special subjects
Smoking and Other Tobacco Use
Epidemiology of Tobacco Use
The prevalence of tobacco use in the United States has declined over the past 50 years, but because of population growth, the number of adults in the United States who use any tobacco product has remained relatively stable at an estimated 46 million ( Epidemiology references ). The percentage of people in the United States who smoke cigarettes has declined since 1964, when the Surgeon General first publicized the link between smoking and ill health. Nevertheless, 11.5% of adults (28.3 million) in the United States still smoke cigarettes ( Epidemiology references ). Smoking is more prevalent among the following groups: Men Young adults People who identify as lesbian, gay, bisexual, or transgender People with disabilities People with less than a high school education People living at or below the poverty income level People with psychiatric disorders (including alcohol and substance use) American Indian and Alaskan Native people Smoking is less common among Hispanics and least common among Asian American women. Nearly all people who smoke start before the age of 18, making tobacco use a pediatric disorder ( Epidemiology references ). Each day, approximately 2300 youth under age 18 smoke their first cigarette, and nearly 200 youth start smoking daily. Major risk factors for childhood initiation of smoking include smoking among family members and peers as well as exposure to tobacco advertising and marketing in print, online, and at the point of sale in stores, along with tobacco use scenes in movies and video games. smoking are less common in the United States. In 2021, an estimated 8.6 million people aged 18 or older (3.5%) smoked cigars and 2.3 million (0.9%) smoked a pipe, water pipe, or hookah ( Epidemiology references ). These percentages have remained relatively stable over the past 15 years. Health harms of pipe and cigar smoking include cardiovascular disease; Vaping None While there is no combustion involved in using e-cigarettes, the aerosol emitted from the device is more than water vapor. In addition to often containingnicotine, e-cigarette aerosol has ultrafine particles, which can be inhaled deeply into the lungs; flavoring such as diacetyl, a chemical linked to serious lung disease; volatile organic compounds; cancer-causing chemicals; and heavy metals (eg, nickel, tin, and lead), though all at lower levels than in combusted tobacco smoke. While the long-term effects of inhaling e-cigarette aerosol are not clearly known, it is reasonable to speculate that they are likely to be less detrimental than the well-known adverse effects of smoking combustible cigarettes. For people who use e-cigarettes and continue to smoke, a common practice ofdual users, the health benefits of e-cigarette use are unproven. The effects of maternal e-cigarette use on fetal development are unknown, as are the long-term effects of e-cigarette use on the developing adolescent brain. E-cigarette use among youth exceeds combustible tobacco use ( Epidemiology references ). The long-term risks of e-cigarette smoking, a relatively new phenomenon, are unknown. (See also information about e-cigarettes from the acetate, which is the most recognized agent associated with EVALI ( Epidemiology references ). The CDC encourages clinicians to continue to report possible EVALI cases to their local or state health department for further investigation. If EVALI is suspected, the clinician should obtain a detailed history of substances used, sources of products, duration and frequency of use, and devices used and how those devices were used. (chewing tobacco and snuff) is used by approximately 2.1% of people ≥ 18 years of age ( Epidemiology references ) and approximately 1.6% of high school students ( Inadvertent oral exposure to tobaccois uncommon but may cause serious toxicity. Young children occasionally ingest cigarettes from unguarded packs, cigarette butts from ashtrays, e-cigarette liquid, ornicotinegum. In 2022, 6745 cases of potentially toxic exposure to e-cigarettes and liquidnicotineproducts were reported to the American Association of Poison Control Centers (AAPCC) (seeAAPCC: E-cigarettes and Nicotine). Cutaneous exposure to tobaccocan be toxic. Tobacco harvesters and processors who handle raw tobacco (especially if wet) without protection may absorbnicotinethrough the skin and develop symptoms ofnicotinetoxicity, a syndrome termed green tobacco sickness. Secondhand smoke None 1.Cornelius ME, Loretan CG, Jamal A, et al: Tobacco Product Use Among Adults - United States, 2021.MMWR Morb Mortal Wkly Rep72(18):475-483, 2023. Published 2023 May 5. doi:10.15585/mmwr.mm7218a1 2.Park-Lee E, Ren C, Cooper M, et al: Tobacco Product Use Among Middle and High School Students - United States, 2022.MMWR Morb Mortal Wkly Rep71(45):1429-1435, 2022. Published 2022 Nov 11. doi:10.15585/mmwr.mm7145a1 3.Rebuli ME, Rose JJ, Noël A, et al: The E-cigarette or Vaping Product Use-Associated Lung Injury Epidemic: Pathogenesis, Management, and Future Directions: An Official American Thoracic Society Workshop Report.Ann Am Thorac Soc20(1):1-17, 2023. doi:10.1513/AnnalsATS.202209-796ST 4.Homa DM, Neff LJ, King BA, et al: Vital signs: disparities in nonsmokers' exposure to secondhand smoke--United States, 1999-2012.MMWR Morb Mortal Wkly Rep64(4):103-108, 2015 