United States

United States - country profile

Cigarettes in United States

The prevalence of current cigarette smoking among U.S. adults aged 18 and over was stable from 2006 (20.8%) to 2009 (20.6%), and then decreased to 13.8% in January-June 2018; this latest figure was not significantly different from the 2017 figure of 13.9%. During the last ten years there has been a steady decline in smoking prevalence for men, from 23% in 2008 to 15.6% in 2018; and for women, from 18% in 2008 to 12% in 2018. The NHIS is an annual survey - a nationally representative, in-person survey of the noninstitutionalized U.S. civilian population. The adult component of the 2017 sample, adult component included 26,742 adults aged ≥18 years. The NHIS estimates are considerably lower than the WHO estimates of current smoking prevalence, which are around 4 percentage points higher than the latest NHIS prevalence data.

Tobacco smoking prevalence

Number of current smokers:
Adult current tobacco smoking prevalence:
20.0%
A
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Adult current tobacco smoking prevalence (female):
Adult current tobacco smoking prevalence (male):
A
(1) WHO global report on trends in prevalence of tobacco use 2000-2025, third edition. (2019). World Health Organization. https://www.who.int/publications/i/item/who-global-report-on-trends-in-prevalence-of-tobacco-use-2000-2025-third-edition. (2) Department of Economic and Social Affairs (Ed.). (2019). World Population Prospects 2019 (Online Edition Rev. 1.; Population Division). United Nations. https://population.un.org/wpp/Download/Standard/Population/

Smoking-related mortality

Annual number of deaths attributable to tobacco smoking:
Annual number of deaths attributable to tobacco smoking (female):
Annual number of deaths attributable to tobacco smoking (male):
Annual percentage of all deaths attributable to tobacco smoking:
Annual percentage of all deaths attributable to tobacco smoking (female):
Annual percentage of all deaths attributable to tobacco smoking (male):
A
The Tobacco Atlas. Available at: https://tobaccoatlas.org/topic/deaths/ Data source: GBD 2016 Risk Factors Collaborators.

Nicotine Vaping Devices (E-cigarettes) in United States

In 2016, the Food and Drug Administration (FDA) announced the "deeming" of e-cigarettes and other Electronic Nicotine Delivery Systems (ENDS) as tobacco products. It is therefore legal to sell and use e-cigarettes in the USA. The FDA operates under the Family Smoking Prevention and Tobacco Control Act of 2009, sometimes known as the TCA (Tobacco Control Act), and also acts under the Food, Drug, and Cosmetic Act. The law requires age restrictions, a warning label, ingredients lists, and registration. Sale to those under 18 years is prohibited, and retailers must verify the age of customers under 27 years via photo ID before a sale is made. Some states have increased the minimum age to 21. Sale from vending machines is restricted to adult-only establishments. A pre-market approval process for e-cigarettes is mandated, which is considered by some harm reduction scientists to be onerous and to have the potential to radically reshape the market, reducing the choice of products available and forcing smaller e-cigarette companies to exit the market. The Child Nicotine Poisoning Prevention Act of 2015 requires packaging to be child-proof. Many states and some cities have additional laws covering e-cigarettes, such as dictating where they can be used, or, in the case of California, banning flavours outright. More recently, in summer 2019, the San Francisco city supervisors approved an ordinance prohibiting the sale, manufacture and distribution of tobacco products, including electronic cigarettes - this will include online sales delivered in the San Francisco area, and is set to be signed off by the mayor in June 2019, coming into force 7 months after that. In November 2018, the FDA announced that all flavoured e-cigarette products (other than tobacco, mint and menthol flavours or non-flavoured products) should be sold only in age-restricted, in-person locations, and, if sold online, under heightened practices for age verification. Proposals around banning flavours are still being considered by the FDA - and are hotly contested by harm reduction advocates. In August 2019, Michigan State announced that it will ban flavoured nicotine liquids/e-cigarettes, becoming the first state to do so. New guidance was issued in June 2019 about 'Premarket Tobacco Product Applications' (PMTA): manufacturers of e-cigarettes or other non-combustible tobacco products that were on the market as of August 8, 2016, must submit a PMTA by August 8, 2022. Any new products that manufacturers seek to market after August 8, 2016 must receive a marketing order from the FDA before it may be commercially marketed in the United States.

