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Study Highlights State of Smoking in US

Cigarette smoking has been declining in the United States over the past 50 years. In 1965, about 42% of adults smoked. As of 2015, 15% said they did. That’s progress. But not enough, according to “Who’s Still Smoking? Disparities in adult cigarette smoking prevalence in the United States,” a publication from American Cancer Society researchers. It reviews how common cigarette smoking is across different groups of adults. The report was published in the journal CA: A Cancer Journal for Clinicians

What they found: Traditional ways to decrease tobacco use are leading to positive health effects for most groups of people, but certain vulnerable populations are having fewer health benefits. Cigarette smoking is much more common among people:

  • with less education and/or whose income puts them below the US Federal poverty level
  • within certain ethnic/racial groups
  • in lesbian, gay, bisexual, and transgender (LGBT) communities
  • who have mental illness
  • in the military
  • in certain areas of the US

What ACS researchers and experts recommend: Health providers and payers, cancer organizations, and the government at the national, state, and local level need to create more new strategies that target people in these groups. For example, the US Food and Drug Administration's “This Free Life” campaign is aimed at reducing tobacco use in the LGBT community. Leaders can also put more effort into what we know works to reduce smoking, such as increasing taxes on cigarettes. In addition, tobacco cessation services should be more widely available. 


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Adults with a high school education or less are 3 times more likely to smoke cigarettes than those with a college education. This is a major shift from 50 years ago. Then, the percentage of people with a college education (almost 40%) who smoked was about the same as the percentage of adults with all other levels of education (45%). 

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Adults in higher-income households are much less likely to smoke cigarettes than those in households below the poverty level – 10% vs. 25%. 

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Cigarette smoking rates are highest among American Indians and Alaskan Natives and lowest among Asians and Hispanics. 

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Mental Illness

Adults with a serious, recent mental illness are more than twice as likely to smoke cigarettes as those who haven't had a serious mental illness. There's significant variation among different types of mental illness too. More adults with schizophrenia smoke than adults with another type of mental illness. In fact, nearly 60% of adults with schizophrenia smoke.

Recruits undergo basic training at Marine Corps Recruit Depot Parris Island in South Carolina


Adults serving in the military are much more likely to smoke cigarettes than those in the general population. But the study notes the number of smokers within the military has declined significantly in recent decades. Despite this drop, there are still large differences based on military pay grade. In 2011, about 30% of service members in the lowest 4 pay grades of enlisted members (E1-E4) smoked. Less than 5% of those in the highest 6 pay grades of commissioned officers (O4-O10) smoked. In order to become an officer, one must have a college education, too. 

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Sexual Orientation

In the US, adults who identify as lesbian, gay, bisexual, or transgender (LGBT) are significantly more likely to smoke than other adults. ACS researchers note that studies show the social stresses of living in a society that can be hostile to people in the LGBT community may contribute to the higher prevalence.

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The popularity of smoking varies a lot across states. For example, only 8.7% of adults in Utah smoke. But in Kentucky, 26.2% of adults do. 

How to Quit Smoking

It’s hard to quit, but you can do it. Start your new life today. Learn how to give yourself the best chance of quitting tobacco and staying quit by knowing what you’re up against, what your options are, and where to go for help. We can help.