Less than 10 percent now smoke, but we’re still far from finished

The U.S. recently crossed a milestone that sounds like the beginning of the end for cigarette smoking: Fewer than 10 percent of American adults now smoke.

But percentages can obscure as much as they reveal. Even at 9.9 percent, that still represents tens of millions of Americans who continue to smoke — roughly the population of Texas.

The progress is real and should be applauded. But the harder question is what it will take to reach those still smoking and whether we’re ready for that.

To understand this moment, it helps to look at how tobacco control was originally designed. For decades, cigarettes were the dominant form of nicotine consumption. Public health leaders used a range of strategies to reduce smoking, including taxation, advertising restrictions, smoke-free laws, warning labels, litigation and public education. Together, these efforts drove one of the most significant declines in a harmful behavior in the modern history of public health.

Today, nicotine exists in a far more complex ecosystem. Millions of Americans now use nicotine in forms that barely existed a generation ago, including e-cigarettes, oral nicotine pouches and other non-combustible products. Although cigarette smoking continues to decline, nicotine use has not diversified rather than disappear.

Nicotine is highly addictive, and how it’s delivered matters, although no form of nicotine delivery is risk-free. But the way people use nicotine is changing, and that changes all sorts of things, including how dependence develops and how difficult it is to quit.

What has changed far less is how we help people quit. The most widely available tools today — patches, gum, lozenges, counseling and a handful of prescription medications — were mostly developed decades ago. Although they have been refined over time, there hasn’t been a true breakthrough to keep pace with how nicotine use has evolved. Dependence is shaped not only by the substance itself, but by how it is delivered, how quickly it reaches the brain and the habits built around it.

You can see this gap in today’s policy debates, where regulators and public health leaders are grappling with how to balance youth prevention with harm reduction for adults. Even as smoking rates fall to historic lows, parts of the U.S. policy framework still support tobacco production — a reminder that the systems built around nicotine have not evolved as quickly as the behaviors they were designed to address.

These debates often focus on specific products rather than the bigger picture of how nicotine is actually used today. The more important question is what it takes to help people quit in a world where nicotine no longer comes in just one form.

The challenge now for researchers, clinicians and policymakers is to rethink how we approach cessation. This does not mean abandoning the progress of tobacco control or minimizing the risks associated with emerging nicotine products. Protecting young people from nicotine addiction remains a critical priority. But the next chapter will require a deeper focus on how nicotine dependence works — how it develops, how it persists and how it changes as nicotine delivery evolves.

Even modest percentage declines represent millions of people. Moving from roughly 10 percent smoking prevalence to about 6 percent, a federal public health target for 2030, would require helping millions more Americans quit. Achieving this goal will take more than a continuation of the same effort — it will require addressing a different phase of the problem.

The end of widespread smoking is within reach, but getting there will depend on whether we are willing to rethink how we approach the final stretch.

Mario Danek is the CEO of Qnovia and has spent his career working in the nicotine and smoking cessation space.

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