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Cigarette smoking among adults has declined to record low levels in the United States, but some of the most vulnerable in society continue to smoke at far higher rates compared with the population at large.

In , the American Cancer Society (ACS) called the continued high prevalence of cigarette smoking among these groups "one of the most pressing challenges facing the tobacco control community."

"These populations included individuals in lower education and/or socioeconomic groups; from certain racial/ethnic groups; in the lesbian, gay/bisexual, and transgender (LGBT) community; with mental illness; and in the military, particularly among those in the lowest pay grades," the report noted.

In 2015, a total of 15% of adults in the United States were cigarette smokers, compared with 42.4% in 1965, the data showed.

While cigarette smoking rates have declined among the vulnerable populations identified in the report, the declines have not kept pace with the adult population as a whole and disparities have widened, said the lead author, Jeffrey Drope, PhD, the ACS's vice president for economic and health policy research.

Specifically, the results showed the following:

• Fifty years ago, smoking prevalence was 40%-45% among all educational-attainment groups, but now, just 6.5% of college-educated adults identified as cigarette smokers, compared with 23% of adults with a high school education or less
• In 2015 and 2016, about one in 10 adults living in high-income households used tobacco, compared with one in four adults living below the poverty line
• American Indians and Alaskan Natives continued to have the highest smoking prevalence (24.3% among men and 23.4% among women); women in this group have had a recent upward trend in smoking following a nearly 20-year downward trend
• Among people with mental illness, 27.9% of those reporting a past-year psychiatric episode reported current smoking, as did nearly 60% of people diagnosed with schizophrenia
• Smoking prevalence among LGBT men and women in the United States remains much higher than among heterosexuals; rates were highest in one survey among people identifying as bisexual (around 33%)

Smoking rates among military personnel have mirrored downward trends in the general population in recent decades, but remain significantly higher (24% in 2011), the researchers found. Roughly 30% of service members in the lowest pay grades (E1-E4) continued to smoke, compared with less than 5% of service members in the highest six pay grades of commissioned officers (O4-O10).

And smoking prevalence continues to vary considerably across states, from a low of 8.7% in Utah to 26.2% in Kentucky in 2016.

Smoking rates in the area of the country dubbed 'Tobacco Nation" by the advocacy group Truth Initiative remain higher than in the nation at large (22% versus 15%).

Stretching from the upper Midwest through much of the South, the 12 states -- Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Tennessee, and West Virginia -- have smoking rates that exceed "many of the most smoking-dependent countries in the world," the reported noted.

Drope told 番茄社区app that identifying innovative ways to reach these subpopulations that continue to smoke cigarettes at high rates should be a top priority of smoking prevention and cessation outreach.

"We need to think outside the box," he said. "The tobacco industry has undoubtedly been more effective at using social media and other new tools to reach these populations. We are starting to use them, but we aren't where we need to be yet."

Drope said the anti-smoking community's focus on the safety of new tobacco products, such as electronic cigarettes and heat-not-burn products, while important, is a potential distraction.

"There are still 40 million cigarette smokers in this country, and they are concentrated in these groups highlighted in this report. These are people who are addicted to a deadly product, and roughly two-thirds of them can be expected to die as a result if they continue to smoke."

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