Cigarette smoking in the United States has fallen below 10 percent for the first time in recorded history, a public health milestone more than six decades in the making.
A report published March 10, 2026 in NEJM Evidence, drawing on data from the Centers for Disease Control and Prevention, found that 9.9 percent of US adults reported smoking cigarettes in 2024, down from 10.8 percent in 2023.
That single decimal point crossing below the double-digit threshold is more significant than it sounds.
“In public health, the number 10 percent is very symbolic to us,” said Israel Agaku, the researcher who published the analysis in NEJM Evidence.
“Things below 10 percent are considered rare events or unusual events.”
By that definition, cigarette smoking in America has become statistically rare for the first time since the habit became widespread in the twentieth century.
That is a genuine triumph of public health.
But the same report carried a number that complicates the celebration considerably.
Seven percent of American adults used e-cigarettes, or vapes, in 2024, nearly double the 3.7 percent who reported using e-cigarettes in 2020.
In four years, vaping among adults has almost doubled.
And the generation most responsible for that surge is the same generation that the tobacco industry specifically targeted when it first introduced the products that are now driving the increase.
How the Report Was Conducted
The data comes from the National Health Interview Survey (NHIS), the CDC’s primary tool for tracking health behaviors across the US adult population.
The NHIS is a nationally representative household survey conducted continuously throughout the year, covering the civilian, non-institutionalized population across all 50 states and the District of Columbia.
Participants self-report their tobacco and nicotine product use, including cigarettes, e-cigarettes, cigars, smokeless tobacco, and nicotine pouches.
The 2024 data covers all adults aged 18 and older and was broken down by age group, geographic classification, sex, and sexual orientation to identify which populations are most affected by each trend.
There is an important contextual note about how this data reached the public, one that speaks to a broader concern about the state of public health infrastructure in the United States.
The cigarette smoking rate among US adults fell below 10 percent for the first time in recorded history in 2024.
That is a big deal in itself. Also remarkable is how everyone is finding out about it. Reports of the historic dip in smoking did not come from the US government, which had collected the data.
Instead, the news came via an analysis by Israel Agaku, the founder and CEO of research technology company Chisquares.
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.
In other words, the agency that collected the most important tobacco surveillance data in the country no longer has the staff to analyse and publish it.
That is a public health governance failure sitting directly alongside a public health success story.
Findings From the Report
The headline numbers tell a clear story of two diverging trends.
Cigarette use is falling, steadily and consistently, continuing a trajectory that began after the 1964 Surgeon General’s report first established the causal link between smoking and lung cancer.
At the time of that report, more than 42 percent of adult Americans were smokers.
Six decades of public education, taxation, advertising restrictions, indoor smoking bans, and cessation programs have reduced that figure by more than three quarters.
That reduction represents, conservatively, millions of lives that were not ended or shortened by smoking-related disease.
But the e-cigarette trend is moving in the opposite direction.
E-cigarette use has risen to 7 percent of American adults in 2024, up from 6.5 percent in 2023 and nearly double the 3.7 percent who reported using e-cigarettes in 2020.
The demographic breakdown of who is vaping adds significant urgency to that number.
Among vapers, those between ages 18 and 24 had the highest prevalence of e-cigarette use, followed by those between ages 25 and 44.
And critically, previous CDC data has shown that the majority of young adults who use e-cigarettes have never smoked cigarettes.
This is not a harm reduction story.
For the majority of young adult vapers, e-cigarettes are not a substitute for a more dangerous habit they are trying to quit.
They are the first nicotine product those individuals ever used.
The geography of both habits also follows a consistent pattern.
More than 15 percent of non-metropolitan residents reported cigarette use, compared to city dwellers. Vaping patterns mirrored cigarettes by metro area, with 9.2 percent of rural residents reporting e-cigarette use compared to 6.1 percent in urban areas.
The JUUL Generation That Nobody Planned For
Understanding the vaping surge requires understanding what happened between 2017 and 2019, when the e-cigarette brand JUUL achieved a market penetration among teenagers that public health officials describe as one of the most rapid nicotine adoption events in modern history.
