Wednesday, March 29, 2023
| Year | Cigarettes | Little cigars | Large cigars | Pipe tobacco | Roll-your-own tobacco | Moist snuff | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Million packs soldb | Packs per capitac | Million CPEs soldb | CPEs per capita | Million sticks soldd | Sticks per capita | Million CPEs solde | CPEs per capita | Million CPEs solde | CPEs per capita | Million CPEs soldf | CPEs per capita | |
| 2000 | 21,124.76 | 101.01 | 112.65 | 0.54 | 3,409.69 | 16.30 | 169.81 | 0.81 | 280.93 | 1.34 | 2,049.40 | 9.80 |
| 2001 | 20,605.07 | 97.06 | 108.57 | 0.51 | 3,563.75 | 16.79 | 152.80 | 0.72 | 268.81 | 1.27 | 2,129.63 | 10.03 |
| 2002 | 19,762.18 | 92.05 | 112.39 | 0.52 | 3,706.29 | 17.26 | 143.76 | 0.67 | 328.31 | 1.53 | 2,205.87 | 10.27 |
| 2003 | 18,834.13 | 86.79 | 114.78 | 0.53 | 4,018.50 | 18.52 | 129.09 | 0.59 | 369.63 | 1.70 | 2,298.08 | 10.59 |
| 2004 | 18,780.37 | 85.56 | 135.08 | 0.62 | 4,319.16 | 19.68 | 121.37 | 0.55 | 399.26 | 1.82 | 2,435.07 | 11.09 |
| 2005 | 18,148.6 | 81.75 | 188.60 | 0.85 | 4,436.11 | 19.98 | 120.88 | 0.54 | 482.99 | 2.18 | 2,522.36 | 11.36 |
| 2006 | 18,228.49 | 81.15 | 209.58 | 0.93 | 4,508.08 | 20.07 | 107.76 | 0.48 | 512.49 | 2.28 | 2,581.24 | 11.49 |
| 2007 | 17,419.64 | 76.67 | 238.51 | 1.05 | 4,663.03 | 20.52 | 97.61 | 0.43 | 537.35 | 2.36 | 2,741.22 | 12.06 |
| 2008 | 16,769.2 | 72.91 | 273.55 | 1.19 | 4,672.74 | 20.32 | 98.70 | 0.43 | 630.37 | 2.74 | 2,800.49 | 12.18 |
| 2009 | 15,419.39 | 66.28 | 107.53 | 0.46 | 7,981.90 | 34.31 | 333.20 | 1.43 | 359.12 | 1.54 | 2,919.42 | 12.55 |
| 2010 | 14,639.62 | 62.41 | 44.83 | 0.19 | 9,940.95 | 42.38 | 691.76 | 2.95 | 184.00 | 0.78 | 3,086.37 | 13.16 |
| 2011 | 14,317.63 | 60.24 | 37.69 | 0.16 | 9,997.56 | 42.07 | 1,020.27 | 4.29 | 152.22 | 0.64 | 3,218.50 | 13.54 |
| 2012 | 13,991.92 | 58.25 | 35.24 | 0.15 | 9,438.75 | 39.30 | 1,132.15 | 4.71 | 131.71 | 0.55 | 3,357.06 | 13.98 |
| 2013 | 13,304.4 | 54.88 | 30.53 | 0.13 | 7,783.00 | 32.10 | 1,212.19 | 5.00 | 112.72 | 0.46 | 3,482.77 | 14.37 |
| 2014 | 12,724.33 | 51.99 | 27.12 | 0.11 | 6,961.14 | 28.44 | 1,169.49 | 4.78 | 94.53 | 0.39 | 3,522.71 | 14.39 |
| 2015 | 12,986.03 | 52.57 | 26.53 | 0.11 | 5,757.43 | 23.31 | 1,124.42 | 4.55 | 107.95 | 0.44 | 3,614.78 | 14.63 |
| 2016 | 12,491.24 | 50.11 | 23.77 | 0.10 | 5,056.76 | 20.28 | 1,077.77 | 4.32 | 91.29 | 0.37 | 3,716.81 | 14.91 |
| 2017 | 11,964.83 | 47.59 | 20.73 | 0.08 | 5,168.61 | 20.56 | 1,089.68 | 4.33 | 76.51 | 0.30 | 3,730.76 | 14.84 |
| 2018 | 11,345.8 | 44.78 | 17.81 | 0.07 | 5,018.61 | 19.81 | 1,015.58 | 4.01 | 60.59 | 0.24 | 3,677.15 | 14.51 |
| 2019 | 10,670.03 | 41.81 | 7.75 | 0.03 | 4,666.35 | 18.29 | 964.12 | 3.78 | 56.69 | 0.22 | 3,615.30 | 14.17 |
| 2020 | 10,792.93 | 42.29 | 8.70 | 0.03 | 4,357.01 | 17.07 | 924.51 | 3.62 | 53.58 | 0.21 | — | — |
| AAPCg (95% CI) [P value] | −3.5 (−3.6 to −3.3) [<.001] | −12.1 (−19.0 to −4.6) [<.001] | 0.7 (−2.3 to 3.9) [.60] | 9.4 (7.8 to 11.0) [<.001] | −7.7 (−10.7 to −4.6) [<.001] | 3.0 (2.7 to 3.4) [<.001] | ||||||
Table 1. Total Sales of Various Tobacco Products in Standardized Units of Cigarette Packs or CPEs, 2000–2020, USa
Abbreviations: —, does not apply; AAPC, average annual percentage change; CPE, cigarette pack equivalent.
