More Federal Data on Smoking & Vaping Rates Among American Adults

 

Recently I described how high school vaping rates reported in the National Survey on Drug Use and Health (NSDUH) are much lower than those reported in the CDC’s National Youth Tobacco Survey (NYTS) (here).  Today I review NSDUH adult vaping rates, compared to those in the National Health Interview Survey (NHIS), which is the CDC’s traditional source for adult smoking estimates.

The chart at left shows smoking and vaping rates among all American adults 18+ years.  In 2022, the NHIS estimate of current smokers was 11.6%, or about 29 million. 

Now let’s turn to vaping, keeping in mind that the “Dual Use” column segments count both current vaping and smoking.  In 2022, the NHIS estimate of current vapors was 6%, or nearly 15 million, including almost 4 million dual users.

As I demonstrated in a 2009 published analysis (here), NSDUH current smoking estimates are always higher than NHIS estimates.  Neither survey estimate is right or wrong; instead, taken together, they probably represent a reasonable range.  The 2022 NSDUH percentage of smokers was 15.9%, or about 39.5 million, while the NSDUH vaping prevalence for that year was 8.5% or 21 million, with 8.1 million dual users.

Turning to young adults 18-24 years old, in 2022 the NHIS estimate of current smokers in this group was 4.8% or about 1.4 million, but the vaping prevalence was even higher, at 15.1%, representing 4.3 million.  This means that vaping surpassed smoking among young adults.  The proportions are the same in NSDUH, even though the numbers are higher: the percentage of smokers is 10.6%, or about 3.7 million, figures that are swamped by the percentage of vapers, at 24.3%, or 6.9 million.

 

 

 

Why are NSDUH smoking and vaping estimates always higher than those in NHIS?  First, the surveys ask different questions to account for “current” use.  As we noted in our previous study, “NSDUH identifies almost twice as many some-day smokers as the NHIS, which is likely due to differences in the questions that subjects are asked.”  But we also discussed an even more important factor: “the respondents’ perceptions of smoking within the context of the two surveys. The NHIS is focused on the health status of participants, with more limited attention on behavioral risk factors. In this context, smoking may be perceived as one of the more undesirable behaviors that subjects are asked to report, which may lead to under-reporting.  In contrast, the NSDUH is devoted almost entirely to substance use, with questions about marijuana, cocaine and crack cocaine, hallucinogens, inhalants and non-medical use of prescription drugs. In the context that these substances are far more socially unacceptable than cigarettes, participants may be more comfortable acknowledging that they smoke.”

Fifteen years ago, we wrote, “It is surprising that estimates of national smoking prevalence have been derived from a single source, the NHIS, and that little research has been conducted to assess its accuracy over time… Further investigation of the NSDUH/NHIS discrepancy may lead to better surveys and an improved understanding of smoking trends in the USA.”

To date, nothing has been done to explain this discrepancy, so it is reasonable to consider the NHIS and NSDUH figures as low and high estimates for U.S. smoking and vaping.

 

Astounding Smoking & Vaping Statistics in New CDC Data

 

The U.S. Centers for Disease Control (CDC) just released the full data set from the 2022 National Health Interview Survey (NHIS). Earlier, the agency published “Early Release of Selected Estimates Based on Data From the 2022 National Health Interview Survey,” a document that reflected the CDC’s propensity to cherry-pick data in order to portray all forms of tobacco as deadly and evil.

The chart at left shows the prevalence of smoking and vaping among American adults over the years the survey collected information on vaping -- 2014 to 2022.  Note that the smoking rate, denoted by the black and gray columns, started out at 16.8% and has since declined to 11.6%, for a drop of about 31%.  During that time, the vaping rate increased from 3.7% in 2014, to 6% last year.  One of the more noticeable trends is the increase in vapers who are former smokers, which I will examine in my next blog.

Now let’s look at the same statistics, but only for Americans age 18 to 24 years.  The smoking rate in 2014 was 16.6%, almost identical to that among all Americans, but then something extraordinary happened.  Smoking dropped a whopping 71%, to just 4.8% in 2022, while vaping increased substantially. 

 

The young adult numbers sync with those I’ve reported from the National Youth Tobacco Survey (here).  In short, smoking is a vanishing habit among teens and young adults in America.

Instead of celebrating this as a public health victory, anti-tobacco crusaders continue to denounce a nonexistent vaping crisis.  They decry another generation enslaved by nicotine, but ignore the millions of Americans who daily consume caffeine, which is also addictive and benign.  

While tobacco prohibitionists are, ironically, threatened by the fading of smoking, I have spent an entire career at major academic medical centers watching inveterate smokers pay a life-shortening price for being unable to quit the crusaders’ way, i.e., going nicotine-free.  Thankfully, today’s generation of smoke-free youth and young adults will enjoy a future devoid of the ravages of smoking, even as they continue to consume smoke-free tobacco products.

 

FDA Unveils New Smoker Numbers to Justify a Menthol Ban

 

In its proposed rule to ban menthol cigarettes, the FDA makes a bizarre claim: “In 2019, there were more than 18.5 million current smokers of menthol cigarettes ages 12 and older in the United States.”

The agency derived this number from the National Survey on Drug Use and Health (NSDUH), which reported that 18.3 million adults and 260,000 youth 12-17 years old smoked menthol cigarettes in 2019.

Using that same survey, however, the total number of smokers in 2019 was 46.2 million -- 45.6 million adults and 600,000 youth age 12-17.

No federal official or agency has ever suggested there were that many smokers in 2019.  The CDC and the FDA only acknowledged the existence of 34 million adult smokers and 886,000 youth smokers, using the National Health Interview Survey (NHIS) and National Youth Tobacco Survey (NYTS), respectively. 

The CDC and FDA use the NYTS youth number (886,000), which is nearly 50% higher than the 600,000 reported by the NSDUH.  This is further evidence of why the NYTS numbers should never be the final word for youth tobacco use (here and here). 

Using the FDA’s NSDUH number for adult smokers, the comparison with the NHIS number it formerly used is almost as bad, and in the opposite direction.  Now the agency menthol claim implies that there were 45.6 million adult smokers in 2019 (NSDUH), but before it only acknowledged 34 million (NHIS).

What did the FDA do with 286,000 youth and 11.6 million adult smokers?

When they want to emphasize big smoking numbers, the FDA and CDC use NSDUH and NYTS data.  When they prefer smaller numbers, they use the NHIS.  I have highlighted this deception since 2009. 

It is time to hold these agencies accountable, especially when the FDA uses this manipulation to justify punitive regulation.