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Introduction
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).
Methods
Data sources
Self-reported use of tobacco products
We obtained self-reported data on use of tobacco products...