a Data sources: Data on taxable removals (actual sales) of cigarettes, little cigars, large cigars, pipe tobacco, and RYO tobacco were obtained from the Alcohol and Tobacco Tax and Trade Bureau, US Department of the Treasury (17). Data on volume sales of smokeless tobacco were obtained from the US Federal Trade Commission for 2000–2019 (18).
b The number of cigarette packs and CPEs for little cigars was calculated by dividing the number of sticks by 20. Little cigars resemble cigarettes in all respects and so were considered direct equivalents.c Adult per capita sales based on the US adult population aged ≥18 years using data from the US Census Bureau for each year.
d Large cigars were not converted to CPEs because of variations in size and tobacco content.
e CPEs for pipe and RYO loose smoking tobacco were based on weight (14.6 g tobacco per cigarette pack).
f Moist snuff CPEs assumed the equivalence of a 1.2 oz tin to 2.5 packs of cigarettes based on consumption.
g Overall linear trend during 2000–2020; significant difference defined as P < .05.
| Characteristic | Cigarettes | Cigars | Roll-your-own tobacco | Pipe | Smokeless tobaccob | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| 2002 | 2019 | 2002 | 2019 | 2002 | 2019 | 2002 | 2019 | 2002 | 2019 | |
| Overall | 27.4 (26.7–28.1) | 18.2 (17.7–18.7)c | 5.4 (5.1–5.8) | 4.6 (4.3–4.8)c | 2.6 (2.4–2.9) | 3.0 (2.8–3.3)c | 0.8 (0.6–1.0) | 0.7 (0.6–0.9) | 3.5 (3.2–3.7) | 3.3 (3.1–3.5)c |
| Sex | ||||||||||
| Female | 24.5 (23.6–25.5) | 16.3 (15.7–17.0)c | 1.6 (1.4–1.8) | 2.0 (1.8–2.3)c | 1.8 (1.5–2.1) | 2.4 (2.1–2.7)c | 0.3 (0.1–0.4) | 0.3 (0.2–0.4) | 0.5 (0.3–0.6) | 0.6 (0.5–0.7) |
| Male | 30.8 (29.7–31.9) | 20.3 (19.5–21.1)c | 9.6 (9.0–10.3) | 7.3 (6.8–7.8)c | 3.5 (3.1–3.9) | 3.7 (3.4–4.1)c | 1.4 (1.1–1.7) | 1.2 (1.0–1.4) | 6.7 (6.2–7.3) | 6.2 (5.8–6.6)c |
| Age, y | ||||||||||
| 18–25 | 40.8 (39.9–41.7) | 17.8 (17.0–18.6)c | 11.0 (10.4–11.6) | 7.7 (7.1–8.2)c | 4.5 (4.2–4.9) | 3.2 (2.8–3.5)c | 1.1 (0.9–1.3) | 1.3 (1.1–1.5)c | 4.9 (4.5–5.3) | 5.0 (4.5–5.4)c |
| 26–34 | 32.7 (31.1–34.3) | 23.6 (22.5–24.8)c | 6.6 (5.8–7.5) | 6.4 (5.8–7.1) | 3.4 (2.8–4.1) | 3.6 (3.1–4.1)c | 0.5 (0.3–0.7) | 1.0 (0.7–1.3)c | 5.4 (4.7–6.1) | 4.4 (3.8–4.9) |
| 35–49 | 30.8 (29.6–32.0) | 21.6 (20.7–22.6)c | 5.8 (5.2–6.5) | 4.5 (4.1–5.0)c | 3.2 (2.7–3.7) | 3.3 (2.9–3.6)c | 0.5 (0.3–0.7) | 0.6 (0.4–0.7) | 3.2 (2.8–3.7) | 4.1 (3.7–4.6)c |
