The number of U.S. adults who smoke cigarettes has reached the lowest level ever recorded, according to new government data. However, despite the progress, health officials say too many Americans are still using tobacco products.
According to the report from the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institute of Health’s National Cancer Institute (NCI), an estimated 14 percent of U.S. adults — about 34 million people— reported smoking cigarettes “every day” or “some days” when they were surveyed in 2017. That’s down from 15.5 percent in 2016. The figure has declined a whopping 67 percent since 1965.
However, the latest data showed that about 47 million, or 1 in 5, Americans still use a variety of tobacco products, including e-cigarettes, which are increasingly popular among young people.
“This new all-time low in cigarette smoking among U.S. adults is a tremendous public health accomplishment – and it demonstrates the importance of continued proven strategies to reduce smoking,” CDC Director Robert Redfield, said in a statement. “Despite this progress, work remains to reduce the harmful health effects of tobacco use.”
Researchers observed a particularly notable decline in cigarette smoking among young adults. In 2017, about 10 percent of young adults aged 18 to 24 smoked cigarettes, compared to 13 percent in 2016.
Cigarette smoking remains the leading preventable cause of death and disease in the United States, killing an estimated 480,000 Americans each year. About 16 million Americans suffer from a smoking-related illness. Officials say it is responsible for the overwhelming burden of death and disease from tobacco use.
The new data is based off a nationally representative survey of more than 26,000 adults aged 18 and older. The report was published today in the CDC’s Morbidity and Mortality Weekly Report.
Participants were asked about their use of tobacco products, including cigarettes, cigars, e-cigarettes, hookah/water pipes/pipes, and smokeless tobacco.
The report found that cigarettes were the most commonly used product among U.S. adults at 14 percent. This was followed by cigars, cigarillos, or filtered little cigars at 3.8 percent; e-cigarettes at 2.8 percent; smokeless tobacco at 2.1 percent; and pipes, water pipes, or hookahs at 1 percent.
The use of tobacco products was higher among people who were uninsured; people with a disability; people who identify as lesbian, gay, or bisexual; and people with an annual household income under $ 35,000.
Geographically, adults living in the Midwest or the South were more likely to use tobacco.
Use of tobacco was highest among non-Hispanic American Indian/Alaska Natives, followed by multiracial, white, and black adults.
About 2 in 5 adults who reported serious psychological distress said they used a tobacco product, compared to 1 in 5 of those without such conditions.
“For more than half a century, cigarette smoking has been the leading cause of cancer mortality in the United States. Eliminating smoking in America would, over time, eliminate about one-third of all cancer deaths,” said NCI Director Norman E. Sharpless, M.D. “The persistent disparities in adult smoking prevalence described in this report emphasize the need for further research to accelerate reductions in tobacco use among all Americans.”
The report also calls for comprehensive tobacco control programs at the national, state, and local levels to further drive down the number of Americans using tobacco.
FDA Commissioner Scott Gottlieb called the continued drop in adult smoking rates “encouraging” and said the FDA is committed to accelerating declines.
“We’ve taken new steps to ultimately render combustible cigarettes minimally or non-addictive and to advance a framework to encourage innovation of potentially less harmful products such as e-cigarettes for adults who still seek access to nicotine, as well as support the development of novel nicotine replacement drug therapies,” Gottlieb said in a statement. “At the same time we’re also working to protect kids from the dangers of tobacco product use, including e-cigarettes.”
Although the herbal supplement kratom is still legal and widely available, its opioid-like effects have caused significant withdrawal symptoms in at least two newborns in the United States and that should raise concerns, researchers say.
A case study of a baby boy exposed to kratom during his mother’s pregnancy — only the second American case reported — likely signifies a broader trend among pregnant women toward seeking alternatives to opioid painkillers such as morphine, heroin and oxycodone (OxyContin), said study author Dr. Whitney Eldridge.
“I think mothers are becoming increasingly aware of the dangers of using prescription and non-prescription opioids during pregnancy,” said Eldridge, a neonatologist at Morton Plant Hospital and St. Joseph Women’s Hospital, both in Florida.
“As opioid use among pregnant women has increased, I fear they may see kratom as a potentially safe, legal, non-opioid alternative aid for opioid withdrawal, as its opioid-like properties are not well-advertised,” Eldridge added.
In February, the U.S. Food and Drug Administration classified compounds in kratom as opioids, basing its findings on a computer analysis showing it activates receptors in the brain that also respond to opioids.
But controversy over kratom — which is sold as a dietary supplement, typically to manage pain and boost energy — remains, as it continues to be sold as a non-opioid remedy for opioid withdrawal. Non-opioid alternatives to treat opioid dependence continue to be researched and scrutinized, experts said.
The case study, published online Nov. 7 in the journal Pediatrics, centered on a newborn boy whose mother had a seven-year history of oxycodone use, but who had successfully completed drug rehabilitation. She had last used oxycodone two years before her baby was born, and her urine test was negative for drug use.
Kratom — which grows naturally in the Southeast Asian countries of Indonesia, Malaysia, Papua New Guinea and Thailand — is less potent than morphine and doesn’t slow breathing. But 33 hours after his birth, the baby boy in this case study began showing symptoms consistent with opioid withdrawal, including sneezing, jitteriness, excessive suck, scratching at the skin around his face, and irritability.
His mother denied using prescription medications, supplements or illegal drugs during her pregnancy, but the baby’s father reported that the mother drank kratom tea daily during pregnancy. She had bought the tea to help with sleep and her own opioid withdrawal symptoms.
Treated with morphine and a common blood pressure drug over the next several days, the boy’s condition improved and he was discharged from the hospital at 8 days old.
“Prior to this case, I was unfamiliar with kratom and unaware of its potential to be a source of withdrawal for [newborn babies],” Eldridge said. “After caring for this infant, I started to pay attention to how heavily kratom is advertised and realized pediatricians and obstetricians need to be familiarized with its potential to affect our patients.”
Further research is needed to “make an educated decision as to how to classify kratom,” she suggested.
“It may have a role to play in opioid dependency, [but] currently there is too little data to say what role it should be,” Eldridge added. “Meanwhile, pregnant women should disclose kratom use to their physicians just as they would alcohol or tobacco, and physicians have a responsibility to educate pregnant women about the potential impact of kratom for their newborn.”
Eldridge’s sentiments were echoed by Dr. Martin Chavez, chief of maternal-fetal medicine at NYU Winthrop Hospital in Mineola, N.Y.
“I think what hit home most with this case study … is that we really have to do a thorough job inquiring what type of alternate medications — whether over-the-counter, holistic or something being provided by a family member — a pregnant woman may be taking,” said Chavez.
“The most important thing is, just because it’s not being prescribed doesn’t mean it’s not having a potential impact [on the baby],” he added. “When in doubt, when you’re pregnant or have a newborn, be totally open with your clinician not only about prescription medications, but any other type of medication you may be taking to alleviate symptoms you’re having.”