US Tobacco Use Drops to Record Low, Disparities Persist | NEJM Study 2024

The rate of cigarette smoking among adults in the United States has dipped below 10% for the first time, a landmark achievement in public health. However, a new analysis of data from the National Health Interview Survey (NHIS) also reveals that overall tobacco use remains stubbornly high, with nearly one in five adults continuing to use some form of tobacco product. This suggests that while progress is being made in reducing cigarette smoking, other tobacco products – like e-cigarettes and cigars – are sustaining overall consumption.

The findings, published in NEJM Evidence, underscore the complex landscape of tobacco use in the U.S. And highlight the need for continued, targeted public health interventions. Researcher Israel Agaku, who led the analysis, examined data collected from nearly 62,000 adults across 2023 and 2024.

Persistent Tobacco Use Despite Declining Cigarette Rates

The analysis showed that 9.9% of U.S. Adults currently smoke cigarettes, down from 10.8% in 2023. However, 18.8% – approximately 47.7 million people – reported using at least one tobacco product. This includes cigarettes, cigars, e-cigarettes, and smokeless tobacco. While cigarette smoking is the most prevalent form of tobacco use, other products contribute significantly to the overall picture. E-cigarette use stands at around 7.0%, while cigar use is at 3.7% and smokeless tobacco at 2.6%.

It’s important to note a change in how smokeless tobacco was categorized in the 2024 survey. The inclusion of nicotine pouches – a relatively new product – in this category means direct comparisons with 2023 data may not be entirely accurate. Nicotine pouches deliver nicotine without tobacco leaves, and their increasing popularity is a factor in the overall tobacco landscape.

Patterns of Tobacco Use: Single vs. Multiple Products

The study also examined how people use tobacco products. The vast majority (80%) of tobacco users rely on a single product. However, a notable 17.4% report using two products simultaneously, and smaller proportions use three or even all four products assessed. This “poly-tobacco use” is a growing concern, as it may indicate a greater overall nicotine dependence and potentially hinder cessation efforts.

Disparities in Tobacco Use Across Demographic Groups

Tobacco use isn’t evenly distributed across the population. Significant disparities exist based on gender, age, socioeconomic status, and geographic location. Men consistently report higher rates of tobacco use than women – 24.1% compared to 13.9% in 2024.

Young adults (ages 18-24) show a particularly high prevalence of e-cigarette use (14.8%), compared to cigarette smoking (3.4%). This suggests a shift in preferences among younger generations, potentially driven by the marketing and availability of e-cigarettes.

Socioeconomic factors also play a role. Individuals with lower levels of education – those holding a General Educational Development (GED) certificate, for example – report significantly higher tobacco use rates, exceeding 40%. Similarly, lower income is associated with increased tobacco consumption. Rural residents (27.0%) also use tobacco at higher rates than their urban counterparts (17.5%).

Occupational Risks and Health Considerations

The NHIS data also revealed variations in tobacco use across different occupational sectors. Workers in primary and extractive industries – including agriculture, forestry, fishing, mining, hunting, and utilities – have the highest prevalence of tobacco use (29.4%). Construction and manufacturing workers also report high rates (approximately 28.6%).

Conversely, those working in education and healthcare sectors exhibit lower tobacco use rates (9.5% and 14.4%, respectively). Individuals with disabilities also report higher tobacco consumption (21.5%) compared to those without disabilities (16.5%). The reasons behind these differences require further investigation.

What the Data Tell Us About Public Health Efforts

The decline in cigarette smoking to below 10% is a testament to decades of public health initiatives, including taxation, smoke-free policies, and public awareness campaigns. However, the persistence of overall tobacco use, driven by other products, indicates that these efforts need to evolve. The Centers for Disease Control and Prevention (CDC) provides comprehensive data and resources on tobacco use in the U.S., including information on trends, disparities, and interventions.

The NHIS data provides a crucial snapshot of these trends, collecting detailed health information from households across the country. The survey’s large sample size – over 29,500 adults in 2023 and 32,600 in 2024 – allows for robust analysis and identification of high-risk populations.

Looking Ahead: Surveillance and Intervention

Continued monitoring of tobacco use patterns is essential for informing public health strategies. The NHIS, along with other surveillance systems, will play a critical role in tracking the impact of new products, policies, and interventions. Researchers will need to carefully examine the long-term health effects of e-cigarettes and nicotine pouches, as well as the factors driving poly-tobacco use.

The findings from this analysis highlight the need for targeted interventions aimed at reducing tobacco use among specific populations, including young adults, individuals with lower socioeconomic status, and workers in high-risk occupations. Supporting cessation programs and implementing comprehensive tobacco control policies remain crucial steps in protecting public health. The National Cancer Institute offers resources and support for those looking to quit tobacco.

Further research is needed to understand the underlying causes of the observed disparities and to develop effective strategies for addressing them. This includes investigating the role of marketing, accessibility, and social factors in shaping tobacco use behaviors. The ongoing analysis of NHIS data, combined with other surveillance efforts, will provide valuable insights for guiding future public health initiatives.