Smoking in United States

United States

Smoking cigarettes causes serious harm to health. Cigarettes are responsible for more than 480,000 deaths yearly, making it the leading cause of preventable death and disease in the United States. Smoking can affect non-smokers as well; exposure to secondhand smoke is responsible for more than 41,000 deaths 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. 

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 data, the prevalence of smoking in adults is higher among: 

• Men compared with women.
• Adults ages 45-64 compared with adults ages 65 and older and adults ages 18-44.
• 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 an income of $75,000 or more; the prevalence of smoking was significantly lower with each increase in income level.
• Adults living in non-metropolitan areas compared with those living in metropolitan areas.
• Adults who have difficulty with self-care compared with adults without a disability.
• 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 at any age, even among heavy and lifelong smokers. A variety of interventions are effective for smoking cessation, including counseling with a cessation specialist, telephone counseling and texting-based programs.

Smoke-free policies and increased taxes on tobacco products have effectively increased cessation rates, decreased smoking-related health problems and reduced the number of young people who start smoking. 

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. 

County Health Rankings & Roadmaps and the Community Preventive Services Task Force both provide evidence-based strategies to address tobacco use. 

Smokers who want to quit can find resources at Smokefree.gov, which provides free evidence-based information as well as professional assistance to support the needs of smokers trying to quit. The Centers for Disease Control and Prevention and the American Lung Association both offer resources for those looking to quit as well.

Healthy People 2030 has multiple goals regarding tobacco use, including:

• Reducing cigarette smoking among adults.
• Increasing successful quit attempts in adults who smoke.

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.

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.