Tobacco Facts.

Tobacco use is the leading cause of preventable death in the United States, and cigarette smoking, the predominant form of tobacco use in the United States, causes 443,000 deaths annually (1). In 2008, 20.6% of U.S. adults were current smokers (2); however, other tobacco products (e.g., smokeless tobacco, cigars, bidis, and kreteks) also were used by some adults and youths (3). Persons who use cigarettes in combination with other tobacco products (polytobacco use) might have an in increased risk for adverse health effects (3). To estimate the prevalence of any tobacco and polytobacco use, CDC analyzed data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) (the most recent data available) module on use of other tobacco products, which was implemented by 13 states. This analysis found that use of any tobacco product ranged from 18.4% (New Jersey) to 35.0% (West Virginia), cigarette use ranged from 14.6% (New Jersey) to 26.6% (West Virginia), and polytobacco use ranged from 1.0% (New Jersey) to 3.7% (West Virginia). Polytobacco use was more prevalent among men (4.4%), persons aged 18-24 years (5.7%), persons who were single (4.8%), persons with household incomes less than $35,000 (9.8%), and persons with less than a high school education (3.6%) or with a high school diploma or General Education Development (GED) certificate or diploma (3.6%). Because no form of tobacco is safe to use, prevention and cessation intervention programs need to address all forms of tobacco use to lower tobacco-related morbidity and mortality in the United States. Additionally, counter-marketing messages for tobacco products can be tailored for specific populations, such as young adults and males.

BRFSS is a state-based, telephone survey of noninstitutionalized, civilian adults aged ≥18 years in all 50 states, the District of Columbia (DC), and U.S. territories. In 2008, 13 states* collected information on the use of tobacco products other than cigarettes through an optional BRFSS module.† Responses to questions on this module and the core questionnaire were used to measure current use of cigarettes,§ smokeless tobacco,¶ and other tobacco products (cigars, pipes, bidis,** kreteks,†† and others).§§ Any tobacco users were considered respondents who currently used any of the following: cigarette, smokeless tobacco, or other tobacco products. Current polytobacco users were considered respondents who were current cigarette smokers and also current users of another form of tobacco (either smokeless tobacco or other tobacco products). BRFSS uses multistage probability sampling to obtain state-specific estimates of risk behaviors. Estimates weighted by probability of selection and post-stratified by age, sex, and race were calculated, as were 95% confidence intervals for each state and aggregated selected demographic subgroups. Response rates for the 2008 BRFSS survey were calculated using Council American Survey and Research Organizations (CASRO) guidelines,¶¶ and ranged from 43.4% to 65.5% (median: 55.3%) in the 13 states. Cooperation rates*** in 2008 ranged from 68.4% to 80.7% (median: 76.0%). Data were combined for the 13 states to examine how tobacco use measures were distributed among demographic groups in those states.††† For comparisons of prevalence by sex, race/ethnicity, income, education, and marital status, statistical significance (p<0.05) was determined using a two-sided z-test.

During 2008, the range of prevalence of any tobacco use in the 13 states was 18.4% (New Jersey) to 35.0% (West Virginia) (Table 1). Polytobacco use also was highest in West Virginia (3.7%) and lowest in New Jersey (1.0%). Among the 13 states, current use of any tobacco was more prevalent among men than women (p<0.001) and decreased with increasing age (Table 2). Any tobacco use was more prevalent among non-Hispanic whites (26.2%) and non-Hispanic blacks (24.4%) than among Hispanics (19.7%, p<0.001 and p=0.001, respectively). Any tobacco use also was most prevalent among persons who were a member of an unmarried couple (36.3%), single (30.3%), widowed or divorced (29.1%), or who had less than a high school education (33.1%). Any tobacco use decreased with increasing levels of annual income, 32.5% for those earning less than $15,000 and 19.2% for those earning $75,000 or more. Polytobacco use was most prevalent among men (4.4%), persons aged 18-24 years (5.7%), single adults (4.8%), persons with less than a high school education (3.6%) and high school diploma/GED (3.6%), and persons with incomes less than $35,000 (9.8%).

Reported by

S Thorne, PhD, A McClave, MPH, V Rock, MPH, K Asman, MSPH, A Malarcher, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

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