The smoking rate among U.S. adults will fall below 10% in 2024 for the first time in recorded history.
That in itself is a big deal. It is also worth noting that everyone is starting to know about it.
Reports of historic declines in smoking rates did not come from the U.S. government, which was collecting the data. Instead, the news came through an analysis of the digital journal NEJM Evidence by Israel Agak, founder and CEO of research technology company Chisquares.
Typically, the U.S. government is responsible for analyzing national survey data on tobacco use and publishing the results. But federal budget cuts that devastated the Centers for Disease Control and Prevention’s Office of Smoking and Health mean that Agak and others like him at businesses and universities are now working to fill the holes left by the government.
For example, Agak’s analysis was published in NEJM Evidence as a “Public Health Alert.” NEJM Evidence is an initiative created late last year by the New England Journal of Medicine and the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) to replace the CDC’s weekly newsletter. CIDRAP also launched the Vaccine Integrity Project last April with the aim of safeguarding the use of vaccines amid government efforts to undermine vaccination policies.
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“We had all this data and no one was analyzing it,” said Agak, an epidemiologist who previously worked as a senior researcher at the Office of Smoking and Health (OSH) and retired from the agency in 2019. “The question for me as a public health official was: Will public health just die?”
Health Department spokesman Andrew Nixon said in a statement that the CDC “remains deeply committed to tobacco prevention and control” and is supporting it through efforts “including outreach, education, and surveillance.”
The new data on tobacco use come from the CDC’s annual National Health Interview Survey, which asks tens of thousands of Americans about everything from exercise habits to illnesses and access to health care.
It found that 9.9% of U.S. adults will report smoking cigarettes in 2024, down from 10.8% in 2023. E-cigarette use was unchanged from last year at 7%, while 2.6% of adults used smokeless tobacco, including nicotine pouches. (This study was not able to compare rates of smokeless tobacco use because the definition of which products fall into that category changed.)
Israel Agak on new smoking rates among U.S. adults: ‘Data alone doesn’t tell the story’2M Research Services LLC
“In public health, the 10% number is very symbolic to us,” says Agak, who is also co-editor-in-chief of the Journal of Tobacco-Induced Diseases. “If it’s less than 10%, it’s considered a rare or unusual event.” By that definition, smoking is currently considered rare in the United States, he said.
However, 9.9% of Americans still use tobacco, or 25 million people. Data also shows that smoking rates are higher among certain populations, such as those who left education before entering university, people with disabilities, and people in rural areas.
“While the continued decline in tobacco use among U.S. adults is laudable and historic, it is important to address persistent disparities racially, economically, geographically, and within specific LGBTQ+ communities,” Kathy Crosby, CEO and president of the tobacco control nonprofit Truth Initiative, said in a statement. “It is also essential to repair and maintain federal infrastructure to support tobacco use prevention, smoking cessation, research, and public education.”
Overall, 48 million U.S. adults (18.8%) use at least one tobacco product.
Agak also said the findings suggest the United States is on track to meet the government’s goal of reducing smoking rates to 6.1% by 2030, as part of the Department of Health’s long-term efforts.
The CDC released the survey data last fall, but it did not include the analysis that typically accompanies it in its Morbidity and Mortality Weekly Report.
“A capable government agency” consistently “It is critical that you provide us with your findings to understand national trends in tobacco use,” Dorothy Hatsukami, a professor at the University of Minnesota who studies tobacco dependence, said in an email.
Agak previously worked on a report on smoking at OSH. So he downloaded the dataset available on the CDC site and used the platform’s technology to crunch the numbers himself.
“People need to understand the data because the data alone doesn’t speak for itself,” he said.
He first submitted a draft report to the CDC’s MMWR, where he hoped to continue the tradition of publishing national findings. However, he was told that MMWR could no longer publish works from outside contributors related to smoking. Since the Occupational Safety and Health Administration has effectively shut down, the agency has had no smoking experts to investigate it.
“Why don’t health institutions have experts on the main causes of death?” Agak said. (Smoking is the leading preventable cause of death in the United States, killing more than 480,000 people each year. Heart disease is the leading cause of death in the United States overall.)
A similar informal effort is currently underway to analyze the results of the government’s National Youth Tobacco Use Survey. The Food and Drug Administration released the study’s raw data results this month without any analysis.
Araku is working on something using chi-square. Suchitra Krishnan Sarin of Yale University School of Medicine and Sven Jodt of Duke University School of Medicine told STAT that they are working with colleagues to analyze these findings as well.
“I think leading tobacco researchers should take a step back and wait until this is fully analyzed by several sources,” Jolt said of the results of the Youth Tobacco Survey. “It’s unfortunate that the FDA was unable to release its own analysis on time.” He said tobacco giant Altria’s analysis of the youth study results should not be taken at face value.
While Chisquare and other organizations and institutions can conduct their own analysis, it is not a substitute for the government, Agak said.
“It doesn’t have the weight that an agency like Occupational Safety and Health would have reported, because Occupational Safety and Health had a whole apparatus in place to not only publish but disseminate this research,” he explained. For example, they sent out press releases and pitched to major media outlets to make it more likely that policymakers would hear and act on the results of large-scale research.
“Anyone can create a report,” Agak said. “There are very few people who have the resources and the institutional influence and the respect that the CDC once had to give its results the weight that it used to have. I think that’s what’s been lost.”
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