Quitting Tobacco: Facts and Stats

Tobacco use is still the leading cause of preventable death and disease in the country and leads to 480,000 deaths in the U.S. each year from cigarette smoking alone. While cigarettes cause the most deaths from cancer, respiratory, and vascular disease, they are not the only tobacco product linked to adverse health outcomes. Using smokeless tobacco is a known cause of cancer, and the rise of new tobacco products like e-cigarettes, heated tobacco products, and products containing synthetic or non-tobacco-derived nicotine present emerging health risks. Nicotine is harmful to developing brains and its use during adolescence can disrupt the formation of brain circuits that control attention, learning, and susceptibility to addiction. Exposure to nicotine among youth is particularly dangerous since it affects key brain receptors, making young people more susceptible to nicotine addiction. Quitting tobacco in all its forms has enormous health benefits.

Most smokers – nearly 70% – say they want to quit, and many make quit attempts each year. In 2020, slightly more than half of current smokers (56%) made a quit attempt in the past year. Recent data show an increasing number of people quitting successfully. In 2020, 8.5% of adult current smokers successfully quit smoking in the past year, up from 7.5% in 2018. Among people who have ever smoked, the quit rate has also increased and is higher compared to current smokers, or those who have smoked more than 100 cigarettes in their lifetime and now smoke every day or some days. The successful quit rate among people who had ever smoked increased from 61.7% in 2018 to 66.5% in 2021. 

Interest in quitting is also high among young tobacco users specifically. In 2021, around two-thirds of young tobacco users reported wanting to quit tobacco use altogether and made at least one quit attempt within the past year. For current users of e-cigarettes, the most popular tobacco product among youth, more than half (54.2%) reported they intend to quit vaping and one-third reported a past-year quit-vaping attempt.

Given overwhelming interest in quitting tobacco, online quitting resources are increasingly important to tobacco users. Twelve million U.S. smokers (35.9%) looked online for information on how to quit smoking in 2017, a number that more than doubled over the previous 12 years. Evidence shows that online quit-tobacco programs are increasingly popular – and successful. For example, following the EX Plan on BecomeAnEX.org, a free digital quit-smoking program developed by Truth Initiative^® and the Mayo Clinic, quadruples a tobacco user's chance of quitting. Research also shows that young adults who used This is Quitting, the first-of-its-kind, text message-based quit vaping program from truth^®, had nearly 40% higher odds of quitting compared to a control group. 

QUIT RATES FOR ADULTS

Cigarettes

In 2021, approximately 11.5% (37.9 million) of American adults were current smokers, including 10.1% of women and 13.1% of men. Quit attempts among smokers (about 55%) and rates of successful quit attempts (8%-9%) are similar among men and women. For many smokers, it may take 30 or more quit attempts before successfully quitting smoking. Chances of success increase with each quit attempt.

Quit attempts and quit rates decrease with age, possibly because of increased difficulty changing behaviors that have been established over many years, according to data from 2021.

E-cigarettes

Adult e-cigarette use has remained relatively low since around 2012. The overall adult prevalence of e-cigarette use in 2021 was 4.5%, up from 3.7% in 2020. Although there aren’t much data on e-cigarette quitting rates, there is research on quit attempts for e-cigarette users:

• Among current e-cigarette users between ages 15-36 in 2021, 54.2% reported general intentions to quit, 15.3% reported intention to quit within 30 days, and 33.3% reported a past-year quit attempt.
• Adult e-cigarette users who were never smokers had the highest rates of past quit-vaping attempts (20.9%), compared to dual users (15.3%) and former cigarette smokers (7.9%).

QUIT RATES FOR YOUTH

Rate of teens quitting vaping

DISPARITIES IN QUITTING

Quitting disparities exist among certain populations, including in communities with lower income and education, racial and ethnic minority groups, and the LGBT community.

• Fewer lower-income smokers quit successfully (5.6%) than those living at or above the poverty line (7.9%), despite similar rates of quit attempts. Low-income individuals tend to have less awareness of and access to quit-smoking treatments and use them at low rates.
• In 2015, adult smokers with a private health plan had higher rates of successfully quitting (9.4%), compared with those with any other type of insurance coverage. Adults with private insurance also had the highest rate of quit attempts in the past year (57.2%), compared with those enrolled in federal insurance programs or who are uninsured.
• A stronger set of tobacco control policies – including broader cessation treatment coverage, tax increases, comprehensive marketing restrictions, smoke-free laws, strong graphic health warnings, a higher intensity media campaign, and stronger youth access enforcement – would reduce the smoking prevalence among the bottom two-fifths of income earners by nearly a quarter in just a few years. By 2065, smoking prevalence among the lowest-income groups would drop by almost 45%, avoiding more than 1.5 million deaths.
• Rates of quit attempts and successfully quitting generally increase as education level rises, with 50% of adult smokers across all education levels attempting to quit, according to data from 2015.

Lesbian, gay, and bisexual (LGB) individuals have higher prevalence of tobacco use and lower quit attempt rates than the general population.

• In 2020, 18.9% of lesbian, gay and bisexual adults were current smokers, compared with 15% of heterosexual adults, according to data from the National Health Interview Survey.
• In 2022, youth identifying as LGB or transgender reported higher rates of past 30-day tobacco product use than their heterosexual or cis-gender peers.
• Between 2020 and 2021, e-cigarette use by young people identifying as LGB increased more than their heterosexual peers, widening the gap between vaping rates based on sexual orientation, according to Truth Initiative surveys. 
• About two-thirds (66.7%) of gay, lesbian and bisexual adult smokers were interested in quitting smoking, and 48.4% attempted to quit in the past year, according to the 2015 National Health Interview Survey. Both rates were lower than those who identify as heterosexual (68.1% and 55.4%, respectively).