| ≥50 | 17.3 (16.0–18.7) | 14.7 (13.8–15.5)c | 2.4 (1.9–2.9) | 3.0 (2.6–3.5) | 1.0 (0.7–1.4) | 2.7 (2.3–3.0)c | 1.0 (0.6–1.4) | 0.6 (0.4–0.8)c | 2.3 (1.8–2.8) | 2.0 (1.7–2.4) |
| Race and ethnicity | ||||||||||
| African American | 28.2 (26.0–30.4) | 20.8 (19.3–22.3)c | 7.1 (6.0–8.2) | 8.7 (7.7–9.6)c | 4.5 (3.5–5.4) | 3.4 (2.8–4.0) | 0.4 (0.1–0.7) | 0.7 (0.4–0.9) | 1.7 (1.1–2.4) | 1.3 (0.9–1.8)c |
| Hispanic | 25.0 (22.8–27.2) | 13.5 (12.4–14.7)c | 5.2 (4.2–6.3) | 3.3 (2.8–3.9)c | 3.9 (3.0–4.9) | 2.2 (1.7–2.6)c | 0.3 (0.1–0.4) | 0.5 (0.3–0.7)c | 0.5 (0.3–0.8) | 0.9 (0.7–1.1)c |
| Otherd | 25.5 (22.1–28.9) | 14.5 (12.9–16.1)c | 2.7 (2.0–3.4) | 2.9 (2.3–3.6) | 4.2 (2.9–5.5) | 2.8 (2.1–3.5)c | —e | 1.0 (0.6–1.4) | 1.8 (1.1–2.4) | 2.3 (1.6–2.9) |
| White | 28.0 (27.2–28.8) | 19.5 (18.8–20.1)c | 5.4 (5.0–5.8) | 4.3 (4.0–4.7)c | 2.0 (1.8–2.2) | 3.2 (2.9–3.5)c | 1.0 (0.7–1.2) | 0.8 (0.6–0.9) | 4.4 (4.0–4.7) | 4.5 (4.2–4.8)c |
| Annual household income, $ | ||||||||||
| ≤19,999 | 35.5 (33.8–37.3) | 30.1 (28.5–31.6)c | 5.7 (5.1–6.4) | 6.5 (5.8–7.3)c | 5.4 (4.7–6.2) | 7.7 (6.8–8.6)c | 0.9 (0.7–1.2) | 1.5 (1.1–1.9)c | 3.1 (2.5–3.7) | 3.3 (2.7–3.8) |
| 20,000–49,999 | 29.7 (28.5–30.8) | 21.7 (20.7–22.7)c | 5.0 (4.5–5.5) | 4.4 (3.9–4.9) | 2.8 (2.4–3.3) | 3.6 (3.2–4.1)c | 0.8 (0.5–1.0) | 0.8 (0.6–1.0) | 3.7 (3.3–4.2) | 3.1 (2.7–3.5) |
| 50,000–74,999 | 24.6 (23.0–26.3) | 17.8 (16.5–19.0)c | 4.9 (4.1–5.7) | 4.2 (3.6–4.8)c | 1.4 (1.1–1.8) | 2.3 (1.8–2.9)c | 0.8 (0.2–1.4) | 0.7 (0.4–0.9) | 3.6 (2.9–4.3) | 3.4 (2.8–3.9)c |
| ≥75,000 | 19.7 (18.3–21.1) | 11.7 (11.1–12.4)c | 6.3 (5.5–7.1) | 4.1 (3.7–4.6)c | 0.8 (0.6–1.1) | 1.2 (1.0–1.4)c | 0.7 (0.4–1.0) | 0.5 (0.3–0.6) | 3.2 (2.7–3.8) | 3.5 (3.1–3.8)c |
| Education | ||||||||||
| Less than high school diploma | 35.2 (33.3–37.0) | 26.7 (25.0–28.4)c | 5.9 (5.1–6.8) | 5.2 (4.4–6.0) | 5.2 (4.4–6.0) | 6.6 (5.7–7.5)c | 0.8 (0.5–1.0) | 1.0 (0.7–1.3) | 4.1 (3.3–4.9) | 3.3 (2.7–3.9) |
| High school diploma | 32.3 (31.0–33.6) | 25.2 (24.0–26.3)c | 5.4 (4.8–5.9) | 5.3 (4.7–5.9)c | 3.0 (2.6–3.4) | 4.7 (4.2–5.3)c | 0.8 (0.5–1.1) | 1.1 (0.8–1.3)c | 4.2 (3.7–4.7) | 4.5 (4.0–5.0)c |
| Some college | 29.0 (27.6–30.5) | 20.3 (19.4–21.2)c | 6.0 (5.3–6.7) | 5.0 (4.5–5.5)c | 2.1 (1.6–2.5) | 2.7 (2.3–3.0)c | 1.0 (0.6–1.5) | 0.8 (0.6–1.0) | 3.3 (2.8–3.8) | 3.9 (3.5–4.3)c |
| College degree or more | 14.5 (13.4–15.7) | 8.1 (7.5–8.8)c | 4.6 (4.0–5.3) | 3.4 (3.0–3.9)c | 0.9 (0.6–1.1) | 0.8 (0.6–1.0) | 0.6 (0.3–0.9) | 0.4 (0.2–0.5) | 2.3 (1.9–2.8) | 1.9 (1.6–2.2) |
