Joinpoint trend analysis of prevalence of combustible and non-combustible tobacco product use by adults in the United States, using cross-sectional data from NHIS 2015-2023.

INTRODUCTION: We describe population-level trends in the prevalence of any tobacco use, combustible and non-combustible tobacco use in US adults, by age and sex, from 2015 to 2023. METHODS: Cross-sectional data collected in the annual US National Health Interview Surveys (NHIS) conducted between 2015 and 2023 were used to characterize trends in adult current prevalence of any tobacco use, combustible and non-combustible tobacco product use. All NHIS participants with valid data on tobacco use, age and sex were included in the analyses. Joinpoint regression was used to estimate the annual percentage change (APC) from 2015 to 2023 and 95% confidence intervals (CIs) overall for each outcome and by different age groups (18-24, 25-34, 35-54, and ≥55 years) and for males and females. All statistical tests were two tailed and based on a p<0.05 significance level. RESULTS: Between 2015 and 2023 any tobacco use decreased at a statistically non-significant APC rate of -1.0% (95% CI: -2.1-0.12) across all age and sex groups combined. Overall, combustible tobacco decreased at a statistically significant APC rate of -3.6% (95% CI -4.6 - -2.6), with differences by age group (18-24: -12.2%, 95% CI: -14.6 - -9.7; 25-34: -5.2%, 95% CI: -6.6 - -3.8; 35-54: -2.5%, 95% CI: -4.2 - -0.9; ≥55: -1.2%, 95% CI: -1.8 - -0.5). Non-combustible tobacco product prevalence increased at a statistically significant APC of 8.9% (95% CI: 6.5-15.8) after 2017, with increases in all age groups and both sexes. The decrease in combustible tobacco was due to decreasing cigarette use while the increase in non-combustible tobacco products after 2017 was due to increases in electronic cigarette (EC) use. CONCLUSIONS: Tobacco products use by US adults shifted between 2015 and 2023, with combustible use decreasing, particularly in young adults, while non-combustible use increased.