Landmark Report Reveals Historic Drop in Smoking, But Disparities Persist
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The American Cancer Society’s inaugural US Tobacco Atlas details significant progress in reducing smoking rates, while simultaneously highlighting critical gaps in screening access and the growing threat of e-cigarettes.
The rate of cigarette smoking among American adults has plummeted from 42% in 1965 to just 11% in 2023, a testament to decades of public health efforts. However, a new report from the American Cancer Society (ACS) reveals that despite this success, substantial disparities remain in lung cancer screening rates and tobacco-related burdens, demanding renewed attention and targeted interventions.
The US Tobacco Atlas: A Comprehensive Resource
Released this week, the US Tobacco Atlas is a first-of-its-kind digital resource offering comprehensive data and insights into tobacco use, control policies, and their nationwide impact. Created by the ACS, the Atlas maps tobacco use and control efforts at both national and state levels, translating complex scientific evidence into accessible information for public health professionals, researchers, advocates, and policymakers. The content is organized into four key sections: Tobacco Use, Disparities, Health & Economic Impact, and Tobacco Control Policy Advances.
“The US 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,” stated a senior scientific director at the ACS and lead editor of the report. “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.”
Screening Gaps and Regional Disparities
Despite the well-established link between tobacco use and over 80% of lung cancer deaths, screening rates remain alarmingly low. In 2022, only 18.1% of eligible adults who currently or formerly smoked were up-to-date on lung cancer screening. These rates are particularly concerning in Southern states, where lung cancer burden and barriers to healthcare access are greatest.
According to the report, these disparities are further exacerbated by socioeconomic factors, with Non-White individuals, people with disabilities, LGBTQ+ individuals, and those with lower income and limited education facing disproportionately higher tobacco-related health risks.
The Rise of E-Cigarettes and Youth Usage
While cigarette smoking continues to decline, the report highlights the growing prevalence of e-cigarettes, particularly among young people. In 2024, 1.63 million youth reported using e-cigarettes, with a striking 90% preferring flavored products. This trend is especially pronounced in states with high rates of traditional cigarette use, with 33% of tobacco users reporting using both cigarettes and e-cigarettes.
“The US Tobacco Atlas is more than a report—it is a call to action,” said a chief scientific officer at the ACS. “It reminds us that progress is possible, but not inevitable. It requires bold leadership, equitable policies, and unwavering commitment from every sector of society.”
Progress and Remaining Challenges
The report also notes positive trends, including a record-high national quit smoking ratio of 62% in 2022. However, older adults (45+) demonstrate lower quit attempt and success rates, and access to tobacco cessation aids remains limited, particularly in the South and Midwest. Secondhand smoke exposure has decreased, but remains a concern in rental and public housing, posing a risk to children and the elderly. Smokeless tobacco use, while low overall, is concentrated in states like Wyoming and West Virginia.
The ACS recommends annual lung cancer screening for adults aged 50-80 who have a 20-year or greater pack-year smoking history, regardless of whether they have quit. A pack-year is defined as smoking one pack of cigarettes per day for a year.
“We have made significant strides in reducing smoking prevalence and expanding access to evidence-based cessation resources, we remain deeply concerned about persistent disparities in tobacco use and tobacco-related disease,” explained a senior scientific vice president at the ACS and senior author of the report. “These disparities are particularly pronounced in states with weak tobacco control policies and among populations with lower socioeconomic status.”
Lisa A. Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN), emphasized the need for continued commitment. “Let this Atlas inspire policymakers to recommit to a bold vision: a future where tobacco no longer claims lives, deepens inequities, or burdens our economy. Together, we can finish what we started—and end the tobacco epidemic once and for all.”
