Trends of cigarette smoking and smokeless tobacco use among US firefighters and law enforcement personnel, 1992-2019

Background Previous studies indicate tobacco use was more prevalent among firefighters and law enforcement personnel than in the US adult population. Trends of smoking and smokeless tobacco (SLT) use among these first responders are unknown. We examined trends in current smoking and SLT use among US firefighters and law enforcement personnel and compared smoking and SLT use prevalence in firefighters and law enforcement personnel to US adults in non-first-responder occupations. Methods Trends of smoking and SLT use prevalence among firefighters, law enforcement personnel, and adults in other occupations were assessed by fitting joinpoint regression models using the 1992-2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS). We used multivariable logistic regression models adjusted for demographics to examine associations between occupation and smoking and SLT use status using the 2018-2019 TUS-CPS data. Analyses were conducted in 2021. Results From 1992 to 2019, the smoking prevalence declined overall (all p's < 0.01). Though SLT use prevalence among adults in non-first-responder occupations declined (annual percentage change [APC] = -1.2%; 95% confidence interval [CI] = -1.7% to -0.7%), no changes were shown among firefighters and law enforcement personnel which suggests SLT use may be increasing among firefighters over time. In 2018-2019, firefighters (adjusted odds ratio [AOR] = 3.4; 95% CI = 1.7 to 6.8) and law enforcement personnel (AOR = 3.2; 95% CI = 2.1 to 4.7) were more likely than adults in non-first-responder occupations to use SLT. Conclusions While smoking prevalence declined overall, SLT use is higher among firefighters and law enforcement personnel and may be increasing over time among firefighters. Research should examine reasons for SLT use by first responders. Comprehensive tobacco policies and SLT-specific cessation programs are needed for first responders.