ACS US Tobacco Atlas:
Cigarette Smoking Decrease, Lung Cancer Screening Subpar
The American Cancer Society (ACS) released its first U.S. Tobacco Atlas on November 3, 2025, providing a comprehensive look at tobacco use, its health and economic effects, disparities, and tobacco-control policies across the United States. The digital resource was released during Lung Cancer Awareness Month and is intended to help public health professionals, researchers, policymakers, advocates, and students better understand the ongoing impact of tobacco and identify opportunities for prevention.
One of the most significant findings is the dramatic decline in cigarette smoking among U.S. adults. Smoking prevalence decreased from 42% in 1965 to 11% in 2023, demonstrating the impact of decades of tobacco-control efforts. However, tobacco remains the leading preventable cause of cancer death in the United States, with more than 80% of lung cancer deaths attributed to tobacco use.
Despite the importance of early detection, the report identified a major gap in lung cancer screening. In 2022, only 18.1% of adults eligible for lung cancer screening were up to date with recommended screening. Screening rates were particularly low in Southern states, where lung cancer rates and barriers to healthcare access are often higher. ACS guidelines recommend annual screening for adults ages 50–80 who currently smoke or previously smoked and have at least a 20 pack-year smoking history.
The Atlas also highlights progress and continuing challenges related to quitting smoking. The national quit ratio reached a record 62% in 2022, but adults ages 45 and older had lower rates of quit attempts and successful cessation despite facing greater health risks. The use of tobacco-cessation aids also remains relatively low, particularly in the South and Midwest.
Emerging tobacco products present additional concerns. Although cigarette use has declined, e-cigarette use has become increasingly popular, particularly in states with high cigarette-smoking rates. Approximately 33% of tobacco users use both cigarettes and e-cigarettes. Among youth, 1.63 million reported using e-cigarettes in 2024, and 90% preferred flavored products.
Finally, the report emphasizes significant disparities in tobacco use and related health outcomes. Non-White populations, people with disabilities, LGBTQ+ individuals, and people with lower incomes or less education experience greater tobacco-related burdens. Secondhand smoke exposure has decreased overall but remains a concern in rental and public housing, particularly for children and older adults.
Overall, the U.S. Tobacco Atlas demonstrates that substantial progress has been made in reducing tobacco use, but continued efforts are necessary to improve smoking cessation, expand lung cancer screening, address disparities, and strengthen tobacco-control policies nationwide.
