ongoing health disparities in tobacco use.

The November 19 report cites unequal progress in smoking cessation, showing disparities among racial and ethnic groups, income, education, gender identity and sexual orientation, occupation, geography, and health status, among other factors.

Despite the concerning data, Dr. Murthy appears optimistic, envisioning a tobacco-free future with reduced death and disease burden in these population groups. The report outlines various factors affecting tobacco-related disparities and proposes actions to promote smoking cessation and improve health equity in the U.S.

“Tobacco use imposes a heavy toll on families across generations. Now is the time to accelerate our efforts to create a world in which zero lives are harmed by or lost to tobacco,” Dr. Murthy said in the advisory. “This report offers a vision for a tobacco-free future, focused on those who bear the greatest burden, and serves as a call to action for all people to play a role in realizing that vision.”

The Surgeon General’s advisory sheds light on multiple health disparities related to tobacco use, such as:

• Poverty, racism, discrimination, and other social determinants of health.
• Marketing tactics by the tobacco industry targeting Black and Hispanic people and those with low-income status.
• Gaps in prevention protections and barriers to treatments to help with smoking cessation.
• Social and environmental influences.

Poverty is a major driving force in tobacco-related health disparities, the report found. Cigarette smoking is twice as common among people who live in poverty compared to those who do not.

The report also shows that disparities in secondhand smoke exposure, particularly among children, Black people, and those living in low socioeconomic status, have increased since 2000.

Additionally, people who live in rural areas or reside in the Midwest or South are more likely to use tobacco, as are those who identify as gay, lesbian, or bisexual, and those who live with a mental health condition or substance use disorder.

“Progress, in the form of improvements in tobacco-related policies, regulations, programs, research, clinical care, and other areas, has not resulted in the same outcomes for everyone,” said Adm. Rachel L. Levine, HHS Assistant Secretary for Health, in the advisory. “We have not made progress unless we have all made progress.”

When you quit smoking, you immediately reap health benefits, such as a reduced risk of a cardiovascular event. While some benefits can be seen from cutting back, health experts recommend quitting smoking entirely.

“Cutting down on smoking can potentially be useful if it puts someone on the path to eventually quit,” Dr. Cheng-Han Chen, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California, told Healthline in a recent interview.

“Quitting smoking is essential to minimize the risk of a future cardiovascular event and can potentially be lifesaving,” Chen said.

There is value in calling coaching quitlines like 1-800-QUIT-NOW. The CDC notes these resources are often key to success in quitting smoking. Other resources include websites such as:

Additionally, the Great American Smokeout from the ACS is an email-based program offering support for quitting smoking.

To quit smoking, experts recommend starting your smoke-free journey by making a concrete plan.

“Set a target quit date, preferably within 2 weeks, and support your quit attempt with medication and counseling. This combination of support — rather than relying on one or neither — is key and leads to higher success rates,” Hilary Tindle, MD, PhD, the founding director of ViTAL, the Vanderbilt Center for Tobacco, Addiction, and Lifestyle at Vanderbilt University Medical Center, told Healthline in a recent interview.

“If someone does not succeed on the first quit attempt, keep trying,” Tindle said. “ In the U.S., more than 50% of all people who ever smoked have now quit.”