Prevalence and Patterns of Tobacco Use: Findings From a Multi-State Rapid-Response Survey in the U.S., 2023-2024

Overall tobacco use prevalence is higher in 13 Midwestern and Southern states (high-tobacco-burden states) than in the rest of the U.S., with limited recent data available to keep pace with an evolving tobacco marketplace. This study examined demographic correlates of current tobacco use among residents in these high- versus lower-tobacco-burden states.

The American Cancer Society collected 2 waves of a cross-sectional rapid-response survey in 2023 and 2024 among adults aged 18-65 years residing in the 13 high- and 4 low-tobacco-burden comparison states (N=12,300), analyzed in 2024-2025. Weighted bivariate and multivariable analyses examined demographic correlates of cigarette, E-cigarette, and cigar use.

The prevalence of tobacco use was higher in high-tobacco-burden states than in lower-tobacco-burden states overall (35.3% vs 28.3%) and for each commonly used tobacco product, including cigarettes (19.3% vs 14.7%), E-cigarettes (16.6% vs 14.5%), and cigars (7.4% vs 6.3%). In high-tobacco-burden states, living in households of 2 or more people (p<0.05) and being aged between 25 and 65 years (p<0.01) had greater odds of current smoking, whereas greater education was associated with lower odds of current smoking (p<0.01). Respondents identifying as Black (p<0.01) had greater odds of current cigar use. Those identifying as female had lower odds of current cigarette, E-cigarette, and cigar use (p<0.01).

Besides a higher overall prevalence of tobacco use, the authors observed disparities by various demographic characteristics among residents of high-tobacco-burden states. Findings highlight specific populations that could benefit from targeted cessation efforts.