Table 2. Prevalence of Self-Reported Current (Past 30-Day) Use of Cigarettes and Noncigarette Tobacco Products Among US Adults Aged ≥18 Years, by Demographic Characteristics, National Survey on Drug Use and Health, 2002–2019a
a Data source: Substance Abuse and Mental Health Services Administration (16). All values are percentage (95% CI).
b Prevalence of smokeless tobacco use showed an increasing trend in the adjusted analysis.
c Significant linear trend during 2002–2019 (P < .05). Linear trend assessed in a binary logistic regression model using orthogonal polynomials that adjusted for age, sex, and race and ethnicity.d Includes American Indian/Alaska Native, Pacific Islander.
e Estimate not presented because relative standard error was ≥40%.
| Characteristic | Cigarettes | Cigars | Pipe | Smokeless tobacco | ||||
|---|---|---|---|---|---|---|---|---|
| 2002 | 2019 | 2002 | 2019 | 2002 | 2019 | 2002 | 2019 | |
| Overall | 73.4 (72.6–74.2) | 59.5 (58.8–60.2)b | 40.0 (39.1–40.8) | 33.8 (33.2–34.5)b | 18.6 (17.8–19.3) | 12.5 (12.0–13.0)b | 21.2 (20.5–21.9) | 16.6 (16.1–17.1)b |
| Sex | ||||||||
| Female | 68.5 (67.3–69.6) | 54.8 (53.9–55.8)b | 19.3 (18.5–20.2) | 18.3 (17.6–19.0)b | 4.5 (3.9–5.0) | 3.8 (3.4–4.2) | 6.7 (6.1–7.3) | 5.2 (4.9–5.6)b |
| Male | 78.7 (77.7–79.7) | 64.5 (63.6–65.5)b | 62.3 (61.1–63.5) | 50.5 (49.4–51.5)b | 33.8 (32.6–35.1) | 21.7 (20.9–22.6)b | 36.9 (35.7–38.0) | 28.8 (27.9–29.7)b |
| Age, y | ||||||||
| 18–25 | 71.3 (70.5–72.1) | 43.4 (42.3–44.4)b | 45.8 (44.9–46.7) | 30.8 (29.8–31.8)b | 8.1 (7.6–8.6) | 7.9 (7.3–8.4)b | 23.9 (23.2–24.7) | 16.6 (15.8–17.4)b |
| 26–34 | 73.0 (71.4–74.6) | 60.0 (58.7–61.4)b | 41.5 (39.8–43.2) | 40.1 (38.8–41.5) | 9.5 (8.6–10.5) | 10.6 (9.7–11.4)b | 29.1 (27.6–30.6) | 20.8 (19.7–21.9)b |
| 35–49 | 75.8 (74.6–77.0) | 62.5 (61.3–63.6)b | 42.2 (40.9–43.6) | 37.1 (36.0–38.3)b | 16.7 (15.7–17.7) | 8.6 (8.0–9.3)b | 21.4 (20.3–22.5) | 20.0 (19.1–21.0)b |
| ≥50 | 72.4 (70.8–74.0) | 62.5 (61.3–63.7)b | 35.1 (33.4–36.8) | 30.8 (29.6–31.9)b | 28.2 (26.6–29.9) | 16.5 (15.6–17.5)b | 16.4 (15.1–17.7) | 13.3 (12.4–14.1)b |
| Race/ethnicity | ||||||||
| African American | 63.7 (61.3–66.1) | 45.2 (43.3–47.1)b | 29.8 (27.4–32.2) | 24.5 (22.9–26.1)b | 12.3 (10.3–14.3) | 5.5 (4.6–6.3)b | 13.5 (11.6–15.3) | 6.9 (5.9–7.8)b |
