A new national analysis of NHIS data reveals a historic drop in cigarette smoking among U.S. adults while highlighting persistent tobacco use and widening disparities across demographic and occupational groups.

Tobacco Product Use among U.S. Adults, 2023–2024. Image Credit: shisu_ka / Shutterstock

In a recent report published in the journal NEJM Evidence, researcher Israel Agaku evaluated recent patterns and demographic differences in tobacco product use among adults in the United States using data from the 2023 and 2024 National Health Interview Survey (NHIS).

Background

Nearly one in five adults in the United States still uses some form of tobacco, even after decades of public health campaigns warning about its dangers. Tobacco is a leading cause of preventable disease and death and can cause heart disease, cancer, and respiratory disorders. National programs track smoking patterns to meet public health targets such as the Healthy People 2030 initiative, which aims to reduce adult cigarette smoking prevalence to 6.1%.

However, the rise of electronic cigarettes (e-cigarettes) and other alternatives has complicated the tracking process. Reliable national data are essential for designing effective prevention strategies and identifying high-risk populations. National surveillance reports, therefore, help monitor changes in tobacco product use and identify demographic groups with higher prevalence, particularly during periods when federal public reporting of smoking statistics has been limited or delayed.

Tobacco use is a persistent public health challenge

Despite significant progress in tobacco control policies over the past several decades, tobacco use remains a major public health concern in the United States. Preventable morbidity, medical expenditures, and early deaths occur because of smoking and tobacco consumption. Tracking these habits helps policymakers evaluate progress toward national health goals and identify groups needing targeted intervention.

The NHIS provides critical data regarding these trends. Through household interviews, it collects detailed health data across all 50 states and Washington, D.C. In the 2023 survey cycle, 29,522 adults aged 18 or older were interviewed; in the 2024 cycle, 32,629 were interviewed. These datasets help researchers measure how many people use tobacco and track changes over time.

Defining tobacco product use

In the survey, cigarette smoking was defined as having smoked at least 100 cigarettes during one’s lifetime and currently smoking either every day or on some days. Other tobacco products were categorized separately.

Cigar use included cigars, cigarillos, and filtered little cigars. Smokeless tobacco products included chewing tobacco, snuff, dip, snus, dissolvable tobacco, and nicotine pouches. Vaping devices used to inhale nicotine-containing aerosols were referred to as e-cigarettes.

Researchers examined the use of combustible tobacco products (cigarettes or cigars), and individuals who reported using any tobacco product were classified as current users of any tobacco product overall. Other combustible products, such as pipes and hookahs, were not included in the 2024 assessment.

Overall prevalence of tobacco use

Analysis of the 2024 survey data revealed that 18.8% of U.S. adults, approximately 47.7 million individuals, reported using at least one tobacco product. Combustible tobacco was reported by 12.6% of adults who used cigarettes or cigars. Cigarettes remained the most popular product, with 9.9% of adults reporting current smoking.

Other products also showed notable levels of use, with the prevalence of e-cigarette use at about 7.0%, cigar use at 3.7%, and smokeless tobacco use at 2.6%. The authors note that the 2024 smokeless tobacco category included nicotine pouches, which were not assessed in the same way in the 2023 survey. As a result, prevalence across the two years may not be directly comparable. These results highlight the diversity of tobacco products contributing to overall use.

Among adults who reported any tobacco use, most individuals relied on a single product. About 80% used only one tobacco product, whereas 17.4% reported using two products simultaneously. Smaller proportions used three products (2.3%) or all four products assessed (0.3%). These patterns suggest that although poly-tobacco use exists, single-product use remains the dominant behavior.

Differences across demographic groups

Tobacco use varied significantly across demographic groups. Men reported substantially higher tobacco use than women. In 2024, tobacco use was higher among men (24.1%) compared with women (13.9%).

Age also played a role. Young adults aged 18–24 years showed relatively high e-cigarette use, with 14.8% reporting vaping compared with only 3.4% who smoked cigarettes. This pattern suggests that younger adults may be more likely to use e-cigarettes than combustible cigarettes, although the study did not examine the reasons behind these differences.

People with lower income and educational levels reported higher tobacco use. For example, adults holding a General Educational Development (GED) certificate reported tobacco use rates exceeding 40%. Similarly, adults with lower incomes reported higher tobacco use than those in higher-income groups. Rural residents also reported higher tobacco use (27.0%) compared with urban residents (17.5%). The study describes these differences but does not attribute specific causes.

Occupational and health-related differences

The survey also identified variations across occupational sectors. Workers in primary and extractive industries reported higher tobacco use. Individuals working in agriculture, forestry, fishing, mining, hunting, and utilities had a tobacco use prevalence of 29.4%, while those in construction and manufacturing reported rates of approximately 28.6%.

In contrast, workers in the education and healthcare sectors showed comparatively lower tobacco use. Tobacco use was reported by 9.5% of adults working in education services and 14.4% of those in healthcare and social assistance.

People with disabilities reported higher tobacco consumption (21.5%) compared with those without disabilities (16.5%). The study does not examine the underlying causes of this difference. The report also notes that some subgroup estimates may be suppressed or interpreted cautiously due to small sample sizes and considerations of statistical precision.

Conclusions

The analysis of NHIS data indicates that tobacco use remains widespread among adults in the United States, even as cigarette smoking continues to decline. Adult smoking prevalence dropped from 10.8% in 2023 to 9.9% in 2024, marking the first time adult cigarette smoking prevalence has fallen below 10%.

However, the continued use of cigars, e-cigarettes, and smokeless tobacco products indicates that multiple nicotine delivery systems remain in use. Tobacco use also varies according to income, occupation, and geographic location.

These findings highlight the need for sustained public health efforts to reduce tobacco use, particularly among groups with higher prevalence, while supporting cessation programs and prevention strategies. The authors also note that estimates are based on self-reported survey data and that some year-to-year comparisons may be affected by differences in survey product definitions.