Rates of quitting attempts and successfully quitting vary by racial and ethnic background. Among White, Black, and Hispanic American adults in 2020, Black Americans had the most quit attempts while White Americans had the highest quit-smoking rates. Hispanic Americans had the lowest quitting rates. A 2015 study found that Asian-Americans had the highest quit rate and rate of success.

Additionally, evidence indicates that adult menthol smokers are less likely than non-menthol smokers to successfully quit smoking. The minty flavoring has cooling properties that make cigarettes easier to smoke and harder to quit.  [See “Menthol: Facts, stats and regulations” for additional information]

• Certain groups smoke menthol cigarettes at higher rates, including young people, women, sexual minorities, those with mental illness, and racial and ethnic minorities, especially Black Americans.
• About 85% of all Black American smokers use menthol cigarettes.
• Research shows that if menthol cigarettes were banned nationally, almost 39% of all menthol smokers and 44.5% of Black American menthol smokers would try to quit.

HEALTH / MENTAL HEALTH EFFECTS OF QUITTING TOBACCO

Benefits of quitting vaping

QUIT METHODS

Ways to quit vaping or smoking

DIGITAL QUIT TOOLS

Help to quit vaping online

Interested in quitting tobacco products?

Truth Initiative has helped thousands of people on their journeys to become tobacco-free.

HEALTH CARE COVERAGE FOR QUITTING TOBACCO SUPPORT

The Affordable Care Act requires most health insurance plans, including Medicaid expansion, individual insurance plans, small groups plans, and employer-provided plans, to cover preventive services that the U.S. Preventive Services Task Force recommends. Health insurance plans are in compliance with this requirement if they cover the following without cost-sharing:

• Screening for tobacco use
• At least two quit attempts per year, including coverage for:
  • Four quitting counseling sessions of at least 10 minutes each (including telephone counseling, group counseling, and individual counseling) without prior authorization
  • All seven FDA-approved quitting medications (including both prescription and over-the-counter medications) for a 90-day treatment regimen when prescribed by a health care provider without prior authorization
• Traditional Medicaid covers quitting counseling and medications with no cost-sharing for pregnant women. For all other Medicaid enrollees, quitting medications are no longer excludable from coverage. Cost-sharing and coverage of counseling vary by state and plan.
• Medicare covers NRT nasal spray, NRT inhaler, bupropion and varenicline only. Part D plans can cover other quitting medications. Medicare also covers two counseling attempts each year with four sessions of counseling in each attempt. Cost-sharing depends on whether a Medicare enrollee has been diagnosed with an illness that is caused or complicated by smoking.
• TRICARE, the health care program for military services members and their families, covers quitting counseling from TRICARE-authorized providers in the U.S., TRICARE also covers all seven FDA-approved quitting medications (including both prescription and over-the-counter medications) when prescribed by a TRICARE-authorized provider.

ACTION NEEDED: QUITTING TOBACCO

Evidence-based quit treatments lower smoking rates and save lives and money. A large body of research on quit smoking treatments confirms that a combination of behavioral counseling, medication and social support is the most effective way to treat this deadly addiction. Research also demonstrates the effectiveness of a broad range of health care providers asking about tobacco use, referring tobacco users to treatment, and delivering direct quitting methods. We know that longer duration and comprehensive services and interventions are more successful in helping people quit. As a result, these services, which are relatively inexpensive, provide a strong return on investment.

• All health care providers should inquire about their patients’ tobacco use status and recommend quitting medications and counseling as a matter of course for all patients who visit them. Providers can use the five “a’s” (ask, advise, assess, assist, and arrange) to help current tobacco users create a plan to quit, prepare to quit, and stay tobacco-free.
• People who currently use tobacco products need to be aware of effective cessation services and interventions. Mass media campaigns like CDC's Tips from Former Smokers need to run for additional weeks, and ads that target specific, high-risk populations should be developed. These ads should correct the myths about medicinal nicotine to encourage greater uptake and adherence.
• Quitting treatments offered to tobacco users must be comprehensive. All health care plans should cover all seven FDA-approved medications as well as individual and group counseling delivered in person, online, or by phone with no cost-sharing for plan enrollees.
• Given that it takes most smokers multiple attempts to quit before successfully quitting for one year or longer, all health plans should refrain from placing limits on the number of quit attempts covered.
• The data already exist to support FDA quickly approving existing nicotine replacement therapies (NRT) for long-term use.
• FDA should encourage the development of additional safe and effective interventions – whether they are drug interventions or device interventions. Because smokers are turning to e-cigarettes for help quitting, the FDA must fully regulate e-cigarettes so that consumers know which products might help them completely switch from combustible products or quit altogether. The agency’s Center for Tobacco Products must complete, as soon as possible, a full review of all e-cigarette products, including youth-appealing flavored disposable e-cigarettes. At the same time, the agency’s Center for Drug Evaluation and Research must develop a properly incentivized pathway for e-cigarettes and other products to potentially be approved as quitting drugs. FDA should ensure that any such interventions are on a fast-track and given priority for review.
• Implementation of policies (i.e., restricting the sale of flavored tobacco products, smoke-free housing, smoke- and vape-free workplaces, and increasing excise taxes on tobacco products) should include making quitting tobacco treatments available for those affected by such policies.
• States should fully fund comprehensive tobacco control programs that produce meaningful outcomes, including funding quitting resources for people of all ages. In fiscal year 2024, the states will collect $25.9 billion from the tobacco settlement and taxes, but they will spend just 2.8% of it – $728.6 million – on tobacco prevention and cessation programs for people of all ages, less than a quarter of what the CDC recommends.
• State governments, employers and health insurers should expand access to digital quitting resources. Internet and text message interventions are recommended by the Surgeon General and are often the first place that tobacco users look for assistance in quitting.