Tobacco Facts

For some of the key victories and milestones in the American Lung Association's efforts to fight tobacco use, see our Tobacco Control Timeline

1. CDC has definitively linked smoking to more severe illness from COVID-19.
2. While overall cigarette use declined by 26% over the past decade, 91% of that decline was due to non-menthol cigarettes.
3. Among current youth e-cigarette users, flavored e-cigarette use increased from 71.7% to over 82.9% among high school students and from 59.9% to 73.9% among middle school students.
4. In 2020, disposable e-cigarette use skyrocketed by 1,000% among high school e-cigarette users (from 2.4% to 26.5%) and 400% among middle school e-cigarette users (from 3% to 15.2%).
5. More than 23.6% of high school students in the U.S. use at least one tobacco product, including e-cigarettes, according to the 2020 National Youth Tobacco Survey.
6. 6.7% of middle school students use at least one tobacco product, including e-cigarettes, according to the 2020 National Youth Tobacco Survey.
7. From 2017 to 2020, high school e-cigarette use increased by 68% and middle school e-cigarette use increased by 42%, according to data from CDC’s National Youth Tobacco Survey.
8. Smoking is the number one preventable cause of death in the U.S., killing over 480,000 people per year.
9. Secondhand smoke causes more than 41,000 deaths in the U.S. each year.
10. 28 states and Washington D.C. have passed laws making virtually all public places and workplaces, including restaurants and bars smokefree.
11. The District of Columbia has the highest cigarette tax in the country at $4.50 per pack.
12. Missouri has the lowest cigarette tax in the country at 17 cents per pack.
13. The average cigarette taxes of all states plus the District of Columbia are $1.88 per pack.
14. Two states – Connecticut and Tennessee – provide no state funding at all for tobacco prevention programs.
15. Three states – Alaska,  Maine and Utah – are funding their tobacco control programs at or close to CDC-recommended levels (in Fiscal Year 2021).
16. Colorado and Oregon were the only states to increase their cigarette taxes by significant amounts in 2020.
17. No state approved a comprehensive smokefree workplace law in 2020.
18. 13 states – California, Colorado, Connecticut, Kansas, Kentucky, Maine, Massachusetts, Missouri, North Dakota, Ohio, Oregon, Rhode Island and South Carolina – offer a comprehensive cessation benefit to tobacco users on Medicaid.
19. Each of the 50 states and the District of Columbia provide tobacco quitlines, a phone number for quit smoking phone counseling. The median amount states invest in quitlines is $2.28 per smoker in each state.
20. Nineteen states and the District of Columbia approved Tobacco 21 laws prior to the federal Tobacco 21 law passing.
21. Nationwide, the Medicaid program spends more than $39.6 billion in healthcare costs for smoking-related diseases each year – more than 15.2% of total Medicaid spending.
22. In 2009, the American Lung Association played a key role in the passage of the Family Smoking Prevention and Tobacco Control Act, which gives the U.S. Food and Drug Administration authority over tobacco products.
23. The American Lung Association played a key role in airplanes becoming smokefree in the 1990s.
24. 42 states and the District of Columbia spend less than half of what the CDC recommends on their state tobacco prevention programs.
25. States spend less than three cents of every dollar of the $26.9 billion they get from tobacco settlement payments and tobacco taxes to fight tobacco use in fiscal year 2021.
26. Each day, close to 1,500 kids under 18 try their first cigarette and more than 200 kids become new, regular smokers.
27. Each day, more than 1,200 kids try their first cigar. On average, more than 50 kids try their first cigar every hour in the United States – equaling about 442,000 every year.
28. Smoking costs the U.S. economy over $332 billion in direct health care costs and lost productivity every year.
29. The five largest cigarette companies spent over $23 million dollars per day marketing their products in 2018.
30. Secondhand smoke costs the U.S. economy $5.6 billion per year due to lost productivity.
31. Smoking rates are over twice as high for Medicaid recipients (24.9%) compared to those with private insurance (10.7%).
32. A 2013 study of California's tobacco prevention program shows that the state saved $55 in healthcare costs for every $1 invested from 1989 to 2008.
33. A 2017 study found that states which expanded Medicaid had a 36% increase in the number of tobacco cessation medication prescriptions relative to the states that did not expand Medicaid. This means more quit attempts with proven cessation treatments are being made.
34. A 2019 study found patients in Medicaid expansion states who ordered a cessation medication had a 65% higher chance of quitting than those in non-expansion states.  
35. In 2020, Missouri, Nebraska and Oklahoma implemented Medicaid expansion, providing more smokers with access to tobacco cessation treatments.
36. Uninsured Americans smoke at a rate more than two times higher (22.5%) than people with private insurance (10.7%).
37. An estimated one-third of Americans living in public housing smoke.
38. The smoking rate among adults with moderate to severe psychological distress is 79% higher than among those with none to mild.
39. Indigenous Peoples (American Indians/Alaska Natives) have the highest commercial tobacco smoking rates among any racial/ethnic group.
40. California became the second state to prohibit the sale of most flavored tobacco products in 2020 joining Massachusetts.