Adult Cigarette Smoking Declines but Habit Continues to Exact Economic, Health Toll: Cancer Society

In the United States, 29 percent of all cancer deaths can be attributed to cigarette smoking.

A view of a close up of a lung x-ray of a cigarette smoker, in an undated photo. American Cancer Society via Getty Images

The rate of cigarette smoking among adults has declined over the past six decades, but only a minority of smokers screen for lung cancer, the American Cancer Society (ACS) said in a statement on Nov. 3.

“Cigarette smoking among U.S. adults dropped from 42 percent in 1965 to 11 percent in 2023. Researchers also discovered that only 18.1 percent of eligible adults who currently smoke or formerly smoked were up-to-date with lung cancer screening in 2022, despite cigarette smoking being a leading risk factor for lung cancer,” the statement said.

“Screening rates are lowest in Southern states in the U.S., where lung cancer burden and healthcare access issues are greatest.”

More than 80 percent of lung cancer deaths in the country are attributable to tobacco, ACS said.

The numbers are part of the U.S. Tobacco Atlas report, released by the ACS on Monday, which offers comprehensive data on tobacco use across the United States.

According to the report, 29 percent of all cancer deaths in the country are attributable to smoking cigarettes. In 2019, an estimated 2.2 million years of life were lost due to smoking-related cancer among adults aged 25–79 years.

In 2020, cigarette smoking cost the U.S. economy $436.7 billion, which is roughly 2.1 percent of the nation’s GDP.

While second-hand smoke exposure has fallen, it continues to remain high in public and rental housing, ACS said, adding that elderly people and children are particularly vulnerable to such exposure.

“The U.S. Tobacco Atlas is a powerful tool showcasing not only the toll that tobacco has taken on the U.S., but also the immense progress public health gains have made over the past decades,” said Dr. Nigar Nargis, senior scientific director of tobacco control research at ACS.

“Since the landmark 1964 U.S. Surgeon General’s report on tobacco, millions of lives have been saved by tobacco control, but the scale of the epidemic demands our continued attention and support.”

The 1964 report held smoking cigarettes as responsible for a 70 percent jump in the mortality rate of smokers compared to those who did not smoke.

According to the 2024 Surgeon General’s report, the tobacco industry has designed and marketed products such as menthol cigarettes aimed at delivering multisensory flavor experiences, thus increasing the likelihood of addiction.

It suggested that implementing policies that restrict the availability of menthol cigarettes could reduce smoking initiation and prevalence among young adults and adolescents.

Meanwhile, ACS’s U.S. Tobacco Atlas highlighted the issue of e-cigarette use among American youth.

In 2024, an estimated 1.63 million youth reported using e-cigarettes, with 90 percent favoring flavored variants, it said.

“Youth use of e-cigarettes remains high despite declines,” the ACS said.

According to the report, youth tobacco use rose rapidly in 2018–2019 but then quickly fell after the Food and Drug Administration adopted the T21 law.

The law, signed by President Donald Trump in December 2019, raised the federal minimum age for the sale of tobacco products from 18 to 21 years. As such, it became illegal for businesses to sell any tobacco product, including e-cigarettes, to persons below 21.

On Sept. 1, the Make America Healthy Again Commission, established by Trump, called on the FDA to boost enforcement on illegal vaping products.

Later that month, the Department of Health and Human Services launched its Youth Vaping Resource Guide to help young people combat the youth vaping epidemic.

“Despite recent declines in use, e-cigarettes remain the most commonly used tobacco product among middle and high school students,” the agency said.

“Up to 85 percent of e-cigarette devices and pods sold in U.S. retail outlets are illegal products. Federal enforcement efforts have seized millions of unauthorized devices, but illegal sales persist, threatening the health of young people nationwide.”