Skip to main content
TSRC, Tob. Sci. Res. Conf., 2023, 76, abstr. 30

The changing landscape of tobacco use and switching behaviors among us adults

Altria Client Services, Richmond, VA, USA

Objectives: With the emergence of e-vapor and novel oral nicotine products, the adult tobacco use landscape has been changing drastically in recent years. It’s important to understand the evolving tobacco landscape and transitions from smokeable to smokefree tobacco products to support harm reduction strategies.

Methods: Using National Health Interview Survey (NHIS) 2016 to 2021 datasets, we characterized current adult (21 years of age or older) tobacco consumers (ATCs) into smokeable (cigarettes and cigars) and smokefree (e-vapor and smokeless tobacco products) groups. For adults who had ever smoked 100 cigarettes lifetime (lifetime cigarette smokers), we further studied their switching behaviors by inhalable (e-vapor) versus oral (smokeless tobacco products) use.

Results: From 2016 to 2021, the total ATC population has decreased from 48.5 million to 43.4 million. Among ATCs, we observed a decreasing proportion of exclusive smokeable users (74.6% to 66.2%) and an increasing proportion of exclusive smokefree users (13.0% to 21.7%). Among ATCs who were lifetime cigarette smokers (36 million in 2021), 65.7% remained exclusive smokeable users and 15.1% became exclusive smokefree product users (defined as ‘switched lifetime adult cigarette smokers’). The switched lifetime adult cigarette smoker population has increased from 3.8 million in 2016 to 5.4 million in 2021, where 71.4% were current e-vapor users.

Implications: The prevalence of exclusive smokefree products usage has been increasing while exclusive use of smokeable products has been declining. A growing proportion of lifetime adult cigarette smokers have switched to exclusive smokefree product use. Our analysis may be limited by the lack of assessments of novel tobacco products (e.g., nicotine pouches) in NHIS surveys. Adding these assessments to national surveys is critical to keep pace with the changing landscape.