Tobacco use in the U.S. has reached a turning point, yet the full picture is far from straightforward. Nearly one in five American adults still reaches for a tobacco product every day, even as cigarette smoking has crossed a milestone that public health campaigners have spent decades working towards.

New research published in NEJM Evidence reveals that adult cigarette smoking prevalence fell to 9.9% in 2024, the first time tobacco use in the U.S. has dipped below the 10% mark. On the surface, that sounds like cause for celebration. But dig into the data, and a more complicated picture emerges.

A Milestone With a Catch

The analysis, conducted by researcher Israel Agaku using data from the 2023 and 2024 National Health Interview Survey (NHIS), found that roughly 47.7 million U.S. adults, equivalent to 18.8% of the population, reported using at least one tobacco product in 2024. Cigarettes may be losing ground, but other products are quietly filling the gap.

E-cigarettes were used by 7.0% of adults. Cigars accounted for 3.7%. Smokeless tobacco products, including nicotine pouches, were reported by 2.6%. When it comes to smoking rates in America overall, the picture has not improved as sharply as the cigarette headline might suggest.

The NHIS drew on interviews with 29,522 adults in 2023 and 32,629 in 2024, making it one of the most comprehensive national health surveys in the country. Cigarette smoking was defined as having smoked at least 100 cigarettes in a lifetime while still currently smoking, either daily or on some days.

Who Is Still Smoking?

Tobacco use in the U.S. does not fall evenly across the population. The data exposes stark divides along lines of age, income, geography, and occupation that deserve serious attention.

Men reported considerably higher tobacco use than women, at 24.1% compared with 13.9%. Rural residents were more likely to use tobacco (27.0%) than their urban counterparts (17.5%). Adults holding a GED certificate reported tobacco use rates exceeding 40%, and those on lower incomes consistently reported higher usage than those in better-paid brackets.

Age tells a particularly striking story. Among adults aged 18 to 24, e-cigarettes were far more popular than traditional cigarettes, with 14.8% reporting vaping compared with just 3.4% who smoked. The shift in how younger generations consume nicotine suggests that smoking rates in America are changing in form, not necessarily declining in substance.

Occupation Matters More Than You Might Think

The survey also highlighted notable differences between industries. Workers in agriculture, forestry, fishing, mining, hunting, and utilities reported a tobacco use prevalence of 29.4%. Those in construction and manufacturing were not far behind at approximately 28.6%.

By contrast, workers in education services reported tobacco use of just 9.5%, while those in healthcare and social assistance came in at 14.4%. These occupational gaps point to the importance of targeted workplace health strategies, rather than one-size-fits-all national campaigns.

People living with disabilities also reported higher tobacco consumption at 21.5%, compared with 16.5% among those without disabilities.

Most Users Stick to One Product

Among adults who reported any tobacco use, the vast majority, around 80%, relied on a single product. Approximately 17.4% reported using two products at the same time. Smaller proportions used three (2.3%) or all four products assessed (0.3%).

That said, the continued presence of poly-tobacco use, where individuals combine cigarettes, e-cigarettes, cigars or smokeless products, is a concern for health professionals. Each additional product compounds exposure to nicotine and its related harms.

The Bigger Picture

The national target under the Healthy People 2030 initiative is to reduce adult cigarette smoking prevalence to 6.1%. The latest figure of 9.9% shows progress, but the gap between current tobacco use in the U.S. and that goal remains significant.

The research also sounds a note of caution on comparisons. Because the 2024 survey included nicotine pouches in its smokeless tobacco category in a way that the 2023 survey did not, year-on-year figures for that particular product type may not be directly comparable. All estimates are also based on self-reported data, which introduces some margin of uncertainty.

What the numbers do make clear is that while the downward trend in cigarette smoking is real and meaningful, broader tobacco use across all products and all demographics remains a persistent challenge. For communities already facing economic hardship, geographic isolation, or occupational hazard, the burden is heavier still.

Sustained public health investment, targeted cessation support, and honest conversations about the full spectrum of nicotine products are essential if these trends are to continue moving in the right direction.

Reference: Agaku, I. (2026). Tobacco product use among U.S. adults, 2023–2024. NEJM Evidence. DOI: 10.1056/EVIDpha2500339

Source: news-medical