In 2022, 28.8 million adults in the United States, or 11.6% of adults aged 18 or older, reported current cigarette smoking. In 2015, the prevalence of smoking in individual US states ranged from between 9% and 13% in Utah to between 24% and 27% in West Virginia. By region, smoking prevalence was highest in the Midwest (19%) and South (15%) and lowest in the West (12%). Men tended to smoke more than women: In 2015, 17% of men smoked compared to 14% of women. Cigarette smoking is the leading cause of preventable death in the United States, accounting for approximately 443,000 deaths – 1 of every 5 deaths – each year.Adult Cigarette Smoking in the United States: Current Estimate Centers for Disease Control and Prevention (CDC) Cigarette smoking alone has cost the United States $96 billion in direct medical expenses and $97 billion in lost productivity per year, or an average of $4,260 per adult smoker.
In 1964 the Surgeon General of the United States published its landmark report, Smoking and Health, which identified smoking as the cause of many health problems. Since then, smoking rates have been declining in the US. Since then, the public perception of tobacco has shifted from that of a harmless product to a clear hazard for the health. Over 60 years, smoking rates in the United States plummeted by some 73%, from 43% of all adult Americans in 1965 to 12% in 2022.
Current smoking and vaping among adults
+Prevalence of smoking by age18 – 24 years old8.0%25 – 44 years old16.7%45 – 64 years old17.0%65 and older8.2%
Age% of population who vape13-year olds6%14-year olds10%15-year olds15%16-year olds22%17-year olds24%18-year olds25%
+Prevalence of smoking by educational levelFewer years of education (no diploma)24.1%GED certificate35.3%High school diploma19.6%Some college (no degree)17.7%Associate degree14.0%Undergraduate degree6.9%Graduate degree4.0%
+Prevalence of smoking by ethnicity Non-Hispanic American Indians/Alaska Natives20.9%Non-Hispanic Other races19.7%Non-Hispanic Blacks14.9%Non-Hispanic Whites15.5%Hispanics8.8%Non-Hispanic Asian7.2%
Since 1964, marked by the publication of the Surgeon General's landmark report, Smoking and Health, smoking rates have been declining in the US. Key forces driving down smoking were the recognition of tobacco as an addiction and cause of disease, a declining social acceptance of smoking, mass media counter-marketing campaigns and higher taxes on cigarettes.
According to research by the Centers for Disease Control and Prevention (CDC), for every 100 U.S. adults age 18 or older, more than 15 smoked cigarettes in 2016. In other words, there were about 37.8 million cases of cigarette smokers in the United States. At the same time, more than 16 million Americans were living with a smoking-related disease. Nonetheless, the number of smokers in 2016 has decreased to 15.5% from 2005, a difference of 5.4% difference. This pointed to an increase in the number of smokers who have quit.
In 2020, the Journal of the American Medical Association (JAMA) estimated that 5.66 million adults, or 2.3% of the U.S. population, reported that they were vaping. Among users in the U.S. population, more than 2.21 million were also current cigarette smokers (39.1%), more than 2.14 million were former smokers (37.9%), and more than 1.30 million had never smoked (23.1%). Previous 2018 statistics estimated that about 14.9% of adults aged 18 and over had ever used electronic cigarettes, and around 3.2% of all adults in the United States were current e-cigarette users. The study also noted that 34 million U.S. adults were current smokers, with e-cigarette usage at its highest among current smokers and former smokers who are attempting to quit smoking cigarettes or had recently quit.
The decade of the 2010s saw both the advent and uptick in the prevalence of vaping among American youths, as e-cigarettes became the latest nicotine-delivery device for U.S. consumers. The first commercial e-cigarette hit the markets in 2006. Reports in 2018 estimated that youth vaping is present among 27.5% of the youth population. This is a stark comparison to the 5.5% of reported youths within the United States who smoke combustible nicotine such as cigarettes.
According to a U.S. government survey data released in April 2023, smoking rates in the United States fell even further by 2022, with 1 of 9 U.S. adults reporting to be a smoker. In 2022, the percentage of U.S. adult smokers dropped from 12.5 percent in 2020–2021 to about 11 percent. The survey data also showed that e-cigarette use increased to nearly 6 percent in 2022 from about 4.5 percent the previous year. Only about 2 percent of high school students smoked traditional cigarettes in 2022, but about 14 percent used e-cigarettes, according to other CDC data.
Women and smoking The cigarette industry began a propaganda campaign geared toward women beginning in the 1920s in the United States. These campaigns became more aggressive as time has progressed and marketing in general became more prominent. The practice of marketing aimed exclusively at women has continued into the present day and has now expanded globally.