Prevalence

Adult current e-cigarette vaping prevalence:
5.0%
A
smoking_rooms
Ever tried e-cigarette vaping:
A
Al Rifai M, et al. Abstract 1209-110. Presented at: American College of Cardiology Scientific Session; March 28-30, 2020 (virtual meeting).
B
1. Wang TW, Asman K, Gentzke AS, et al. Tobacco Product Use Among Adults - United States, 2017. MMWR Morb Mortal Wkly Rep 2018;67:1225-1232. 2. Bao W, Xu G, Lu J, Snetselaar LG, Wallace RB. (2018) Changes in Electronic Cigarette Use Among Adults in the United States, 2014-2016. JAMA. 319(19):2039-2041. doi:10.1001/jama.2018.4658
1
1. Data for current use is from the 2017 National Health Interview Survey (NHIS). Sample includes adults 18 and over. NHIS is an annual, nationally representative, in-person survey of the non-institutionalized U.S. civilian population. The 2017 Sample Adult component included 26,742 adults. A Gallop poll in 2018 showed a far higher prevalence of current adult vapers (9% total; 2% regular and 7% occasional) 2. Data for 'ever tried/vaped' was used from 2017 National Health Interview Survey (NHIS) as reported by Bao et al. (2018)

Regulation

Regulatory status:
Allowed
A
widgets
Regulated as tobacco product:
Yes
A
widgets
A
Data cross-referenced where possible using the following sources :1. Vapetrotter website. Available at: https://www.vapetrotter.com/laws/ ; 2. Global tobacco control website. Available at:https://www.globaltobaccocontrol.org/node/14052 ; 3. Tobacco Control Laws website. Available at : https://www.tobaccocontrollaws.org/legislation/

Availability

Legal to buy device online - personal use:
Yes
Legal to buy nicotine online - personal use:
Yes
Legal to import device - trade:
Yes
Legal to import nicotine - trade:
Yes
Legal to sell device:
Yes
Legal to sell nicotine:
Yes
Legal to purchase without prescription:
Yes
healing

Regulations and restrictions

Notifications of new products required:
Yes
widgets
Health warning on packaging required:
Yes
widgets
Minimum age restrictions on sales:
Yes
18 years widgets
Restrictions on flavour range:
No
Legal restrictions on use in public places:
Yes

Perception of harm

Don't know:
Equally as harmful as cigarettes:
Not harmful, or less harmful than cigarettes:
Harmful, or more harmful than cigarettes:
A
Huang J, Feng B, Weaver SR, Pechacek TF, Slovic P, Eriksen MP. Changing Perceptions of Harm of e-Cigarette vs Cigarette Use Among Adults in 2 US National Surveys From 2012 to 2017. JAMA Netw Open. Published online March 29, 20192(3):e191047. doi:10.1001/jamanetworkopen.2019.1047

Snus in United States

There are no comments specific to snus in United States in the database.

Regulation

Regulatory status:
Allowed
1
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Regulated as tobacco product:
Yes
1
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1
US product also available which can vary from Swedish snus in that it has less nicotine, and is sweeter, more flavoured.

Availability

Legal to import product for trade:
Yes
Legal to import product for personal use:
Yes
Legal to buy product online:
Yes
Legal to use product:
Yes

Regulations and restrictions

Notifications of new products required:
Yes
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Health warning on packaging required:
Yes
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Minimum age restrictions on sales:
Yes
21 years filter_drama

Heated Tobacco Products in United States

In 2017, a total of 5.2% of U.S. adults were aware of heated tobacco products, including 9.9% of current cigarette smokers. Overall, 0.7% of U.S. adults, including 2.7% of current smokers, reported having ever used heated tobacco products. On 1st May 2019 the FDA approved sales of IQOS in the USA.

Availability

Products are marketed:
Yes
1
A
healing
A
1. Philip Morris International website. Available at: https://www.pmi.com/smoke-free-products/iqos-our-tobacco-heating-system; 2. Industry contact provided information; BAT Harm Reduction Report 2018, Available at:https://www.bat.com/group/sites/uk__9d9kcy.nsf/vwPagesWebLive/DO9DCL3P
1
1. ploom tech; 2. glo 3. iqos

Nicotine Replacement Therapy in United States

There are no comments specific to nicotine replacement therapy in United States in the database.

Product promotion

Market size:
862.30 million €
A
Market size per smoker:
A
Consumer Health: Euromonitor from trade sources/national statistics. Date Exported: 8/9/2019. (c) Euromonitor International 2019

Availability

Legal to purchase without prescription:
Yes
A
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Products are marketed:
Yes
A
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Place available:
General store
A
A
WHO Report on the Global Tobacco Epidemic 2019. https://www.who.int/tobacco/global_report/en/ (2019).