Hawaiʻi Health Data Warehouse


The topic of Tobacco includes current use of tobacco products, initiation, cessation, secondhand smoke exposure, and tobacco-related policy. Tobacco use must be examined from all angles, because it is the single most preventable cause of death and disease in the United States (US). Electronic cigarettes, also called e-cigarettes, e-cigs, vapes, e-hookahs, vape pens, electronic smoking devices (ESDs), and electronic nicotine delivery systems (ENDS), are included in this section since most contain nicotine – a highly addictive component of tobacco.

Why It’s Important

Tobacco use is the leading cause of preventable disease, disability, and death in the US. Tobacco use accounts for one of every five deaths in this country, approximately 480,000 people each year, including more than 41,000 from secondhand smoke. Furthermore, for each person who dies from tobacco use, another 33 will suffer from a tobacco-related illness. Tobacco use has been linked to diseases in nearly every organ. The US spends more than $225 billion each year on medical care to treat smoking-related disease in adults.

What Is Known

About 1 in 5 adults (20.1%) use cigarettes, e-cigarettes, cigars, smokeless tobacco, hookah or pipe tobacco every day or some days and 18.0% of students grades 6-12 (4.0% to 32.4%, respectively) used at least 1 form in the past 30 days.

  • Tobacco product use is started and established primarily during adolescence and 81% of youth who ever tried tobacco choose flavored tobacco as their first tobacco product.1
  • Each day, about 1,600 people younger than 18 years smoke their first cigarette.2
  • In 2019, 5.0% of middle school students and 8.1% of high school students in Hawaiʻi public schools reported current cigarette smoking. By contrast, 15.7% of middle school and 25.5% of high school students currently used e-cigarettes (YRBS).
  • In 2019, 10.5% of middle school and 17.8% of high school students in Hawaiʻi public schools said they had ever tried smoking a cigarette (experimentation). Experimentation with e-cigarettes was 30.6% for middle school students and 48.3% for high school students (YRBS).
  • Quitting tobacco use greatly decreases a person’s risk for many negative health outcomes, some within a very short time after stopping.
  • E-cigarettes are not safe for youth, young adults, pregnant women, or adults who do not currently use tobacco products.
  • There is no risk-free level of exposure to secondhand smoke; even brief exposure can be damaging to health.
  • Smoke-free laws are an effective approach to reduce exposure to secondhand smoke and to reduce the prevalence of tobacco use.

Who Is at Risk

Everyone is susceptible to the negative consequences of tobacco use. However, some disparities exist. Since the first Surgeon General Report on tobacco was published in 1964, tobacco protections have expanded and resulted in cleaner air, higher tobacco taxes, and fewer advertisements overall. In the US, tobacco related disparities affect different population groups based on socially determined circumstances and characteristics like age, education, income, occupation, geographic location, race, ethnicity, sex, sexual orientation, gender identity, mental health status, substance abuse and military status.

In Hawai‘i, tobacco use is most prevalent among individuals who:

  • Are Native Hawaiian
  • Identify as lesbian, gay, bisexual or transgender
  • Have behavioral health conditions (mental health conditions and substance use disorders)
  • Are of low socioeconomic status

E-cigarettes are the most commonly used tobacco product among youth, surpassing conventional cigarettes in 2014. E-cigarette use is strongly associated with the use of other tobacco products (particularly combustible forms). It has become an epidemic among youth and young adults.

How To Reduce Risk

The most effective way to reduce the risk of tobacco-related illness and death is to avoid using tobacco products. If you currently use tobacco products, you should quit. The health benefits of quitting start almost immediately and increase over time. If you do not smoke, exposure to secondhand smoke still increases the risk of disease. Policies that prohibit smoking indoors, in public locations, and in vehicles with children can help reduce the risk to everyone.

Page last updated July 28, 2022.

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1 Truth Initiative. Flavors. June 2021. https://truthinitiative.org/sites/default/files/media/files/2021/06/Truth_FlavoredTobacco_FactSheet2021_FINAL.pdf. Accessed 7/21/2022.
2 Centers for Disease Control and Prevention. Office on Smoking and Health (OSH). https://www.cdc.gov/tobacco/about/osh/index.htm. Updated Nov 16, 2021. Accessed 7/21/2022.