U.S. Can’t Decide How Many Adults Use Smokeless – 8.1 Million or 5.1 Million?

Federal officials routinely obfuscate on the subject of smokeless tobacco, and particularly on the number of smokeless users in the U.S.

The newest numbers are reported by Dr. Rachel Lipari and Mr. Struther Van Horn of the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). They say, “In 2014, an estimated 8.7 million people aged 12 or older used smokeless tobacco in the past month.” (available here)  Their finding is based on data from the National Survey on Drug Use and Health (NSDUH).

That number included teens (Age 12-17 years).  When including only adults (18 and older), the NSDUH estimate is 8.1 million in 2014, which contrasts with a 2015 CDC-supported National Health Interview Survey (NHIS) adults-only estimate of 5.1 million. The 59% higher NSDUH number probably results from the use of different definitions.  NSDUH collects information on past-30 day use, whereas current users in NHIS is every day or some days.

The primary conclusion in the Lipari/Van Horn report is that “Smokeless tobacco is not a healthy alternative to cigarette smoking.”  This is a non sequitur, as the NSDUH survey includes no information on health. 

The government inconsistency also extends to smoking numbers, as I discussed previously (here, here and here).  The NSDUH estimate of adult U.S. smokers for 2014 was 55.8 million, about 40% higher than the NHIS estimate of 40 million for that year.

It is time for federal officials to acknowledge the gross inconsistency of the government’s tobacco use estimates. In all likelihood, the higher NSDUH estimates, which reflect the fact that Americans use tobacco products more irregularly than every day or some days, are closer to reality than those based on the NHIS.

Jane Brody and the New York Times: Counting Smokers Badly

Jane Brody falsely reported in her November 12 New York Times “Personal Health” column that, according to the National Survey on Drug Use and Health (NSDUH), the smoking prevalence among young adults (age 18-25 years) is 40% (here).  The error was picked up by the American Council on Science and Health (here), and the Times later posted a correction, noting that the rate is 34%. (The original number was the prevalence of all tobacco use, rather than the prevalence of smoking.)  

But is 34% the accurate figure?  Perhaps; it depends on which federal survey is used. 

Anti-tobacco forces have for years selectively used two sets of numbers based on two federal surveys in a manner that recalls the schoolyard taunt, “Are you bragging or complaining?”  When zealots brag about how regulation, legislation and litigation have driven down smoking rates, they use the CDC-supported National Health Interview Survey (NHIS).  According to the 2010 NHIS, the prevalence of smoking among young adults (18-24 years) was 20% (here).  But when they complain that smoking rates are too high, and demand more regulation, legislation and litigation, they use the NSDUH, which produces higher estimates than NHIS – in this case 34%.

Why does this matter?  Using Jane Brody’s corrected percentage from NSDUH, the number of young adult smokers (18-24 years) in the U.S. is 10,489,854; using NHIS, the number is 6,165,090. 

With respect to variability, this difference of 4.5 million smokers is huge, and here’s why. 

NSDUH estimates are higher because it counts as a smoker anyone who answers “yes” to this question: "During the past 30 days, have you smoked part or all of a cigarette?”  The comparable question in the NHIS is, "Do you now smoke cigarettes every day or some days?"  

I published a formal study of this problem in 2009 (abstract here), and I wrote a blog post about it (here).  At that time, I calculated that there were 9 million more smokers of all ages nationally in NSDUH compared with NHIS.  

How can the federal government develop effective policies to help American smokers when the government can’t even develop and employ consistent estimates of how many Americans smoke? 

I am grateful to Jane Brody for bringing attention to this egregious problem.