Tobacco consumption continues to decline in the United States

For the first time, fewer than 10% of Americans report smoking cigarettes. While these results reflect a gradual reduction in smoking in the country, the study's authors highlight the persistence of social inequalities and the need to strengthen public health policies.

This study is based on a nationally representative survey of 32,629 adults (aged 18 and over)[1].

Significant inequalities exist between ethnic communities.

Smoking prevalence was 12.6 per 100,000 smokers in 2024, compared to 13.5 per 100,000 smokers in 2023, illustrating the long-term reduction in consumption observed. However, the study authors highlight the persistence of significant inequalities in smoking rates. For example, smoking prevalence among men, estimated at 16.2 per 100,000 smokers, is significantly higher than that among women (9.1 per 100,000). Furthermore, consumption levels vary considerably across ethnic groups: while Asian and Hispanic populations have relatively low prevalence rates (4.8 per 100,000 and 8.7 per 100,000 smokers respectively), African American (15.1 per 100,000), White (13.9 per 100,000), and other non-Hispanic (15.2 per 100,000) communities are significantly more affected by the smoking epidemic.

Smoking remains a social marker in the United States

As the study data illustrates, smoking remains a social marker, in the United States as elsewhere. Those with a high level of education (graduate schoolThey recorded a smoking prevalence of 5.8%, nearly six times lower than that of individuals with a high school diploma (32.3%). Overall, the results point to a clear correlation between educational attainment and smoking prevalence. Similarly, populations with the lowest income levels have a smoking prevalence nearly twice that of populations with high income levels. Finally, the study authors noted a significantly higher prevalence among individuals reporting a disability, or working in sectors such as construction, mining, retail, transportation, and hospitality.

E-cigarettes are on the rise

E-cigarette consumption, on the other hand, is increasing, rising from 6.5 to 7 13 times per 100,000 users between 2023 and 2024. The data also reveals marked social inequalities, particularly in terms of gender, income, education level, and occupation. Most importantly, researchers report very strong disparities based on respondents' sexual orientation, with those identifying as gay or lesbian having a prevalence more than three times higher than that of heterosexuals (19.3 versus 6.3). Similarly, 18-24 year olds are characterized by significantly higher levels of consumption than the rest of the population. While the study's authors do not comment on these results, these differences can nevertheless be partly explained by the strategies of the industry, characterized by a specific targeting of these populations.

A public health objective achievable under certain conditions

Significantly, the prevalence of traditional cigarette smoking has fallen below the symbolic threshold of 10 % for the first time (9.9 %). If this decline continues, the Healthy People 2030 target of a prevalence of 6.1 % by 2030 could be achieved. However, the authors emphasize that continuing this reduction requires maintaining a centralized federal tobacco control strategy based on best practices and evidence. Specifically, the researchers stress the need to implement fiscal pathways, strengthen smoking cessation support, and conduct prevention campaigns targeting populations most affected by tobacco use.

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[1] NEJM Evidence, Tobacco Product Use among US Adults, 2023–2024, 16/03/2026, (accessed the same day)

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