Nicotine: Usage trends

Scope and severity
Cigarette smoking is the most common substance use disorder in the United States. A billion cigarettes were produced in the entire United States in 1885. Today over one billion are smoked daily. Nationally, there were 48 million adult (18 years and older) smokers in 2001. The average smoker smokes 20 cigarettes per day.
Low-income adults smoke more than high-income adults. People with less education smoke more than those with college degrees. Habitual users of alcohol, cocaine, and heroin are more likely to be smokers too. More than 80% of alcoholics are smokers, and alcoholic drinkers are at least twice as likely to be smokers than are nondrinkers. The highest prevalence rates are seen with psychiatric patients: up to 88% of schizophrenics smoke, and approximately 50% of patients with anxiety, personality disorders, and depression smoke. Forty percent of adults with attention deficit hyperactivity disorder (ADHD) smoke.
However, the 2001 smoking rate of 25% is markedly decreased from the height of the smoking epidemic in 1965, when 42% of adults over 18 years old smoked. More than half of the smokers in the United States since the mid-1960s have quit. However, following years of steady decline, rates showed only modest declines in the 1990s.
The consumption of cigars has been increasing since 1993 with growing popularity among younger, affluent people. In 1998, 5% of adults had smoked a cigar product in the last month. Pipe smoking is in decline, with only 2% of men in partaking in 1991, and very uncommon usage among women. Pipe smoking is mainly found in men over the age of 45, who are also likely to be users of other tobacco products, especially cigarettes. National data from 1999 shows 6% of adult men and 1% of women use chewing tobacco or snuff. But the popularity of smokeless tobacco is increasing, especially among younger white males.
Gender trends
Historically, smoking became prevalent among men before women, but the gap between male and female smoking rates narrowed in the mid-1980s and has remained constant. The American 2001 smoking rate of 28% men and 22% women decreased from the 1965 peak, when 52% of men and 32% of women smoked. In developing countries, 48% of males smoke. Rates among women are substantially lower (7%) but increasing.
The prevalence of smoking during pregnancy has declined steadily in recent years, although 13-22% of pregnant women continue to smoke. Only about one third of women who stop during pregnancy are still abstinent one year after the delivery.
Studies indicate that men and women differ in their smoking behavior. Women tend to smoke fewer cigarettes per day than men, are more likely to use filtered or low-tar and -nicotine cigarettes, and inhale less deeply. Women are less likely to use smokeless tobacco, cigars, or pipes than men are. Correspondingly, lung cancer rates are lower in women than men. However, in 2001, the United States Surgeon General noted a 600% increase since 1950 in women's death rate from lung cancer, primarily caused by previous decades of cigarette smoking.
Age trends
Most tobacco users begin the habit in their teens. Initiation and addiction to smoking occurs in 90% of tobacco users by their eighteenth birthday. Every day in the United States, more than 6,000 young people try a cigarette, and almost 3,000 become regular smokers. First-time cigarette use is most likely to occur between ages 11 and 15, in sixth through tenth grade. A long-term national study found that 70% of high-school seniors who smoked as few as one to five cigarettes a day were still smoking five years later, and most were smoking more cigarettes per day. Tobacco is often the first drug used by young people who go on to use alcohol, marijuana, and other drugs.
In 1999, 44% of male students and 37% of female students reported using some form of tobacco (cigarettes, cigars, or smokeless tobacco) in the past month. Thirty-five percent of high-school students were current smokers, including 39% of white students, 33% of Hispanic students, and 20% of African American students. The 2000 rate of high school use of bidis was 5% and 5.8% for kreteks.
Overall, the percentage of American high-school students who smoked increased through the mid-1990s after declining in the 1970s and 1980s. The CDC found that the sharpest rise in daily smoking rates began in 1988, the year the Joe Camel advertising campaign began. A study released in 2001 shows that high school smoking levels peaked in 1997 and have since made steady progress downward. The decline is attributed to several factors, including decreased advertising targeted at youth, increased anti-smoking advertising, and increased prices of cigarettes.
Adolescent boys are shifting from smoking to smokeless tobacco partly due to the mistaken belief that it is a safe substitute for smoking. Nationwide in 2000, 4% of middle school boys and 12% of high school boys used chewing tobacco or snuff. White male students were more likely than Hispanic or African American male students to use smokeless tobacco. The median age for first use of smokeless tobacco is 12, two years younger than the median age for first use of cigarettes.
An increasing number of boys and girls are experimenting with cigars, unaware that the risks are similar to cigarette smoking. In 1999, an alarming 25% of high school males, and 10% of high school females were using cigars. White students are more likely than African American students to smoke cigar products.
Ethnic trends
Multiple factors determine patterns of tobacco use among racial and ethnic minority groups in the United States: socioeconomic status, cultural characteristics, degree of assimilation into American culture, stress, biological elements, targeted advertising, price of tobacco products, and the varying capacity of communities to mount effective tobacco control initiatives.
Between 1983 and 1995, cigarette smoking declined for whites (34% to 26%), African Americans (37% to 27%), Hispanics (30% to 19%), and Asian and Pacific Islanders (24% to 15%). The prevalence of tobacco use among Native American and Alaskan Natives stayed at 41% between 1983 and 1995.
The American Heart Association smoking statistics for the year 2000 are as follows:
• Native American men: 38%; women: 31%
• African American men: 32%; women: 22%
• Caucasian American men: 27%; women: 23%
• Hispanic American men: 26%; women: 14%
• Asian and Pacific Islander American men: 22%; women: 12%
It is important to note that although African Americans do not have the highest smoking rates of racial groups in the United States, they appear to bear the greatest adverse health effects, particularly lung cancer in males. Some studies propose that the use of mentholated cigarettes by 80% of African Americans might be a cause.
Occupational and workplace trends
Professional, technical workers, and clergy have the lowest smoking rates whereas the military, law enforcement, and blue-collar workers have the highest rates. More adults are taking up the smokeless tobacco habit if they are no longer allowed to smoke on the job. Professional baseball players have an alarmingly high rate of 35% to 40% chewing tobacco use, and approximately half of those have pre-cancerous lesions of the mouth.
Larger employers with over 100 workers are more likely to adopt restrictive smoking policies, compared to smaller companies. Hospitality, service, and blue-collar workplaces in manufacturing and processing industries are less likely to be smoke-free environments.
Global trends
Tobacco use is one of the major causes of preventable death in the world. The estimated 1.2 billion smokers in the world consume an average of 14 cigarettes per day. In the year 2000, 4.2 million deaths were due to tobacco use, and the figure is expected to rise to 10 million deaths annually by the year 2030. Seven million of those deaths are expected to occur in developing countries. While smoking rates are slowly declining in developed nations, they are steadily growing in developing nations at a rate of 3.4% per year. Smoking will eventually kill about 500 million people alive in the world today. One billion people will die from tobacco in this century.

Nicotine: Therapeutic use

Nicotine: Mental effects