U.S. smoking rate hits an all-time low—but there’s still work to do
How many Americans use tobacco, and how? Every year, the federal government answered these questions—until now. Last spring, the federal Office of Smoking and Health (OSH), a division of the Centers for Disease Control and Prevention, was shuttered, meaning that U.S. health officials are no longer informing the public on smoking rates or guiding policymakers on where to focus tobacco control efforts. Federal data on tobacco use is still being collected through national health surveys, but federal analysis and advice have ground to a halt.
Academic researchers have stepped in to fill the void. One recently published a report in NEJM Evidence that found that in 2024, the cigarette smoking rate among U.S. adults fell to 9.9%—an all-time low.
Is a drop to 9.9% a major public health victory? And does it matter that this statistic didn’t come from the federal government? Harvard T.H. Chan School of Public Health’s Vaughan Rees, senior lecturer on social and behavioral sciences and director of the Center for Global Tobacco Control, weighs in.
Q: What’s your reaction to the 9.9% adult cigarette smoking rate?
A: Of course, nearly 1 in 10 adults smoking is still too many. But we have to understand this figure in context. In the mid-1960s, at the peak of tobacco use in the U.S., nearly half of adults smoked cigarettes. For that to have decreased to 9.9% signals enormous progress. It means millions and millions of lives saved.
That said, I think we need to approach this news with some caution. There are massive inequities within the 9.9% of Americans who smoke cigarettes, with marginalized groups disproportionately represented. People in the lowest income strata and those with the lowest levels of educational attainment smoke at three or more times the rate of the general public. We see similarly high rates among sexual and gender minorities, people who are unhoused or unstably housed, and people with substance use disorders, mental health disorders, and/or a history of incarceration. For several decades, we’ve seen little or no change in smoking rates among these groups, even while the smoking rate has declined in the general population. So while this new rate of 9.9% is gratifying in a way, it also serves to remind us that there remain major disparities in cigarette use that must be addressed urgently—to protect the most vulnerable from the immense health burdens imposed by tobacco.
Q: The NEJM Evidence report also found that the 9.9% rate nearly doubles when we include U.S. adults’ use of e-cigarettes, nicotine pouches, and other non-cigarette nicotine products. What’s your reaction?
A: It’s certainly concerning that more than 18% of American adults are using nicotine products. Many of the disparities I mentioned earlier are present in this figure, as is the fact that use of non-cigarette nicotine products is increasing among young adults ages 18 to 25. All of these products drive nicotine dependence and some contain substances that are associated with health risks, including respiratory problems.
However, it’s worth noting that nicotine products exist along a continuum of risk. They don’t all have the same health risks. Products like e-cigarettes and nicotine pouches aren’t considered safe, but they are significantly less risky than combustible cigarettes. I would never advocate for a non-smoker to start using these products, but for adult smokers who have not been able to quit using conventional methods, non-cigarette nicotine products provide a viable way to reduce the health risks of smoking. From a harm reduction perspective, this may represent a public health gain.
Q: Are there potential issues with the new report’s statistics given that they weren’t produced by federal health officials as in the past?
A: I absolutely trust the report. Its author, Israel Agaku, is an outstanding epidemiologist and former senior member of OSH—who also happened to spend some time here at Harvard Chan School. His analysis, published in a reputable journal, represents high-quality science. The only problem is that it may not have the same level of reach or impact as its predecessors coming directly from OSH. Members of OSH published their analyses in the CDC’s Morbidity and Mortality Weekly Report (MMWR), a critical instrument for communicating epidemiological data in the U.S. Policymakers often turn to MMWR to understand current trends in smoking and shape public health interventions accordingly. The loss of federal capacity to undertake analyses and share them in a high-impact way is significant. It’s just one example of why the closure of OSH is such a loss and an enormous disservice to the American public.
Q: What other important OSH functions have been lost?
A: Beyond conducting and publicizing data analyses to help us understand the shifting landscape of tobacco use in the U.S., OSH coordinated tobacco control efforts through federal and state health agencies. Many of our most successful strategies to make smoking less accessible and less cool ran through OSH in some manner: public education around the harms of tobacco use; restrictions or bans on tobacco marketing, particularly advertisements targeting young people; the adoption of clean air laws restricting where cigarettes can be smoked; the availability of cessation programs and resources, such as telephone quit lines; state-level excise taxes on tobacco products; and restrictions on tobacco sales to youth. Thankfully, federal funding for tobacco control has been restored. But without also reviving OSH, we remain without a guiding agency to ensure that our limited resources are applied coherently for greatest impact. We know tobacco control policies work, and we know how to improve upon them. But without OSH leadership, they won’t be coordinated. We’re left with a patchwork of responses to this huge problem and no coherent strategy.
Q: Is there a risk that the rate of cigarette smoking will tick upward in the wake of the OSH’s closure?
A: Smoking is not a public health problem that will resolve on its own. As long as the tobacco industry remains profitable, there will be powerful interests working to promote cigarette use among Americans, especially young people. Without concerted efforts to oppose those interests, we will see a gradual reversal of the gains we’ve made. I have no doubt about that. We need resources—chief among them a trained, professional workforce, like we had in OSH—to protect the next generation and beyond.
