U.S. Smoking Declines to Record Lows Amid Rising E-Cigarette Use
U.S. adult cigarette smoking rates have declined to record low levels, according to a new report from the Centers for Disease Control and Prevention (CDC). Concurrently, e-cigarette use among American adults has increased. Research on e-cigarettes offers varied perspectives on their effectiveness for quitting traditional smoking, alongside ongoing discussions about their health risks and concerns regarding youth uptake.
Adult Cigarette Smoking Trends
In 2024, approximately 10% of adults in the United States smoked cigarettes, marking a decrease from about 11% in 2023. This trend continues a significant decline observed since 1964, when over 42% of adult Americans smoked.
The CDC report also highlighted geographic disparities: over 15% of individuals in rural areas reported cigarette smoking, a higher rate compared to city dwellers. Adults aged 45-64 showed the highest likelihood of smoking, followed by those aged 25-44.
Adult E-Cigarette Use Trends
The CDC report also found that 7% of American adults used e-cigarettes, or vapes, in 2024. This represents an increase from 6.5% of adults in 2023 and is nearly double the 3.7% reported in 2020.
Similar to cigarette use, vaping patterns showed geographic differences, with 9.2% in rural areas reporting e-cigarette use compared to 6.1% in urban areas. Previous CDC data indicates that men, individuals identifying as lesbian, gay, or bisexual, and those reporting serious psychological distress are more likely to use e-cigarettes.
The highest prevalence of e-cigarette use was observed among adults aged 18-24, followed by those aged 25-44. Notably, previous CDC data also indicates that most young adults who use e-cigarettes have not previously smoked traditional cigarettes.
E-Cigarettes and Smoking Cessation
A study from the University of Oxford, published in the journal Addiction, indicates that nicotine e-cigarettes are more effective for smoking cessation than traditional methods like gums and patches. Researchers, including Angela Difeng Wu, stated that evidence consistently supports e-cigarettes' effectiveness in helping people stop smoking.
The Oxford review, which analyzed 14 systematic reviews from 2014 to 2023 (including a 2024 Cochrane review), suggested that an additional two to five people per 100 users would quit smoking with nicotine e-cigarettes compared to Nicotine Replacement Therapy (NRT).
The CDC notes that while some adults use e-cigarettes in attempts to quit smoking, the Food and Drug Administration (FDA) has not approved any e-cigarette for this purpose.
Health Implications and Risks
The Oxford study's review found evidence on serious adverse events associated with e-cigarettes to be inconclusive. For most other adverse events, the evidence suggested little to no difference compared to other treatments. Experts caution that e-cigarettes are not risk-free and should be avoided by non-smokers.
The CDC states that while e-cigarettes may be considered a harm reduction option compared to traditional cigarettes, their long-term effects are not yet fully understood. E-cigarettes are known to contain harmful chemicals, carcinogens, toxins, heavy metals, and respiratory irritants.
A study published in February 2026 noted no current human evidence that e-cigarettes cause cancer, but confirmed users are exposed to carcinogenic chemicals. This study also found that using e-cigarettes instead of combustible tobacco significantly reduces exposure to cancer-causing chemicals.
Uncertainties and controversies regarding e-cigarettes' role in public health impact international policy and decision-making. Evidence on long-term health effects continues to evolve due to the products' relatively recent availability and continuous development.
Youth Vaping Concerns
The World Health Organization (WHO) has raised significant concerns regarding vapes and e-cigarettes, particularly their impact on children. In 2025, WHO estimated that over 100 million people worldwide vape, including at least 15 million children aged 13 to 15.
WHO data suggests that children are, on average, nine times more likely to vape than adults in countries with available information. Etienne Krug of the WHO commented that e-cigarettes contribute to nicotine addiction and, despite being marketed for harm reduction, risk undermining decades of public health progress in tobacco control.