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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. 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.

Tobacco use is the leading cause of preventable disease, disability, and death in the United States. Tobacco use accounts for one of every five deaths in the United States, 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 national economic cost in medical expenses and lost productivity is over $289 billion annually.

After decades of study, much is known about tobacco use in the United States: In 2017, 14.0% of adults (34.3 million people) were current cigarette smokers: 15.8% of men and 12.2% of women.
  • Tobacco product use is started and established primarily during adolescence.
    • Each day, about 2,000 people younger than 18 years smoke their first cigarette.
    • Each day, over 300 people younger than 18 years become daily cigarette smokers.
  • In 2017, about 5 in every 100 middle school students (5.0%) and only 8 in every 100 high school students (8.1%) in Hawai'i public schools reported current cigarette smoking. This compares with 15.7% of middle school and 25.5% of high school students currently using e-cigarettes (YRBS).
  • In 2017, 12.3% of middle school and 22.1% of high school students in Hawai'i public schools said they had ever tried smoking a cigarette (experimentation). By contrast, experimentation with e-cigarettes was 26.7% for middle school students and 42.3% 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.

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. However, these protections are less likely to reach places where certain populations live, work or play. Consequently, some groups experience a larger burden of death and disease as compared to their counterparts. In the U.S., 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.

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.

Tobacco use is tracked using a range of surveys. Some examples include:
  • National Survey on Drug Use and Health (NSDUH)
  • National Health Interview Survey (NHIS)
  • National Health and Nutrition Examination Survey (NHANES)
  • Youth Risk Behavior Surveillance System (YRBS)
  • National Youth Tobacco Survey (YTS)
  • State Tobacco Activities Tracking and Evaluation System (STATE)

For more information on tracking tobacco use health objectives, please visit the Healthy People 2030 Tobacco Use objectives page.

Behavioral Risk Factor Surveillance System (BRFSS)

Pregnancy Risk Assessment Monitoring System (PRAMS)

Youth Risk Behavior Survey (YRBS)

Youth Tobacco Survey (YTS)

Vital Statistics Death Record Data