State and Sociodemographic Trends in US Cigarette Smoking With Future Projections

There are still significant population-level health consequences of cigarette smoking in US states.

To estimate whether differential sociodemographic trends in smoking prevalence since 1992 will close the prevalence gap between states by 2035.

This cross-sectional study included data from 18 repeated, state-representative US Tobacco Use Supplement to the Current Population Surveys (TUS-CPS) from 1992 to 2022. Data were analyzed between June and October 2024.

Nonlinear time series trends in smoking prevalence in US states from 1992 to 2022 were projected through 2035 and compared with recommended targets. States were grouped into tertiles using their 1990s prevalence. Differential change in sociodemographic groups were compared across tertiles.

The 18 surveys comprised 1 770 442 respondents (997 569 female [56.3%]; 146 865 Hispanic [8.3%], 160 751 non-Hispanic Black [9.1%], and 1 373 454 non-Hispanic White [78.0%]). From 1992 to 2022, all state tertiles experienced significant declines in smoking prevalence, each decreasing by approximately 13 percentage points from 2001 to 2022. In 2022, prevalence was 7.4% (95% CI, 6.9% to 7.9%) in tertile 1 (lowest 1990s prevalence), 10.0% (95% CI, 9.2% to 10.8%) in tertile 2, and 12.7% (95% CI, 11.9% to 13.4%) in tertile 3. Projections to 2035 indicated the prevalence gap closing between tertiles, to 3.8% (95% CI, 2.6% to 5.1%) in tertile 1, to 5.1% (95% CI, 3.2% to 7.2%) in tertile 2, and to 6.6% (95% CI, 4.8% to 9.1%) in tertile 3. The only sociodemographic trend that reduced the gap occurred among individuals aged 18 to 24 year (tertile 3 change, -21.3% [95% CI, -24.5% to -18.2%] vs tertile 1 change, -16.4% [95% CI, -18.5% to -14.4%]; P = .005). Yet age was not a significant factor in projected changes, as the decline in the group aged 50 years and older was greater in tertile 1 than 3 (-4.7% [95% CI, -5.7% to -3.8%] vs -2.3% [95% CI, -3.5% to -1.2%]; P < .001). By 2035, only 4 states (California, Utah, Hawaii, and Colorado) were projected to be significantly under the recommended target of 5% prevalence.

The findings of these repeated cross-sectional surveys suggest that the difference in cigarette smoking prevalence between historically high vs low prevalence states will shrink by 2035, primarily from much faster declines among young adults in the traditionally highest prevalence states. Slower prevalence declines among older adults are likely to slow the decline in health consequences in these states.