Driven by shifting preferences among young adults, cigarette smoking continues to see a marked decline across the country. And a recent study from UC San Diego researchers projects that trend will continue and bring the nationwide smoking prevalence rate below 5% in the next decade.
The study, “State and Sociodemographic Trends in U.S. Cigarette Smoking With Future Projections,” was published April 25 in the medical journal JAMA Network Open.
According to the study, the mean percentage of smokers among people ages 18-24 in states with the lowest prevalence of smoking declined 16.4% between 2001-02 and 2018-22, and in states with the highest prevalence of smoking, it fell 21.3%.
Among 25- to 34-year-olds, the drops were 10.9% and 10%, and among ages 35-49, the declines were 11.9% and 12.1%.
Though smoking cessation rates for people 50 and older have been slower, with prevalence declines of 4.7% and 2.3%, the study’s first author, Matthew Stone, said the continuing overall decrease “is clear evidence that the smoking epidemic will come to an end in our lifetime.”
The “end,” researchers say, would be defined by the national smoking prevalence rate falling below 5%. That figure is based partly on a goal set by Healthy People 2030, a 10-year plan begun in 2020 by the U.S. Office of Disease Prevention and Health Promotion.
“When we say we think we’re nearing the end game in our space, it’s that our projections appear to be such that at least the vast majority of states in this country are aimed to hit that target and the remaining states [that] have sort of lagged behind are not too far off,” said Stone, an assistant professor at the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science and a member of the university’s Moores Cancer Center.
To examine trends and form projections for 2035, researchers analyzed the Tobacco Use Supplements to the U.S. Census Bureau’s Current Population Survey. In sum, 1.77 million respondents were analyzed.
Researchers studied data from 1992 to 2022 and found that states with historically high smoking rates saw the most notable decreases.
California, Utah and Colorado already have rates below 6% and are expected to fall even lower. Among the lowest projections for 2035 are Colorado (1.5%) and Hawaii (1.4%).
“Cigarette smoking has been the major issue in public health for the last 70 years, and the goal is to get [to] a smoke-free society,” said study co-author John Pierce, also a professor at the Herbert Wertheim School and a member of Moores Cancer Center. “Now we’re starting to see the possibility of it, at least in some states.”
Researchers say the shrinking gap between high- and low-prevalence states is bolstered by a decline in smoking by young adults. Differences in smoking rates across age, sex, race and ethnicity remained.
Though young adults seem to be ditching cigarettes, the study does not for shifting trends in marijuana use or vaping.
Pierce and Stone contributed to a 2023 study in the journal Tobacco Control that said a surge in use of electronic cigarettes for vaping “was independent of smoking trends.” Pierce said he and other researchers aim to explore that topic further but that the focus of the latest study is exclusively on cigarette use.
“The issue on smoking for years was ‘Can we get it down?’” Pierce said. “So now we’re getting it down and we’re just reporting on that.”
Several factors could explain the decline in cigarette use, particularly among young people.
Research linking smoking to lung cancer in the 1950s led to an initial drop in national smoking rates. The Master Settlement Agreement of 1998, which settled dozens of state lawsuits against tobacco companies to recover billions of dollars in health care costs associated with treating smoking-related illnesses and placed restrictions on tobacco advertising.
Social trends are believed to be a factor, too.
“I think smoking has just become uncool,” Stone said. “The sort of norms around smoking have changed as a result of these advertising campaigns, the lack of ment from the tobacco industry and the associated health effects.
“We’ve sort of demonized smoking as a society, and I think that’s really impacted youth. Some people still think it’s cool, but by and large, it’s sort of gone the way of the dinosaur.” ♦
