Smoking in United States

United States

Smoking cigarettes has an adverse impact on overall health. As the leading cause of preventable death in the United States, cigarette smoking is responsible for the deaths of more than 480,000 Americans every year. Smoking damages nearly every organ and can cause heart disease, stroke, diabetes, multiple types of cancer and respiratory conditions such as emphysema and chronic bronchitis. 

More than 16 million Americans live with a disease caused by smoking. Smoking can affect nonsmokers as well; exposure to secondhand smoke is responsible for more than 41,000 deaths every year. The annual cost of premature death due to smoking in the U.S. is nearly $180 billion; smoking-related disease costs the economy another $185 billion in lost productivity. Combined with health expenditures, cigarette smoking costs the U.S. more than $600 billion each year.

In recent years, there has been an increase in the popularity of e-cigarettes, especially among youth and young adults. E-cigarettes often contain nicotine and other cancer-causing chemicals. In October 2021, the U.S. Food and Drug Administration authorized the marketing of certain tobacco-flavored e-cigarettes as a tool to help adults addicted to cigarettes smoke less and reduce their exposure to harmful chemicals.

According to America’s Health Rankings analysis, the prevalence of smoking in adults is higher among: 

• Men compared with women.
• Adults ages 45-64 compared with adults ages 18-44 and adults ages 65 and older.
• American Indian/Alaska Native and multiracial adults compared with Asian adults.
• Adults with less than a high school education, who have a prevalence more than 4 times higher than college graduates. 
• Adults with an income less than $25,000, who have a prevalence 3 times higher than those with incomes of $75,000 or more; the prevalence of smoking was significantly lower with each increase in income level.
• Adults living in nonmetropolitan areas compared with those living in metropolitan areas.
• Adults who have difficulty with self-care compared with adults without a disability.
• Lesbian, gay, bisexual and queer (LGBQ+) adults compared with straight adults.

Other research has found that the following populations also have a high prevalence of smoking:

• Adults who are divorced, separated or widowed.
• Adults who report serious psychological distress, such as feelings of sadness, nervousness and worthlessness.

Quitting smoking can have profound benefits on current and long-term health, even among heavy and lifelong smokers:

• Individuals who quit smoking before age 40 live an average of 10 years longer than those who continue. 
• The risk of stroke becomes similar to that of nonsmokers five years after quitting. 
• Pregnant women who quit smoking during the first trimester give birth to infants of comparable weight and height to those of nonsmoking women. 

A variety of interventions are effective for smoking prevention and cessation. States that have expanded Medicaid coverage for tobacco cessation programs have shown declines in smoking prevalence. This is a vital area for improvement because of the high prevalence of smokers enrolled in Medicaid. Excise taxes and increased prices have been effective in preventing nonsmokers from starting, increasing cessation and decreasing smoking-related health problems. In December 2019, the Federal Food, Drug and Cosmetic Act was changed to raise the minimum age of purchase for tobacco products from 18 to 21, which has effectively decreased tobacco use among 18- to 20-year-olds. 

Additional smoking prevention and cessation resources include: 

• The Centers for Disease Control and Prevention offers guidelines and examples of successful programs for preventing and controlling tobacco use.
• County Health Rankings & Roadmaps’ What Works for Health tool provides a list of evidence-based strategies to address tobacco use. 
• Smokefree.gov provides free, accurate and evidence-based information as well as professional assistance to support the immediate and long-term needs of smokers trying to quit. There are also resources specifically for women and pregnant women.

Healthy People 2030 has multiple objectives regarding adult tobacco use, including reducing current cigarette smoking and increasing past-year attempts to quit smoking.

Chaloupka, Frank J., Kurt Straif, and Maria E. Leon. “Effectiveness of Tax and Price Policies in Tobacco Control.” Tobacco Control 20, no. 3 (May 1, 2011): 235–38. https://doi.org/10.1136/tc.2010.039982.

Cornelius, Monica E., Caitlin G. Loretan, Ahmed Jamal, Brittny C. Davis Lynn, Margaret Mayer, Iris C. Alcantara, and Linda Neff. “Tobacco Product Use Among Adults – United States, 2021.” MMWR. Morbidity and Mortality Weekly Report 72, no. 18 (May 5, 2023): 475–83. https://doi.org/10.15585/mmwr.mm7218a1.

DiGiulio, Anne, Zach Jump, Stephen Babb, Anna Schecter, Kisha-Ann S. Williams, Debbie Yembra, and Brian S. Armour. “State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2008–2018.” MMWR. Morbidity and Mortality Weekly Report 69, no. 6 (February 14, 2020): 155–60. https://doi.org/10.15585/mmwr.mm6906a2.

Jha, Prabhat, Chinthanie Ramasundarahettige, Victoria Landsman, Brian Rostron, Michael Thun, Robert N. Anderson, Tim McAfee, and Richard Peto. “21st-Century Hazards of Smoking and Benefits of Cessation in the United States.” New England Journal of Medicine 368, no. 4 (January 24, 2013): 341–50. https://doi.org/10.1056/NEJMsa1211128.

Kramarow, Ellen, and Nazik Elgaddal. “Current Electronic Cigarette Use in Adults Aged 18 and Over: United States, 2021.” NCHS Data Brief No. 475. Hyattsville, MD: National Center for Health Statistics, July 21, 2023. https://doi.org/10.15620/cdc:129966.

Shah, Reena S., and John W. Cole. “Smoking and Stroke: The More You Smoke the More You Stroke.” Expert Review of Cardiovascular Therapy 8, no. 7 (July 2010): 917–32. https://doi.org/10.1586/erc.10.56.

U.S. Department of Health and Human Services. “E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General.” Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016. https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdf.