Trends in tobacco use in the US have shifted dramatically over the past half century, thanks, in part, to improved scientific and medical knowledge, policies aimed at reducing cigarette use, and the emergence of tobacco-free products like electronic cigarettes (e-cigarettes). Although these trends demonstrate how major strides can be made in public health in a matter of decades, there still remains a need to strengthen public health protections around tobacco use.
Epidemiological cohort studies (in which groups of people are followed for a long time to measure the impact of exposure to a specific factor) providing clear evidence of the link between cigarette smoking and lung cancer were first conducted in the 1950s.1 Around that time, the majority of US adults were smokers: smoking prevalence was 56.9% in 1955.2 Public opinion and behavior, however, began to shift after the release of the 1964 US Surgeon General Report, which concluded that the average smoker had a 9- to 10-fold increased risk of developing lung cancer compared to non-smokers, while smoking was responsible for a 70% increased mortality rate among smokers versus non-smokers.3 Smoking prevalence dropped shortly thereafter. Among US adults, it was 42.4% in 1965 but fell to 33.2% by 1980; by 2022, it was only 11.6%, according to data from the American Lung Association.4 According to one study, over 8 million US deaths attributable to smoking have been averted since 1964.5
Increased taxes on tobacco products, the introduction of smoking bans to places like workplaces and restaurants, restrictions on advertising, and increased support for smoking cessation have all contributed to the dramatic decline in tobacco use in the US. The trends also hold true for adolescents. In 1997, 36.4% of US high school students reported smoking cigarettes, but only 3.8% did in 2021.4 Between 1991 and 2021, daily cigarette use decreased from 9.8% to 0.6%, while frequent use—defined as smoking on 20 or more days during the 30 days before the survey—dropped from 12.7% to 0.7%.6
In recent years, however, the trend of decreased tobacco use in the US has been matched—and in some ways even exceeded—by a trend towards increased use of e-cigarettes. Though they do not contain tobacco, most e-cigarette products contain nicotine, which is often extracted from the tobacco plant, and carry a range of health risks, including lung injury, nicotine addiction, and harms to brain development in adolescents.7 According to data from the Centers for Disease Control and Prevention, whereas only 4.5% of US adults used e-cigarettes in 2019, 6.5% did so in 2023.8
Additionally, between 2017 and 2023, the number of US adults who exclusively smoke cigarettes decreased by 6.8 million, but the number of US adults who exclusively use e-cigarettes increased by 7.2 million.9 E-cigarette usage among adolescents surged in the 2010s, reaching a peak of 27.5% among high school students in 201910; in 2024, only 5.9% of US youths reported e-cigarette usage,11 but it still remains a serious public health concern. Though the trend of reduced tobacco smoking among the US population remains a public health achievement, the newer trend of increased e-cigarette usage demands attention and intervention.
References
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3. The 1964 Report on Smoking and Health. Reports of the Surgeon General – Profiles in Science https://profiles.nlm.nih.gov/spotlight/nn/feature/smoking (2019).
4. American Lung Association. Tobacco Trends Brief: Overall Tobacco Trends Brief. https://www.lung.org/research/trends-in-lung-disease/tobacco-trends-brief/overall-smoking-trends.
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7. CDC. Health Effects of Vaping. Smoking and Tobacco Use https://www.cdc.gov/tobacco/e-cigarettes/health-effects.html (2025).
8. Products – Data Briefs – Number 524 – January 2025. https://www.cdc.gov/nchs/products/databriefs/db524.htm (2025) doi:10.15620/cdc/174583.
9. Arrazola, R. A. Notes from the Field: Tobacco Product Use Among Adults — United States, 2017–2023. MMWR Morb Mortal Wkly Rep 74, (2025), DOI: 10.15585/mmwr.mm7407a3
10. Cullen, K. A. et al. e-Cigarette Use Among Youth in the United States, 2019. JAMA 322, 2095–2103 (2019), DOI: 10.1001/jama.2019.18387
11. Commissioner, O. of the. Youth E-Cigarette Use Drops to Lowest Level in a Decade. FDA https://www.fda.gov/news-events/press-announcements/youth-e-cigarette-use-drops-lowest-level-decade (2024).