JUUL’s product was deliberately engineered for palatability.
Its pods contained nicotine salt formulations that delivered a smoother, less harsh hit than traditional cigarettes, making it far easier for first-time users, particularly young people, to use without the discomfort that had historically discouraged tobacco initiation.
Its design was sleek, discreet, and rechargeable via USB.
It looked like a flash drive.
Its flavors included mango, fruit, and mint, products that were manifestly aimed at a younger palate rather than existing adult smokers seeking an alternative.
The result was predictable in retrospect.
“I think this is the JUUL generation,” said Thomas Carr, director of national policy at the American Lung Association.
“From 2017 to 2019, they got teens to get hooked on JUUL, and they’re now adults, and unfortunately, they haven’t been able to quit using e-cigarettes.”
The teenagers who were targeted by JUUL’s marketing between 2017 and 2019 are now between 21 and 26 years old.
They are the young adults showing up in this 2024 CDC data as the highest-prevalence vaping demographic in the country.
The industry created a generation of nicotine-dependent young adults, and those young adults are now being counted in public health surveys as evidence of a new and growing problem.
What the Survey Says About Who Is Most Affected
Beyond age and geography, the CDC data reveals several other demographic patterns that have important implications for public health outreach and policy.
Cigarette smoking rates are higher among certain populations, such as those whose education stopped before college, people with disabilities, and rural residents.
Previous CDC data has consistently found that men, those who identify as lesbian, gay, or bisexual, and those who report serious psychological distress are more likely to report current e-cigarette use.
The association between serious psychological distress and both cigarette and e-cigarette use is a pattern that public health researchers have documented across many years of tobacco surveillance data.
Nicotine is a mood-altering substance that produces short-term reductions in anxiety and stress, making it particularly compelling for people who are already experiencing elevated psychological distress.
The long-term consequence, however, is a deepening cycle of dependence in which the absence of nicotine produces the very anxiety symptoms that the substance temporarily relieves, creating a physiological trap that makes quitting extraordinarily difficult.
For the communities most likely to be caught in that trap, including lower-income rural populations, people with mental health conditions, and LGBTQ+ individuals, the shift from cigarettes to vapes does not represent an escape from nicotine dependence.
It represents a change of delivery mechanism within the same underlying addiction.
The Harm Reduction Question That Has No Clean Answer
The most contested and genuinely complicated question in the vaping policy debate is whether e-cigarettes are a net positive or net negative for public health.
The answer depends enormously on which population you are asking about.
For a longtime heavy smoker who switches entirely from cigarettes to e-cigarettes, the evidence broadly supports the idea that they have reduced their exposure to the most harmful byproducts of tobacco combustion.
“Cigarettes are terrible, and it is possible that e-cigarettes are safer, not safe, safer than cigarettes,” said Dr. Maria Rahmandar, medical director of the substance use and prevention program at Ann and Robert H. Lurie Children’s Hospital of Chicago.
“So could it be better for somebody to switch in a harm reduction philosophy? Yes, however, we still don’t know long-term effects of e-cigarettes either.”
The operative word throughout that statement is “safer,” not “safe.”
E-cigarettes expose users to a range of harmful substances that have nothing to do with tobacco combustion.
There are harmful chemicals, carcinogens, toxins, heavy metals, respiratory irritants, and other things inside vapes that certainly can cause immediate harm, Rahmandar noted.
Research published by the American Lung Association has linked e-cigarette use to lung inflammation, increased susceptibility to respiratory infection, and a condition called EVALI, e-cigarette or vaping product use-associated lung injury, which hospitalised thousands of Americans in 2019 and 2020 and killed dozens before the outbreak was traced primarily to vitamin E acetate used as a cutting agent in illegal THC vaping products.
The long-term consequences of inhaling propylene glycol, vegetable glycerin, flavoring chemicals, and ultrafine particulates on a daily basis for decades are simply not yet known.
The oldest regular e-cigarette users in the world have only been vaping for approximately 15 to 20 years.
