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13 Fitzgerald Health Education Associates, Inc., December 2014 fhea.com Update: Tobacco Use Adult Smoking Rate Gets Lower; Youth Rate Now Higher than Adults T he rate of cigarette smoking among adults in the United States dropped from 20.9% in 2005 to 17.8% in 2013, according to new data from the US Centers for Disease Control and Prevention (CDC); this is the lowest prevalence of adult smoking since the CDC's National Health Interview Survey be- gan keeping records of smoking in 1965 (MMWR. 2014; 63(47):1108-1112). The number of cigarette smokers dropped from 45.1 million in 2005 to 42.1 million in 2013 even though the US population increased. The good news on falling smoking rates in adults is tempered by high rates of cigarette smoking among certain groups: those below the poverty level, those who have less education, Americans of multiple race, American Indians/Alaska Natives, males, those who live in the South or Midwest, those with a disability or limitation, and those who are lesbian/gay/bisexual. Tim McAfee, MD, MPH, Director of the CDC's Office on Smoking and Health, noted that there is a long way to go to help more people quit. Surveys show that about 70% of cigarette smokers want to quit. Among smokers, the proportion of those who smoke every day decreased from 80.8% in 2005 to 76.9% in 2013, and among daily smokers the aver- age number of cigarettes smoked per day declined from 16.7 in 2005 to 14.2 in 2013. Unfortunately, al- though smokers are smoking fewer cigarettes, cut- ting back by a few cigarettes a day rather than quitting completely does not produce significant health benefits. Smokers who quit before they are 40 years old can get back almost all of the 10 years of life expectancy they lose by smoking. Other Forms of Tobacco Use on the Rise Use of other forms of smoking tobacco such as ci- gars and hookahs is not declining, the CDC notes (MMWR. 2014;63(45):1021-1026). In some popula- tions, especially among young adults and adoles- cents, use of these products may even be increasing. Although cigarettes were the most prevalent to- bacco product used by white and Hispanic high school students (14% and 13.4%, respectively), cigar use was close behind (11.4% and 12.1%) and was more prevalent than cigarette use for other races/ethnicities. Cigar use among black high school students was nearly 50% higher than cigarette use (14.7% vs 9.0%) and more than twice as high (4.5% vs 1.7%) among black middle school students. A Closer Look at Youth Smoking Rates More than 1 in 5 high school students currently use a tobacco product. More than 90% of those using a tobacco product are using combustible tobacco products such as cigarettes, cigars, hookahs, and pipes. The January 2014 Surgeon General's Report concluded that unless youth smoking rates drop rapidly, 5.6 million children and adolescents current- ly aged 0 to 17 will die early from cigarette smok- ing–related illness. Nine out of 10 smokers try their first cigarette by age 18. The CDC's survey in 2013 found that 22.9% of high school students and 6.5% of middle schoolers reported using a tobacco product within the last 30 days. In addition, 12.6% of high school students say they currently use two or more tobacco products. E-Cigarettes: Are They Recruiting Smokers? Among high school students, 4.5% reported using e- cigarettes within the last 30 days, and 1.1% of mid- dle schoolers reported using e-cigarettes in the last 30 days. A recent study by Thomas A. Wills, PhD, and colleagues published online in Pediatrics (December 15, 2014) found the largest prevalence rates of e-cig- arette-only use in the literature to date. Seventeen percent of the 1941 high school students in Hawaii who were surveyed in 2013 used e-cigarettes only, 12% smoked cigarettes and e-cigarettes, and 3% smoked only cigarettes. The study concluded that there is a possibility that e-cigarettes are recruiting medium-risk adolescents who otherwise would be less susceptible to tobacco product use. •