Smoking Rates in U.S. Plummet, Experts Project Further Decline, but Challenges Remain
WASHINGTON — The United States has witnessed a remarkable decline in cigarette smoking over the past several decades, a public health triumph decades in the making.In 1955,more than half of American adults were smokers.Today, smoking prevalence has plummeted to just 11.5%, and experts now predict this figure will dip below 5% by 2035. this steep decrease has invigorated efforts to eradicate the tobacco epidemic for good.
A Long and Winding Road
The meaningful changes in smoking habits were not immediate, of course. The shift followed early scientific studies in the 1950s linking smoking to serious diseases such as lung cancer. Those findings ushered in an era of slow but steady progress. The 1960s brought the first strong public warnings,and since then,smoking has declined in tandem with various public health initiatives.
Government action played a pivotal role. The 2009 Family Smoking Prevention and Tobacco Control Act empowered the U.S. Food and Drug Management to regulate tobacco products. States, though, bore much of the responsibility for safeguarding public health, with many launching aspiring tobacco control programs. California led the way in 1988 with the first statewide effort; its success inspired similar programs nationwide.
A key inflection point arrived in 1998 with the Master Settlement Agreement. This landmark legal accord held the tobacco industry accountable for healthcare costs associated with smoking. It also restricted advertising, funded anti-smoking campaigns, and provided funding for tobacco control programs across the country. Despite these achievements, disparities persist, with variations in cigarette prices and investments in tobacco control contributing to different smoking rates and health outcomes across states.
State-by-State Progress Tracked
Researchers at the University of California San Diego recently analyzed data from a large national survey – the Tobacco Use Supplements to the U.S. Census Bureau’s Current Population Survey – to track smoking trends. This monthly survey,covering approximately 54,000 households,provides detailed insights into employment,economic well-being,and tobacco use.
Between June and October 2024, researchers examined responses from 1.77 million individuals to track state-level changes in smoking rates between 1992 and 2022. Thay assessed whether the gap between states with high and low smoking rates had narrowed and how these trends varied across age, race, sex, and education levels.Their study, published in JAMA Network Open, revealed that while differences in smoking rates still exist among states, the most significant declines occured in areas where smoking was previously most prevalent. However, gains have not been uniform across all age groups.“The rapid decline in smoking among young adults is clear evidence that the smoking epidemic will come to an end in our lifetime,” said Matthew Stone, Ph.D., first author and assistant professor at the UC San Diego Herbert Wertheim School of Public Health and Moores cancer Center. “Indeed, we project that the national smoking prevalence will be under 5% by 2035. Though, the much slower decline in smokers over the age of 50, particularly in previously high smoking states, will mean that the high rates of lung cancer, heart disease and chronic obstructive pulmonary disease that are caused by lifelong smoking will take longer to decrease.”
Young Adults Leading the Charge
The decline in smoking among young adults has been particularly noteworthy. Younger generations have shown a propensity to adopt healthier habits more quickly than older generations. This trend bodes well for continued reductions in smoking rates nationally. However, the slower progress among adults aged 50 and older could delay realization of the full potential of these improvements.
Need for Vigilance
John P. Pierce,Ph.D., corresponding author and Distinguished Professor at the UC San Diego Herbert Wertheim School of Public Health and Moores Cancer Center, stressed the importance of sustained vigilance. “while the ongoing decline in cigarette smoking is a major public health success story,” he said, “recent evidence suggests that the tobacco industry has successfully recruited a new generation of teenagers into e-cigarette use and nicotine addiction. Further research is needed to assess the long-term impact of this shift.”
recent data from the National Youth Tobacco Survey show that e-cigarette use among middle and high school students remains a significant concern, with flavored e-cigarettes being particularly appealing to young people. The FDA has been cracking down on unauthorized e-cigarette products,issuing warning letters and import alerts to address the issue. These actions are aimed at preventing the marketing and sale of e-cigarettes to underage individuals.
Healthy People 2030
The Healthy People 2030 initiative, which establishes national health objectives, initially aimed for a smoking rate below 5%. Due to changes in monitoring methods, that target was slightly adjusted upward to 6.1%. However, the new research from UC San Diego suggests that achieving the original 5% target by 2035 remains within reach.
The research team conducted a sensitivity analysis, comparing states projected to meet the 5% target with states identified in earlier studies based on cigarette sales data. They found strong alignment,thereby bolstering confidence in their projections.
Continued Efforts
Reaching a low national smoking rate will require continued efforts. States with slower progress must strengthen their tobacco control programs. Some strategies, such as raising cigarette taxes, investing in anti-smoking campaigns, and improving access to cessation programs, remain vital. For instance, New York’s high cigarette tax (currently $5.35 per pack) is often cited as a factor in its relatively low smoking rate.
The UC San Diego team also emphasized, “efforts need to be tailored to different groups. Older adults, in particular, need targeted help to quit smoking. Without focused intervention, the benefits of lower smoking rates among young people could be overshadowed by continued high rates of disease among older Americans.”