With gender-targeted marketing, including packaging and slogans (especially "slimmer" and "lighter" cigarettes), and promotion of women smoking in movies and popular TV shows, the tobacco industry was able to increase the percent of women smoking. In the 1980s, tobacco industries were made to have the surgeon general's warning printed on each packaging of the tobacco products. This slowed the rate of women smoking but later it slightly increased after the advertisements started to look more present day and have more appealing packaging, that appealed to the younger generation. In more recent times, cigarette smoking has been banned from public places and this has decreased smoking rates in the United States.
Pre-1920s In January 1908, the New York City Board of Aldermen unanimously passed the Sullivan Ordinance; it prohibited smoking by women in public places.Brandt, Allan M. (2007). The Cigarette Century. New York: Basic Books, page 57. The mayor at the time, George B. McClellan Jr., vetoed the ordinance in February. There were many other such laws and rules. In 1911, the Sherman Anti-Trust Act divided the American Tobacco Trust into several different companies, making market share critical to each company's survival. The resulting competition spurred innovations in both product and marketing, and eventually progressed to the idea of brands. By 1915, Reynolds' Camel had become the first truly national brand. Soon to follow were Liggett & Myers' Chesterfield and the American Tobacco Company's Lucky Strike. These brands were modern and appealed to the modern sensibilities that were taking over the people of the United States at the time.Brandt, Allan M. 2007. The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America. New York: Basic Books, pp. 54–55
1920s–1940s
In the early part of the 20th century, the anti-tobacco movement was aimed primarily at women and children. Smoking was considered a dirty habit and smoking by women was seriously frowned upon by society. As the century progressed so did women's desire for equality.Brandt, Allan M. 2007. The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America. New York: Basic Books, pp. 57–59 The suffrage movement gave many women a sense of entitlement and freedom and the tobacco industry took advantage of the marketing opportunity. "Torches of Freedom" was a phrase used to encourage women's smoking by exploiting women's aspirations for a better life during the early twentieth century first-wave feminism in the United States. The term was first used by psychoanalyst A. A. Brill when describing the natural desire for women to smoke and was used by Edward Bernays to encourage women to smoke in public despite social taboos. Cigarettes were described as symbols of emancipation and equality with men.
Tobacco companies began marketing cigarettes to appeal to women during the burgeoning women's movement of the 1920s. The American Tobacco Company began targeting women with its ads for Lucky Strikes. They employed ads featuring prominent women, such as Amelia Earhart, and promised slimming effects. Most of the ads also conveyed a carefree and confident image of women that would appeal to the modern woman of the 1920s. The ads grew more extravagant with paid celebrity testimonials and far-reaching claims of how Lucky Strikes could improve their lives. Their most aggressive campaign directly challenged the candy industry by urging women to "reach for a Lucky instead of a sweet". These aggressive campaigns paid off, making Lucky Strike the most smoked brand within a decade.Brandt, Allan M. 2007. The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America. New York: Basic Books, pp. 70–73
Other companies followed the successful ad campaigns of the American Tobacco Company with their own versions. The Phillip Morris Company introduced Marlboro cigarettes in 1925. Marlboros were advertised as being as "mild as May" and featured elegant ivory tips that appealed to women. Other brands offered similar ads appealing to a woman's sense of beauty and style and made cigarettes an alluring part of many women's lives. Fear of weight gain remains a chief reason women continue to smoke. The ad campaigns successfully promoted cigarettes as a product possessing specific qualities including equality, autonomy, glamour, and beauty.Brandt, Allan M. 2007. The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America. New York: Basic Books, pp. 71–78
In 1929 Edward Bernays decided to pay women to smoke their "torches of freedom" as they walked in the Easter Sunday Parade in New York. This was a shock because until that time, women were only permitted to smoke in certain places such as in the privacy of their own homes. He was very careful when picking women to march because, "while they should be good looking, they should not look too model-y", and he hired his own photographers to make sure that good pictures were taken and then published around the world. Ruth Hale called for women to join in the march saying, "Women! Light another torch of freedom! Fight another sex taboo!"Brandt, Allan M. (2007). The Cigarette Century. New York: Basic Books, pp. 84-85. Once the footage was released, the women's walk was seen as a protest for equality and sparked discussion throughout the nation. The targeting of women in tobacco advertising led to higher rates of smoking among women. In 1923 women only purchased 5% of cigarettes sold; in 1929 that percentage increased to 12%, in 1935 to 18.1%, peaking in 1965 at 33.3%, and remaining at this level until 1977.