| Hispanic | 61.1 (58.5–63.7) | 46.4 (44.6–48.1)b | 27.6 (25.4–29.8) | 23.1 (21.6–24.5)b | 6.8 (5.3–8.3) | 5.2 (4.4–6.0)b | 9.0 (7.7–10.4) | 8.6 (7.7–9.6) |
| Other | 59.6 (55.4–63.7) | 41.8 (39.4–44.2)b | 26.9 (23.5–30.3) | 22.4 (20.4–24.3)b | 9.9 (7.6–12.3) | 7.2 (6.0–8.4)b | 13.6 (11.2–15.9) | 9.7 (8.5–10.9)b |
| White | 78.1 (77.2–78.9) | 68.1 (67.3–68.9)b | 44.7 (43.7–45.7) | 40.0 (39.1–40.8)b | 22.2 (21.3–23.1) | 16.4 (15.7–17.1)b | 25.1 (24.2–25.9) | 21.4 (20.7–22.1)b |
| Annual household income, $ | ||||||||
| ≤19,999 | 67.9 (66.1–69.7) | 57.1 (55.4–58.8)b | 30.7 (29.1–32.4) | 25.5 (24.0–27.0)b | 12.9 (11.6–14.2) | 11.1 (10.0–12.2)b | 18.3 (16.8–19.7) | 13.7 (12.6–14.9)b |
| 20,000–49,999 | 73.0 (71.8–74.3) | 58.9 (57.7–60.2)b | 37.6 (36.3–38.9) | 29.0 (27.8–30.2)b | 18.1 (17.0–19.2) | 11.8 (10.9–12.7)b | 20.8 (19.8–21.8) | 13.7 (12.8–14.5)b |
| 50,000–74,999 | 75.7 (73.9–77.5) | 61.2 (59.6–62.9)b | 43.0 (41.0–45.0) | 34.5 (32.8–36.1)b | 19.2 (17.4–20.9) | 12.9 (11.7–14.0)b | 22.5 (21.0–24.1) | 16.6 (15.4–17.8)b |
| ≥75,000 | 76.7 (75.2–78.2) | 60.1 (59.0–61.2)b | 49.1 (47.3–50.9) | 40.0 (38.8–41.1)b | 23.5 (21.9–25.2) | 13.3 (12.4–14.1)b | 23.3 (21.8–24.7) | 19.7 (18.8–20.5) |
| Education | ||||||||
| Less than high school diploma | 67.1 (65.1–69.1) | 54.9 (52.8–56.9)b | 30.6 (28.7–32.4) | 22.3 (20.6–24.0)b | 14.7 (13.2–16.2) | 8.5 (7.4–9.6)b | 20.5 (18.8–22.3) | 12.6 (11.4–13.9)b |
| High school diploma | 74.7 (73.3–76.0) | 61.5 (60.1–62.8)b | 37.2 (35.8–38.5) | 30.0 (28.7–31.3)b | 16.6 (15.4–17.8) | 11.0 (10.1–11.9)b | 21.6 (20.5–22.8) | 17.4 (16.4–18.4)b |
| Some college | 76.7 (75.3–78.1) | 62.4 (61.2–63.6)b | 43.1 (41.4–44.7) | 36.0 (34.8–37.1)b | 18.9 (17.5–20.4) | 13.8 (12.9–14.7)b | 22.0 (20.8–23.3) | 18.6 (17.7–19.5) |
| College degree or more | 72.8 (71.2–74.4) | 57.1 (55.8–58.4)b | 47.1 (45.4–48.9) | 38.8 (37.6–40.1)b | 23.5 (21.9–25.0) | 13.8 (12.8–14.7)b | 20.3 (19.0–21.6) | 15.5 (14.6–16.4)b |
Table 3. Prevalence of Self-Reported Ever Use of Cigarettes and Noncigarette Tobacco Products Among US Adults Aged ≥18 Years, National Survey on Drug Use and Health, 2002–2019a
a Data source: Substance Abuse and Mental Health Services Administration (16). All values are percentage (95% CI).
b Significant linear trend during 2002–2019 (P < .05). Linear trend assessed in a binary logistic regression model using orthogonal polynomials that adjusted for age, sex, and race and ethnicity.
Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
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This activity is intended for public health/prevention officials, family practitioners, internists, and other clinicians acting as advocates against tobacco use or who treat and manage patients using tobacco.
The goal of this activity is for learners to be better able to describe 20-year trends in tobacco use in the United States from 2000 to 2020, based on sales data for cigarettes, cigars, roll-your-own tobacco, and pipes from the US Department of the Treasury, standardized to cigarette packs and cigarette pack equivalents, as well as self-reported data on past 30-day tobacco use for those aged 18 years and older from The National Survey on Drug Use and Health.
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Introduction
In the past 2 decades, many tobacco control policies were enacted, and several new or modified products were introduced into the US marketplace. Continued tobacco surveillance is critical in this evolving landscape. We examined 20-year trends in tobacco use from sales and self-reported data.
Methods
We obtained data on taxable removals (sales) of cigarettes, cigars, roll-your-own (RYO) tobacco, and pipe tobacco from the US Department of the Treasury. We assessed self-reported past 30-day tobacco use from the National Survey on Drug Use and Health among people aged 18 years or older. Volume sales were standardized to cigarette packs and cigarette pack equivalents (CPEs) and trends measured by using joinpoint and logistic regression.
Results
From 2000 to 2019–2020, declines occurred in per capita sales of cigarettes (101.01 to 42.29 packs/capita), little cigars (0.54 to 0.03 CPEs/capita), and RYO tobacco (1.34 to 0.21 CPEs/capita). Volume sales also decreased for chewing tobacco and scotch/dry snuff (all P < .05). Conversely, volume sales increased for pipe tobacco, moist snuff, and snus for the respective assessed periods. Large cigar volume sales did not change significantly. We found consistent trends in self-reported use, except for RYO tobacco (decreased volume sales but increased self-reported use) and pipe smoking (increased volume sales, but trivial self-reported use <1% throughout the study period). Current use of any tobacco product decreased from 32.2% to 22.9% during the assessed period.
Conclusion
Harmonizing the tax and regulatory structure within and across the diversity of tobacco products may help reduce aggregate tobacco consumption in the US.
Healthy People sets science-based, 10-year national objectives for improving the nation’s health and well-being [1,2]. Tobacco-related Healthy People 2030 objectives include reducing adult tobacco use to 16.2% or less (from 20.1% in 2018), current cigarette smoking to 5% or less (from 13.9% in 2019), and any combustible tobacco use (ie, cigarettes, cigars, pipes) to 5% or less (from 16.8% in 2018) [2]. Holistically examining long-term trends in the diversity of tobacco products in the US marketplace is important because these products are not independent of one another nor are their trends. Switching from one product to another is largely driven by market forces (eg, product design and marketing) and economic factors (eg, tax imbalances) [3–7]. Yet tobacco products that are close substitutes are being regulated differently [8]. Little cigars and large cigars are both cigars but are taxed differently, as are pipe and roll-your-own (RYO) tobacco, which are both loose forms of smoking tobacco [5,6]. Furthermore, only in August 2016 did the “deeming rule” extend the regulatory authority of the US Food and Drug Administration beyond cigarettes to other similarly harmful combustible products, such as cigars, hookah, and pipe tobacco [9]. Yet these newly deemed combustibles are marketed in a plethora of flavors, whereas cigarette flavors are banned (except menthol) [3,10,11].
It is therefore imperative for policy makers to understand the long-term trends in tobacco product consumption and how these trends may have shifted in response to policy interventions [4,6]. Such information can help eliminate loopholes that dampen the impact of tobacco control policies through tax avoidance strategies [4–6,12]. Some studies have examined trends in US tobacco consumption over varying lengths of time by using both population and sales data [13–15]; however, no recent study has examined trends over the past 2 decades to gain insights into longer-term trends that may be different from year-on-year changes, seasonal variations, or even multiyear trends over shorter periods of time. To fill this gap, we examined changes in the consumption of cigarettes, cigars, smokeless tobacco, RYO tobacco, and pipe tobacco during the 20-year period from 2000 to 2020. Analyzed data comprised both volume sales data (2000–2020) and self-reported data (2002–2019).