The diseases caused by cigarette smoking, including lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease, typically take 20 to 30 years of regular use to manifest fully.
The honest answer about the long-term health consequences of vaping is that science does not yet have enough data to give a definitive answer, because the technology has not existed long enough for the longitudinal studies to produce clear conclusions.
The Shot at a Tobacco-Free Generation That Got Derailed
Perhaps the most consequential line in the entire CDC report is one that describes not what happened, but what did not.
“I think we had a shot at the first tobacco-free generation prior to e-cigarettes coming onto the market,” said Thomas Carr of the American Lung Association.
“Unfortunately, it’s kind of derailed that progress.”
That assessment is supported by the youth tobacco data.
Data from the 2024 National Youth Tobacco Survey showed that 5.9 percent of middle and high school students used electronic cigarettes in the past 30 days, a decline from 7.7 percent in 2023.
Youth vaping rates have been falling since their 2019 peak, partly as a result of FDA enforcement actions against flavored products and increased public awareness of the risks.
But those declining youth rates exist against a backdrop in which an entire cohort of young adults was already hooked before the enforcement arrived.
The JUUL generation is already in the data.
And the pattern of that cohort suggests that nicotine addiction acquired in adolescence or early adulthood through e-cigarettes is proving just as difficult to break as the cigarette dependence the previous generation struggled to shed.
The FDA Approval Gap That Leaves Vapers Without Guidance
One regulatory reality sits at the center of the vaping debate and is rarely communicated clearly to the public.
The FDA has not approved any e-cigarette product as a smoking cessation aid.
That matters for two reasons.
First, it means that the marketing of e-cigarettes as a tool for quitting smoking has never been reviewed or validated by the regulatory body responsible for approving cessation therapies in the United States.
Nicotine replacement therapies, including patches, gums, lozenges, and prescription medications like varenicline, have all been through rigorous clinical trials demonstrating efficacy and safety.
E-cigarettes have not.
Second, it means that the millions of adults who are using e-cigarettes as a quit-smoking strategy are doing so without the benefit of evidence-based clinical guidance about whether the approach is actually working, at what dose, for which populations, and with what risks.
The FDA has authorised the marketing of certain e-cigarette products as tobacco products, meaning they have been reviewed for market authorisation.
That is a different and considerably lower bar than the approval required to make health claims about cessation efficacy.
How the Report Applies to Real Life
The picture that emerges from the 2024 CDC data is one of genuine progress shadowed by a genuine new problem.
The six-decade decline in cigarette smoking is one of the most significant public health achievements in American history.
It required sustained political will, public education, taxation policy, advertising restrictions, legal action against tobacco companies, and the work of countless clinicians, researchers, and advocates.
Allowing that achievement to be quietly offset by a new generation of nicotine-addicted young adults, hooked not on cigarettes but on sleek rechargeable devices designed by the same industry that spent decades denying cigarettes caused cancer, would represent a profound failure to learn from history.
For individuals, the most practical takeaways from this data are straightforward.
If you smoke cigarettes, the evidence for quitting remains overwhelming, and evidence-based cessation resources including counseling, nicotine replacement therapy, and prescription medication have all been shown to significantly improve quit rates.
If you vape and have never smoked cigarettes, the data suggests you are not engaged in harm reduction.
You are a nicotine-dependent person using a product whose long-term health consequences are genuinely unknown, manufactured by an industry with a documented history of prioritising profit over the health of its customers.
And if you are a parent of teenagers or young adults, the data on who is vaping and how they got there is a reminder that the tobacco industry has never stopped looking for new customers.
It found them in a generation that grew up being told cigarettes were dangerous.
It just gave them a USB-shaped alternative instead.
Sources: ABC News, March 26, 2026 | STAT News, March 17, 2026 | NEJM Evidence, Israel Agaku analysis | CDC NCHS Data Brief No. 524, January 2025 | American Lung Association, E-Cigarettes and Lung Health | US Food and Drug Administration, E-Cigarettes and ENDS | Smokefree.gov, Cessation Resources
