How America Reduced Smoking Rates from 42% to Below 10% in 60 Years

How old am I? Old enough to remember planes with ashtrays in the armrests. Old enough to recall restaurants with smoking sections separated from nonsmoking areas by little more than a rope or a sign. Old enough to remember when a host would ask, "Smoking or non-smoking?" before seating you.

I’m 47 — not ancient, even if I sometimes feel that way — and yet the America I grew up in the 1980s was so saturated with cigarette smoke that these memories feel like relics from another time.

In 1980, roughly a third of American adults still smoked. The smoking mascot Joe Camel, later accused of targeting children, debuted the year I turned 10.

Now, here’s a figure from 2024: 9.9 percent. That’s the share of American adults who smoke cigarettes, according to data from the National Health Interview Survey analyzed in a paper published this month in NEJM Evidence. It’s the first time the rate has fallen below 10 percent in the survey’s history.

In public health terms, smoking in America is now officially “rare.”

The decline of smoking: A 60-year public health victory

This decline — from 42.4 percent in 1965 to 9.9 percent in 2024 — is one of the great public health achievements of the modern era. It didn’t happen because of a single breakthrough or miracle drug. Instead, it resulted from decades of coordinated effort: science, policy, litigation, and collective will, all working against fierce resistance from one of the most powerful industries on Earth.

If you’re looking for evidence that large-scale, long-term progress is possible — even when the odds seem impossible — there are few better examples than the story of smoking.

The smoke got in your eye: The scale of the change

At its peak, Americans consumed more than 4,000 cigarettes per person per year — that’s more than half a pack a day. Roughly half of all physicians smoked. Cigarette companies spent billions on marketing, lobbied aggressively against regulation, and actively suppressed evidence of harm.

The human toll was devastating. Since 1964, more than 20 million Americans have died from smoking-related causes. Today, smoking still kills approximately 480,000 Americans annually, contributing to about one in five deaths.

Globally, tobacco killed roughly 100 million people in the 20th century — more than the total number of people killed in World War II. It remains, by a wide margin, the leading cause of preventable death in the modern world.

The turning point: 1964 and the Surgeon General’s report

The turning point came on January 11, 1964, when Surgeon General Luther Terry held a historic press conference at the State Department. He announced the findings of his advisory committee, which had reviewed more than 7,000 scientific studies and concluded that smoking causes lung cancer and other diseases.

This landmark report marked the beginning of a decades-long campaign to reduce smoking through public awareness, policy changes, and legal action. It set the stage for warning labels on cigarette packs, advertising bans, smoke-free air laws, and higher taxes on tobacco products — all tools that helped drive the smoking rate to historic lows.