Approximately one fourth of the population uses tobacco products, and 19.4 percent smoke cigarettes. According to the 2016 National Survey on Drug Use and Health (NSDUH), an estimated 63.4 million people aged 12 or older used a tobacco product during the past month, including 51.3 million cigarette smokers.7 Smoking rates continue to go down year to year; the percentage of people over age 18 who smoke cigarettes declined from 20.9 percent in 2005 to 15.8 percent in 2016, according to the 2017 National Health Interview Survey.8
However, smoking rates are substantially higher among some of the most vulnerable people in our society. The 25 percent of Americans with mental disorders, including addiction, account for 40 percent of the cigarettes smoked in the U.S.9 (see "Do people with mental illness and substance use disorders use tobacco more often?"). More than 40 percent of people with a General Education Development certificate (GED) smoke—which is the highest prevalence of any socioeconomic group.10 Also, people who live in rural areas, particularly in the South Atlantic states, use all forms of tobacco at higher rates than people who live in urban areas. These differences cannot be fully explained by different levels of poverty or affluence.11
Smoking among youth is at historically low levels. According to the NIDA-sponsored Monitoring the Future (MTF) survey,12 in 2015, an estimated 4.7 million middle and high school students used tobacco products during the past month, according to data from the National Youth Tobacco Survey (NYTS)13 e-cigarettes) were the most commonly used tobacco products among middle (5.3 percent) and high school (16.0 percent) students in 2015.13 E-cigarettes deliver synthetic nicotine and do not contain tobacco; however, they are classified as tobacco products for regulatory purposes. These findings are echoed by other studies,14–17 including the MTF survey.12 Scientists have not yet determined the medical consequences of long-term e-cigarette use or the secondhand effects of e-cigarette vapor (see "What are electronic cigarettes?").
Between 1964 and 2012, an estimated 17.7 million deaths were related to smoking18 leads to more than 480,000 deaths annually.1 If current smoking rates continue, 5.6 million Americans who are currently younger than 18 will die prematurely from smoking-related disease.13
In addition to the tremendous impact of premature deaths related to tobacco use, the economic costs are high. Experts estimate that between 2009 and 2012, the annual societal costs attributable to smoking in the United States were between $289 and $332.5 billion. This includes $132.5 to $175.9 billion for direct medical care of adults and $151 billion for lost productivity due to premature deaths. In 2006, lost productivity due to exposure to secondhand smoke cost the country $5.6 billion.1 About 70 percent of current smokers’ excess medical care costs could be prevented by quitting.19