The cigarette smoking rate among U.S. adults fell below 10% for the first time in recorded history in 2024.
That’s a big deal in itself. Also remarkable is how everyone is finding out about it.
Reports of the historic dip in smoking didn’t come from the U.S. government, which had collected the data. Instead, the news came via an analysis in the digital journal NEJM Evidence by Israel Agaku, the founder and CEO of research technology company Chisquares.
Typically, the U.S. government is responsible for analyzing national survey data on tobacco use and publishing the results. But federal cuts that decimated the Office of Smoking and Health at the Centers for Disease Control and Prevention mean that Agaku, and others like him at companies and universities, are now working to fill in a range of gaps left by the government.
Agaku’s analysis, for example, was published as a “public health alert” in NEJM Evidence — an initiative created late last year by the New England Journal of Medicine and the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota as an alternative to the CDC’s weekly publication. CIDRAP also launched the Vaccine Integrity Project in April last year with a mission to protect vaccine use amid government efforts to weaken policy on immunizations.
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“We had all this data and no one was analyzing it,” said Agaku, an epidemiologist who previously worked as a senior scientist at the Office of Smoking and Health (OSH) and left the agency in 2019. “For me as a public health person, the question was, does public health just die?”
Health department spokesperson Andrew Nixon said in a statement that the CDC “remains deeply committed to tobacco prevention and control,” which it supports through efforts “including outreach, education, and surveillance.”
The new data on cigarette use come from the National Health Interview Survey, which is conducted annually by the CDC and asks tens of thousands of Americans questions about everything from their exercise habits to their illnesses and access to health care.
It shows that 9.9% of U.S. adults reported smoking cigarettes in 2024, down from 10.8% in 2023. Use of e-cigarettes remained unchanged from the previous year at 7%, while 2.6% of adults used smokeless tobacco, including nicotine pouches. (The survey couldn’t compare smokeless tobacco use rates because it had changed the definition of which products fall in that category.)
Israel Agaku on new smoking rates among U.S. adults: “Data cannot speak for itself.”2M Research Services LLC
“In public health, the number 10% is very symbolic to us,” said Agaku, who’s also co-editor-in-chief of the Journal of Tobacco Induced Diseases. “Things below 10% are considered rare events or unusual events.” By that definition, he said, smoking could now be considered rare in the U.S.
That said, 9.9% of Americans still equates to 25 million people who use cigarettes. And the data show cigarette smoking rates are higher among certain populations, such as those whose education stopped before college, people with disabilities, and people in rural areas.
“The continued decline in cigarette use among adults in the U.S. is laudable and historic, but it’s critical that we address persistent disparities among certain racial, economic, geographic, and LGBTQ+ communities,” Kathy Crosby, CEO and president of the tobacco control nonprofit Truth Initiative, said in a statement. “It is also imperative that we restore and maintain a federal infrastructure to support tobacco use prevention, cessation, research, and public education.”
Overall, 48 million, or 18.8%, of U.S. adults use at least one tobacco product.
The survey results also suggest that the U.S. is on track to reach the government’s goal of reducing smoking prevalence to 6.1% by 2030 as part of a long-running health department initiative, Agaku said.
The CDC released the data from its survey last fall, but without the analysis that usually accompanies it and gets published in its Morbidity and Mortality Weekly Report.
“A government agency that can consistently provide us with the results from the survey is vital to understand national trends in tobacco use,” Dorothy Hatsukami, a professor at the University of Minnesota who studies tobacco addiction, said via email.
Agaku had worked on previous smoking reports at OSH. So he downloaded the dataset available on the CDC site and used his platform’s technology to crunch the numbers himself.
“People have to make sense of data, because data cannot speak for itself,” he said.
He first submitted a draft of the report to the CDC’s MMWR, hoping to continue the tradition of publishing the national survey results there. But he was told that MMWR could no longer publish work from external contributors related to smoking. Since OSH was effectively shut down, the agency didn’t have smoking experts available to review it.
“How does the health agency not have experts on the leading cause of death?” Agaku said. (Smoking is the top cause of preventable death in the U.S., responsible for more than 480,000 deaths each year. The leading cause of death in the U.S. overall is heart disease.)
A similar unofficial effort is now underway to analyze the results from the government’s National Youth Tobacco Use survey. The Food and Drug Administration released the raw data results of the survey this month without any accompanying analysis.
Agaku is working on one using Chisquares. Suchitra Krishnan-Sarin at the Yale University School of Medicine and Sven Jordt at the Duke University School of Medicine told STAT that they’re working with colleagues to analyze those findings as well.
“I think leading tobacco researchers should take a step back and wait till this is fully analyzed by several sources,” Jordt said of the youth tobacco survey results. “It’s unfortunate that FDA could not publish their own analysis on time.” He said that an analysis of the youth survey results by tobacco giant Altria should not be taken at face value.
While Chisquares and other organizations and institutions can perform their own analyses, Agaku said, it’s no substitute for the government.
“It doesn’t come with the same gravitas as if an agency like OSH had reported on it, because OSH had an entire machinery for not just publishing but also disseminating this work,” he explained — sending out press releases and pitching major outlets, for example, so that policymakers are more likely to hear about the results of big surveys and act on them.
“Anyone can generate a report,” Agaku said. “Few have the resources or institutional leverage and respect the CDC once had to make that result count. I think that’s what is lost.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
