For some of the key victories and milestones in the American Lung Association's efforts to reduce tobacco use, see our Tobacco Control Timeline
- The states with the best grades in the “State of Tobacco Control” 2025 report were California, Massachusetts and the District of Columbia.
- The states with the worst grades in the “State of Tobacco Control” 2025 report were Alabama, Georgia, Mississippi and Texas.
- A 2021 study found that menthol cigarettes were responsible for 1.5 million new smokers, 157,000 smoking-related premature deaths and 1.5 million life years lost among African Americans from 1980 to 2018.
- While overall cigarette use declined by 26% from 2009 to 2019, 91% of that decline was due to non-menthol cigarettes.
- Among current youth e-cigarette users in 2024, flavored e-cigarette use was 87.6% among middle and high school students.
- After e-cigarettes, nicotine pouches were the second-most commonly used tobacco product among middle and high school students in 2024; 85.6% of kids who use nicotine pouches used flavored products.
- Approximately 10.1% of high school students in the U.S. use at least one tobacco product, including e-cigarettes, according to the 2024 National Youth Tobacco Survey.
- 5.4% of middle school students use at least one tobacco product, including e-cigarettes, according to the 2024 National Youth Tobacco Survey.
- Smoking is the number one preventable cause of death in the U.S., killing over 490,000 people per year.
- Secondhand smoke causes more than 19,000 deaths in the U.S. each year.
- Twenty-eight states and Washington D.C. have passed laws making virtually all public places and workplaces, including restaurants and bars smokefree.
- New York has the highest cigarette tax in the country at $5.35 per pack.
- Missouri has the lowest cigarette tax in the country at 17 cents per pack.
- The average cigarette taxes of all states plus the District of Columbia are $1.97 per pack.
- Four states – Delaware, Maine, Oklahoma and Utah– are funding their tobacco control programs above or close to CDC-recommended levels (in Fiscal Year 2025).
- Three states – Maryland, New Mexico and Rhode Island – increased their cigarette taxes in 2024.
- No state approved a comprehensive smokefree workplace law in 2024.
- Twenty states – California, Colorado, Connecticut, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Minnesota, Missouri, Ohio, Oregon, Rhode Island, South Carolina, Texas, Vermont, Virginia and Wisconsin– offer a comprehensive cessation benefit to tobacco users on standard Medicaid.
- 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 $2.26 per smoker in each state. The average amount states invest in quitlines is $4.91 per smoker in each state.
- Nationwide, the Medicaid program spends more than $68.3 billion in healthcare costs for smoking-related diseases each year – more than 20.3% of total Medicaid spending.
- 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.
- The American Lung Association played a key role in airplanes becoming smokefree in the 1990s.
- 40 states and the District of Columbia spend less than half of what the CDC recommends on their state tobacco prevention programs.
- States are spending less than four cents of every dollar of the over $22.1 billion they are estimated to receive from tobacco settlement payments and tobacco taxes to reduce tobacco use in fiscal year 2025.
- Each day, more than 1,200 kids under 18 try their first cigarette and 60 kids become new, regular smokers.
- Each day, more than 600 kids try their first cigar. On average, close to 30 kids try their first cigar every hour in the United States – equaling about 245,000 every year.
- Smoking costs the U.S. economy over $600 billion in direct health care costs and lost productivity every year.
- The five largest cigarette companies spent over $21.9 million dollars per day marketing their products in 2022.
- Secondhand smoke costs the U.S. economy $7 billion per year due to premature death.
- Smoking rates are over twice as high for Medicaid recipients (17.6%) compared to those with private insurance (8.4%).
- A 2023 study of California's tobacco prevention program shows that the state saved $155 in healthcare costs for every $1 invested from 1989 to 2019.
- 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.
- 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.
- No states expanded their Medicaid program in 2024, leaving 10 states that have yet to provide greater access to healthcare, including medications and counseling to quit smoking.
- Uninsured Americans smoke at a rate close to two times higher (16.8%) than people with private insurance (8.4%).
- The smoking rate among adults ever diagnosed with anxiety or depression is 68% higher than among those never diagnosed with either disease.
- Close to 80% of Black Americans who smoke, smoke menthol cigarettes.
- Massachusetts and the District of Columbia are the only states that prohibit the sale of all flavored tobacco products, including menthol cigarettes.
- The prevalence of cigarette smoking and e-cigarette use among adults did not change from 2022 to 2023.
Page last updated: January 16, 2025