Since at least the colonial era, tobacco has been a popular commodity in the United States, with tobacco use increasing almost exponentially from the 1800s to the mid-1960s (DHHS 2000a). The invention of the cigarette fueled this dramatic rise in tobacco consumption, and cigarette smoking quickly outpaced the use of any other form of tobacco product (Brandt 2007). When tobacco use peaked in the mid-1960s, more than 40 percent of the U.S. adult population smoked cigarettes (National Center for Health Statistics 2005). This chapter reviews the growth of tobacco use over the 20th century, and the dramatic reversal of that trend beginning in 1965. The chapter examines recent trends in the epidemiology of smoking over the past four decades, takes a close look at the characteristics of smokers and those who have quit smoking, and discusses variations in the prevalence rate of smoking by sociodemographic characteristics and state of residence. Finally, the chapter highlights some possible threats to continued progress in reducing smoking in the United States.
In the late 19th and early 20th centuries, Americans consumed tobacco primarily in the form of chewing tobacco and cigars. According to Giovino, the per-capita consumption of tobacco products in the early 1880s was approximately 6 pounds of tobacco per person aged 18 and older; 56 percent of that tobacco was in the form of chewing tobacco, whereas only 1 percent took the form of manufactured cigarettes (Giovino 2002). For several reasons, cigarettes became the preferred tobacco product of Americans over