Major disparities in smoking rates based on ethnicity, income and sexual orientation: Surgeon general

Despite progress the United States population has made in reducing its cigarette smoking, the measure of that progress has not been equal for all groups, according to a new report from the Surgeon General.

The report, released Tuesday morning, found that disparities in tobacco use persist by race and ethnicity, sexual orientation and gender identity, income level, education level, occupation, geography, and behavioral health status, among other factors.

What's more, the report found that cigarette smoking and secondhand smoke exposure cause about half a million deaths nationwide annually, which is nearly 1 in 5 deaths.

"Tobacco use imposes a heavy toll on families across generations. Now is the time to accelerate our efforts to create a world in which zero lives are harmed by or lost to tobacco," Surgeon General Vivek Murthy said in a statement. "This report offers a vision for a tobacco-free future, focused on those who bear the greatest burden, and serves as a call to action for all people to play a role in realizing that vision."

Cigarette smoking has dramatically declined in the U.S. since the 1960s, after a report from the Surgeon General in 1964 stated that cigarette smoking causes lung cancer and likely heart disease. What followed were anti-smoking campaigns, a heightened public awareness of the dangers of smoking and more government regulations around tobacco use.

In 1965, 42.4% of adults ages 18 and older reported being current cigarette smokers, compared to 11.5% in 2021, according to the new report.

However, in 2020, the latest year for which complete data is available, 27.1% of American Indian and Alaska Native people reported being current cigarette smokers. That's more than double the 13.3% of white participants and nearly double the 14.4% of Black Americans who repotted being current smokers, the report stated.

Additionally, smoking among Americans living in poverty was more than twice as common, compared to those not living in poverty, the report found. In 2020, 20.2% of those making under $35,000 a year were reportedly current cigarette smokers, compared to 6.2% of those making $100,000 or more per year.

Smoking was also higher among Americans who identify as gay, lesbian or bisexual. Among adults, 16.3% of LGB adults identified as being current cigarette smokers compared to 12.5% of heterosexual adults between 2019 and 2021, according to the report.

When looking at rates among high school students over the same period, 10.4% of LGB teenagers reported current cigarette use, double the 5.3% of heterosexual teenagers.

"While there is much to celebrate, the progress has not been equal across all populations or communities," Adm. Rachel L. Levine, the assistant secretary for health at the Department of Health and Human Services, said in a statement. "Progress, in the form of improvements in tobacco-related policies, regulations, programs, research, clinical care and other areas, has not resulted in the same outcomes for everyone. We have not made progress unless we have all made progress."

To eliminate such disparities, the Surgeon General's Office recommended several action items, including providing more equitable access to health care, setting a maximum nicotine yield to reduce cigarette addictiveness and establishing further policies to reduce the exposure to secondhand smoke.