A new analysis of National Health Interview Survey (NHIS) data shows that adult cigarette smoking in the United States has dropped below 10% for the first time, according to a report published on Mar. 15 in NEJM Evidence by researcher Israel Agaku. The study also finds that nearly one in five adults continues to use some form of tobacco, highlighting ongoing disparities across demographic and occupational groups.
The findings are significant because tobacco remains a leading cause of preventable disease and death in the U.S., contributing to heart disease, cancer, and respiratory disorders. National programs such as Healthy People 2030 aim to reduce adult cigarette smoking prevalence to 6.1%, making accurate tracking of tobacco use patterns essential for public health planning.
The NHIS collects health data through household interviews across all states and Washington, D.C., with over 29,000 adults surveyed in 2023 and more than 32,000 in 2024. The survey defines current smokers as those who have smoked at least 100 cigarettes in their lifetime and currently smoke every day or on some days. Other products assessed include cigars, smokeless tobacco (such as chewing tobacco and nicotine pouches), and e-cigarettes.
According to the latest data, about 18.8% of U.S. adults—approximately 47.7 million people—reported using at least one tobacco product in 2024. Cigarette smoking was reported by 9.9% of adults, while e-cigarette use stood at about 7%. Cigar use was reported by 3.7%, and smokeless tobacco by 2.6%. Most users relied on a single product; however, some reported using multiple products simultaneously.
Tobacco use varied widely among different groups: men used tobacco more than women (24.1% versus 13.9%), young adults aged 18–24 were more likely to vape than smoke cigarettes (14.8% versus 3.4%), and individuals with lower income or education levels had higher usage rates—exceeding 40% among those with a GED certificate. Rural residents reported higher usage than urban residents (27% versus 17.5%). Occupational differences were also noted: workers in agriculture, mining, construction, and manufacturing had higher rates compared to those in education or healthcare sectors.
Adults with disabilities reported greater tobacco consumption compared to those without disabilities (21.5% versus 16.5%). The report cautions that some subgroup estimates may be less precise due to small sample sizes or changes in survey definitions between years.
While adult cigarette smoking has reached historic lows—dropping from 10.8% in 2023 to under ten percent—the continued popularity of cigars, e-cigarettes, and smokeless products means that overall tobacco use remains widespread across the country.
The authors conclude that "these findings highlight the need for sustained public health efforts to reduce tobacco use," especially among high-prevalence groups.
