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Cigarette smoking in the United States

Cigarette smoking remains the leading cause of preventable morbidity and mortality in the United States, resulting in an estimated 443, 000 premature deaths and $193 billion in direct health-care expenditures and productivity losses each year. The prevalence of cigarette smoking among youth and adult smokers has declined, but that decline has stalled during the past 5 years among adults. Despite overall declines in cigarette smoking, disparities in smoking and other tobacco use still persist among certain racial/ethnic minority groups, particularly among American Indians/Alaska Natives (AI/ANs) (). In addition to racial/ethnic disparities in cigarette smoking, other groups have higher prevalence of cigarette smoking, with higher use reported among persons with low socioeconomic status; persons with histories of mental health and substance abuse conditions; the lesbian, gay, bisexual, and transgender community; and persons living in the South and Midwest regions of the United States.

Each day in the United States, approximately 3, 900 persons aged 12-17 years smoke their first cigarette, and an estimated 1, 000 adolescents become daily cigarette smokers (). The vast majority of persons who begin smoking during adolescence are addicted to nicotine by age 20 (). Among youth, factors associated with smoking include low socioeconomic status, low academic achievement (e.g., poor grades and absenteeism), high-risk sexual behavior, and use of alcohol and other drugs (9, 10). As with adult smoking, racial/ethnic differences in cigarette smoking exist among youth smokers, with AI/ANs having the highest prevalence of cigarette smoking, particularly among females. In comparison, youth smoking among black females has consistently been lower and has declined during past years. These declines have contributed to the overall lower prevalence of cigarette smoking among black youth smokers.

Although multiple tobacco-related disparities exist, this report highlights only racial/ethnic and socioeconomic disparities because of limited data for other demographic groups. To highlight racial/ethnic and socioeconomic disparities in current cigarette smoking among youths and adults, CDC analyzed aggregated data from the National Survey on Drug Use and Health (NSDUH) for 2006-2008. NSDUH is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) and is designed to provide annual information about alcohol, tobacco, and illegal drug use among the noninstitutionalized U.S. household population aged ≥12 years. Specifically, NSDUH findings highlight racial/ethnic disparities in cigarette smoking among youths aged 12-17 years and adults aged ≥18 years as well as disparities in cigarette smoking among persons with low socioeconomic status in the United States. For the purposes of this report, adults who have lower levels of educational attainment, who are unemployed, or who live at, near, or below the U.S. federal poverty level are considered to have low socioeconomic status.

To measure declines in smoking among non-Hispanic white men and women and non-Hispanic black men and women aged ≥18 years, as well as the declining disparities among these populations since the 1964 Surgeon General's report on smoking and health (11), CDC analyzed public use data files from the National Health Interview Survey (NHIS) for 1965-2008. Similar data are unavailable from NSDUH before 2002. Because NHIS does not collect data on tobacco use by youth, NSDUH is the primary data source for this report.

Population-weighted prevalence estimates with 95% confidence intervals were calculated using statistical software to account for the multistage probability designs of the NSDUH and NHIS. Statistical significance (p

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