The American Cancer Society publishes the first-ever American Atlas of Tobacco

The American Cancer Society (ACS) has published the first edition of the Tobacco Atlas of the United States, a digital scientific resource presenting detailed data on tobacco use, control policies and their effects at the national and regional levels.[1].

According to this report, the proportion of American adults smoking cigarettes fell from 42 per 1,000 in 1965 to 11 per 1,000 in 2023, illustrating major progress in public health. However, smoking remains a major social marker, and substantial progress is needed in screening: only 18.1 per 1,000 of eligible current or former smokers were up-to-date with their lung cancer screening in 2022, a particularly low rate in the South, where the burden of lung cancer and inequalities in access to care remain significant.

A mixed record of progress and socioeconomic disparities

The Tobacco Atlas is presented as a knowledge tool that can be used by public health professionals, researchers, activists, policymakers and students to analyze the burden of smoking and the strategies to be implemented to address this public health problem.

The Atlas highlights both the successes and the ongoing challenges.. Tobacco remains the leading preventable cause of premature cancer death in the United States. It is responsible for more than 80% of lung cancer deaths. The national smoking cessation rate reached a record high of 62% in 2022, but attempts and successes are lower among adults over 45.

Meanwhile, e-cigarettes are gaining ground: 33% of smokers combine tobacco and e-cigarettes. In 2024, 1.63 million young people reported vaping, including 1.21 million high school students and 410,000 middle school students. Nearly 90% of young people reported using flavored vaping products (candy, mint, etc.).

Chewing tobacco remains marginal but concentrated in certain states such as Wyoming and West Virginia.

The ACS emphasizes that tobacco-related disparities remain significant. Non-white, LGBTQ+, low-income, and less educated populations are the most affected, particularly in states with weak tobacco control policies.

Exposure to secondhand smoke has decreased overall, but remains a concern in social housing and environments where children or the elderly live.

A call to strengthen prevention policies

" The American Tobacco Atlas is a valuable tool that highlights not only the devastating effects of tobacco in the United States, but also the considerable progress made in public health over the past few decades. »" said Dr. Nigar Nargis, scientific director in charge of tobacco control research at the American Cancer Society and lead author of the report.

" Since the landmark 1964 report by the U.S. Surgeon General on tobacco, millions of lives have been saved through tobacco control efforts, but the scale of the epidemic requires us to continue to focus on our work and maintain our support. ".

The ACS calls for intensified efforts to achieve a future where tobacco causes no cancer, no social inequality, and no avoidable economic burden. The Atlas urges renewed leadership encompassing not only tobacco products in the strict sense but also new nicotine products entering the market. This strengthening of actions must aim to reduce social inequalities and regional disparities, requiring bold policies to end the tobacco epidemic.

The ACS also points to shortcomings in lung cancer screening. The ACS lung cancer screening guidelines, updated in 2023, recommend annual screening for adults aged 50 to 80 who smoke or used to smoke and have a smoking history of 20 or more years, regardless of when they quit. According to a U.S. study published in 2024, only 18.1% of adults aged 50 to 79 who were eligible for annual lung cancer screening due to a significant smoking history reported being up-to-date with their screening.[2]. The health organization specifies that a pack-year is equivalent to smoking one pack (approximately 20 cigarettes) per day for one year.

Finally, the Society advocates intensifying tobacco control efforts to improve national public health, allocating funds to tobacco control programs based on factors such as the prevalence of smoking in the state and the cost of effective and sustainable campaigns or interventions. The Centers for Disease Control and Prevention (CDC) estimates that only Maine fully funds its tobacco control efforts, while Michigan, West Virginia, and Georgia have very poor results.

According to the ACS, effective anti-smoking measures include mass media campaigns and public education programs to stop or prevent initiation of smoking, advertising restrictions to avoid marketing targeting of social groups, graphic health warnings on cigarette packs, raising the age for selling tobacco products, increasing excise taxes on tobacco, banning flavored tobacco or vaping products (as is already the case in California, Utah, New York, Maine…) or making it mandatory for the nicotine content of cigarettes to be at non-addictive levels.

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[1]Nargis N, Westmaas JL, Wang S, Nighbor T, Asare S, Patel M, Orr-Souza E, Xue Z, Islami F, Bandi P, Star J, Kratzer T, Freedman N, Jemal A, The US Tobacco Atlas, Atlanta, GA: American Cancer Society, published in 2025, accessed November 7, 2025

[2]Bandi P, Star J, Ashad-Bishop K, Kratzer T, Smith R, Jemal A, Lung Cancer Screening in the US, 2022, JAMA Intern Med., published August 1, 2024, accessed November 13, 2025

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