American Cancer Society Releases Pioneering U.S. Tobacco Atlas: Cigarette Smoking Declining, but Lung Cancer Screening Subpar

ATLANTA, November 3, 2025 - The American Cancer Society (ACS) today announced the inaugural release of The U.S. Tobacco Atlas, a fact-based, digital scientific resource offering comprehensive data and insights on tobacco use, control policies, and their impact nationwide. The report notes that cigarette smoking among U.S. adults dropped from 42% in 1965 to 11% in 2023. Researchers also discovered that only 18.1% of eligible adults who currently smoke or formerly smoked were up-to-date with lung cancer screening in 2022, despite cigarette smoking being a leading risk factor for lung cancer. Screening rates are lowest in Southern states in the U.S., where lung cancer burden and healthcare access issues are greatest.

"TheU.S. Tobacco Atlas is a powerful tool showcasing not only the toll that tobacco has taken on the U.S., but also the immense progress public health gains have made over the past decades," said Dr. Nigar Nargis, senior scientific director, tobacco control research at the American Cancer Society and lead editor of the report. "Since the landmark 1964 U.S. Surgeon General's report on tobacco, millions of lives have been saved by tobacco control, but the scale of the epidemic demands our continued attention and support."

Created by ACS, The U.S. Tobacco Atlas maps tobacco use and control efforts at national and state levels in the U.S. and summarizes and translates scientific evidence into accessible information. The content is organized into four main sections: Tobacco Use, Disparities, Health & Economic Impact, and Tobacco Control Policy Advances. It can be used by public health professionals, researchers, advocates, policymakers, and students to chart the burden and relief strategies for tobacco use, facilitating a deeper exploration.

"The U.S. Tobacco Atlas is more than a report-it is a call to action. It reminds us that progress is possible, but not inevitable. It requires bold leadership, equitable policies, and unwavering commitment from every sector of society," said Dr. William Dahut, chief scientific officer at the American Cancer Society. "Together, we can accelerate the end of the tobacco epidemic and move closer to a world where no one has cancer because of tobacco."

Additional highlights from the report include:

• Despite progress, tobacco use remains the leading preventable cause of cancer death in the US, with over 80% of lung cancer deaths attributed to tobacco.
• The national quit smoking ratio reached a record 62% in 2022, although older adults (45+) have lower quit attempts and success rates, and a greater health risk. Also, the use of tobacco cessation aids is low, especially in the South and Midwest.
• Secondhand smoke exposure has declined, although it remains high in rental and public housing, and children and the elderly are especially vulnerable.

• Smokeless tobacco use rates are low overall, but concentrated in certain states (e.g., Wyoming, West Virginia).

• E-cigarettes are rising in popularity, especially in states with high cigarette use; 33% of people who use tobacco also use both cigarettes and e-cigarettes.
• Despite declines, 1.63 million youth reported using e-cigarettes in 2024, with 90% preferring flavored products.

• Non-White individuals, people with disabilities, LGBTQ+ individuals, and those with lower income and limited education face higher tobacco-related burdens.

"While we have made significant strides in reducing smoking prevalence and expanding access to evidence-based cessation resources, we remain deeply concerned about persistent disparities in tobacco use and tobacco-related disease," said Dr. Ahmedin Jemal, senior scientific vice president, surveillance, prevention, and health service research at the American Cancer Society and senior author of the report. "These disparities are particularly pronounced in states with weak tobacco control policies and among populations with lower socioeconomic status, and within communities historically targeted by the tobacco industry. This report brings these inequities into sharp focus and underscores the urgent need for strengthening state and federal tobacco control policies, as well as targeted interventions."

"For decades, we have made remarkable progress in reducing tobacco use-the leading preventable cause of death and disease in the United States. Yet today, that progress is under threat," said Lisa A. Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN). "Let this Atlas inspire policymakers to recommit to a bold vision: a future where tobacco no longer claims lives, deepens inequities, or burdens our economy. Together, we can finish what we started-and end the tobacco epidemic once and for all."

ACS lung cancer screening guidelines, updated in 2023, recommend annual screening for adults 50-80 years of age who smoke or used to smoke and have a 20-year or greater pack-year smoking history, regardless of quit date. A pack-year is equal to smoking one pack (or about 20 cigarettes) per day for a year.

Other editors for this edition of The U.S. Tobacco Atlas include Dr. J. Lee Westmaas, Dr. Tyler Nighbor, Dr. Samuel Asare, Dr. Minal Patel, Eva Orr-Souza, MPH, Zheng Xue, MSPH, Dr. Farhad Islami, Dr. Priti Bandi, Jessica Star, MA, MPH, and Tyler Kratzer, MPH.

Added ACS Resources:

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About the American Cancer Society
The American Cancer Society is a leading cancer-fighting organization with a vision to end cancer as we know it, for everyone. For more than 110 years, we have been improving the lives of people with cancer and their families as the only organization combating cancer through advocacy, research, and patient support. We are committed to ensuring everyone has an opportunity to prevent, detect, treat, and survive cancer. To learn more, visit cancer.org or call our 24/7 helpline at 1-800-227-2345. Connect with us on Facebook,X, and Instagram.