Cigarette smoking dips below 10%. The CDC didn’t tell you

In 2024, the rate of cigarette smoking among U.S. adults dropped below 10% for the first time on record.

This milestone is significant in itself, but the way this information is being disseminated is equally noteworthy. 

The U.S. government, which gathered the data, did not report the historic decline. Instead, the findings were revealed in an analysis published in the digital journal NEJM Evidence by Israel Agaku, the founder and CEO of the research technology company Chisquares. 

Traditionally, the U.S. government analyzes and publishes national tobacco use survey data. However, federal budget cuts have severely impacted the Office of Smoking and Health at the Centers for Disease Control and Prevention (CDC), forcing Agaku and others in academic and corporate settings to address the void left by the government. 

Agaku’s analysis was released as a “public health alert” in NEJM Evidence, an initiative launched by the New England Journal of Medicine and the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota as a substitute for the CDC’s weekly reports. CIDRAP also started the Vaccine Integrity Project last April to safeguard vaccine use amid governmental policy changes.

“We had all this data and no one was analyzing it,” said Agaku, an epidemiologist who previously served as a senior scientist at the Office of Smoking and Health until 2019. “For me as a public health person, the question was, does public health just die?”

According to health department spokesperson Andrew Nixon, the CDC “remains deeply committed to tobacco prevention and control,” supporting such initiatives through “outreach, education, and surveillance.”

The latest cigarette use data derives from the National Health Interview Survey, conducted annually by the CDC, which queries tens of thousands of Americans about their lifestyle habits, illnesses, and healthcare access. 

The survey indicates that in 2024, 9.9% of U.S. adults smoked cigarettes, a decrease from 10.8% in 2023. Meanwhile, e-cigarette usage held steady at 7%, and 2.6% of adults used smokeless tobacco, including nicotine pouches. (Changes in product definitions precluded comparison of smokeless tobacco use rates.) 

“In public health, the number 10% is very symbolic to us,” said Agaku, who also co-edits the Journal of Tobacco Induced Diseases. “Things below 10% are considered rare events or unusual events.” By this standard, smoking may now be deemed rare in the U.S.

Despite this, 9.9% translates to 25 million Americans who still smoke. The data highlights higher smoking rates in certain groups, such as those with less education, individuals with disabilities, and residents of rural areas. 

Kathy Crosby, CEO and president of the tobacco control nonprofit Truth Initiative, emphasized the need to tackle ongoing disparities among racial, economic, geographic, and LGBTQ+ communities, stating, “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.” She also stressed the importance of restoring and maintaining federal infrastructure to support tobacco prevention, cessation, research, and education.

In total, 48 million U.S. adults, or 18.8%, use at least one tobacco product.

The survey results indicate that the U.S. is on course to meet the government’s objective of reducing smoking prevalence to 6.1% by 2030 as part of a longstanding health department initiative, Agaku noted.

The CDC released its survey data last fall, but omitted the analysis typically included 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,” said Dorothy Hatsukami, a University of Minnesota professor specializing in tobacco addiction, via email. 

Having contributed to earlier smoking reports at OSH, Agaku accessed the dataset on the CDC’s website and utilized his company’s technology to analyze the information himself. 

“People have to make sense of data, because data cannot speak for itself,” he explained.

Agaku initially submitted his report to the CDC’s MMWR in hopes of continuing the tradition of publishing national survey outcomes there. However, he was informed that MMWR could no longer accept work from external contributors on smoking issues. With OSH effectively dismantled, the agency lacked experts to review it.

“How does the health agency not have experts on the leading cause of death?” Agaku questioned, noting that smoking is the top cause of preventable death in the U.S., leading to over 480,000 deaths annually. Heart disease remains the leading overall cause of death in the country.

Currently, a similar independent effort is underway to assess results from the government’s National Youth Tobacco Use survey. The Food and Drug Administration released the raw data results this month without accompanying analysis. Agaku is analyzing this data through Chisquares, while Suchitra Krishnan-Sarin at Yale University School of Medicine and Sven Jordt at Duke University School of Medicine are collaborating with colleagues to review the findings. 

“I think leading tobacco researchers should take a step back and wait till this is fully analyzed by several sources,” Jordt commented on the youth tobacco survey results. He expressed disappointment that the FDA could not publish their analysis promptly, adding that an analysis by tobacco company Altria should be scrutinized carefully. 

While entities like Chisquares can conduct their own analyses, Agaku argued, these efforts cannot replace the authority of government reports.

“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 said, noting that governmental agencies have the resources to distribute findings widely and garner attention from policymakers.

Agaku concluded, “Anyone can generate a report. 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.