Cigarette smoking by Americans declined steadily from the mid-1960s to around 2005, when this progress began to slow. From 2013 to 2017, however, cigarette smoking rates fell sharply, during a period in which the use of electronic cigarettes or e-cigarettes increased sharply. This study examines the connection between these two developments and the implications.

In 1964, U.S. Surgeon General Luther Terry issued the landmark report on the health dangers of cigarette smoking. Drawing on more than 7,000 studies, the report found that cigarette smoking was a cause of lung cancer among men, a likely cause of lung cancer among women, and the leading cause of chronic bronchitis for both men and women.

The following year, Congress passed the “Federal Labeling and Advertising Act of 1965” directing cigarette manufacturers to post health warning labels on all cigarette packaging. Since then, the federal government, American Cancer Society, the American Heart Association, the American Lung Association and other organizations have conducted continuing, large scale public education campaigns encouraging Americans to quit smoking or resist taking up the habit.

These efforts have been very successful. The share of American adults using tobacco products fell steadily from 42.4 percent in 1965 and 30.1 percent in 1985 to 20.9 percent in 2005. 3 This progress slowed from 2005 to 2011, when 18.0 percent of adults still smoked, and then accelerated again from 2013 to 2017, at by which time the share of American adults still smoking cigarettes had fallen to 14.0 percent.

In fact, all forms of smoking fell markedly from 2011 to 2017 with one exception: From 2011 to 2017, while cigarette smokers fell from 19.0 percent of adults to 14.0 percent, the use of electronic or e-cigarettes more than doubled from 1.3 percent to 2.8 percent. Larger declines in cigarette smoking and greater increases in e-cigarette use occurred among young Americans.

From 2011 to 2017, the share of high school students who smoked cigarettes dropped from 15.8 percent to 7.6 percent, while their use of e-cigarettes jumped from 1.5 percent to 11.7 percent.

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