The Centers for Disease Control and Prevention estimates that more than 34 million American adults are cigarette smokers. It also notes that more than 16 million people are living with a disease caused by smoking, such as lung cancer. In fact, cigarette smoking accounts for one in five deaths each year and remains the leading cause of preventable disease, disability and death in the U.S.

Research has revealed that as the world faced the COVID-19 pandemic’s mandatory lockdowns and changes to how we live and work, many people turned to cigarettes. This is evidenced by the first increase in cigarette sales in 20 years combined with drastic declines in people calling smoking cessation hotlines. Nationally, the total annual number of calls to 1-800-QUIT-NOW dropped an average of more than 86,000 since the pandemic began.

Because smoking increases the risks of lung cancer, heart disease and other deadly illnesses, it’s important to examine this current hike in cigarette usage to gain a better understanding of what’s behind it. We have gathered data from a variety of sources to analyze this trend and identify the states seeing the biggest shift. 

Key findings include:
  • Smoking quitline 1-800-QUIT-NOW saw an annual average decline of 86,812 calls in both 2020 and 2021.
  • Michigan experienced the largest decrease in smoking helpline calls, dropping an average of 14,408 calls annually in 2020 and 2021. That is more than four times the amount of any other state.
  • National cigarette sales saw their first increase in more than 20 years, surging 14.1% over projected totals during the pandemic.
  • Theories explaining the rise of cigarette usage include the mental health impact of the lockdowns, a reduction in regulated public smoking opportunities and stockpiling of cigarettes.
  • Missouri charges a cigarette tax rate of only $0.17 per 20-pack, a stark contrast to the $4.94 rate found in Washington, D.C.

States Where Smokers Stopped Trying to Quit

States with major drops in 1-800-QUIT-NOW calls

The number of adult smokers in the U.S. has steadily declined over many decades, due in part to the availability of smoking cessation programs, tobacco tax programs and smoke-free air laws enacted across the country. In 1965, 42% of Americans were smokers — that number has now decreased to 14% of the population.

The 1-800-QUIT-NOW helpline acts as the national portal number that routes callers to their respective state’s smoking quitline. It tracked a major decline in the amount of calls rolling through its system starting in early 2020 as the pandemic began. That year alone, the number of calls dropped by more than 190,000 from the previous year’s total.

Michigan Smokers Couldn’t Kick the Habit

Number of 1-800-QUIT-NOW calls dropped annually in Michigan since the start of the COVID-19 pandemic

Smokers from Michigan seeking assistance in quitting decreased from the 1-800-QUIT-NOW call reports more than four times as much as any other state during 2020 and 2021. Call totals dropped off by 14,408 calls on average each of these years. For additional context, note that Michigan is home to a much higher percentage of smokers (18.7%) than the national average (14%). In comparison, the remaining nine states rounding out the top 10 each averaged between 3,000 and 4,000 fewer callers. 

Trailing behind Michigan’s average annual call drop total are Alabama (3,944), West Virginia (3,897), Ohio (3,838), Mississippi (3,837), Oklahoma (3,829), Pennsylvania (3,641), Indiana (3,351), Florida (3,121) and Arkansas (3,113). All other states experienced an average decline of less than 3,000 calls.

American Tobacco Revenue Grew During the Pandemic

Percentage that cigarette sales have increased during the COVID-19 pandemic

A report from the Federal Trade Commission shows an increase in cigarette sales in 2020 — the first such increase in 20 years. Tobacco manufacturers sold a total of $203.7 billion worth of cigarettes during the first year of the pandemic, almost a billion more than were sold in 2019.

The tobacco industry anecdotally claimed it had halted decades of declining cigarette sales during the pandemic. Researchers have seemingly backed up that claim. They identified a 14.1% increase above their estimated cigarette sales projections since the pandemic began. 

Reasons for an Increase in Smokers

Reasons why cigarette smoking is on the rise since the pandemic began

Theories explaining the cause of the increases in cigarette sales and corresponding drops in cessation helpline calls have not been proven yet. But experts do seem to agree on some potential reasons.

Mental Health Stress of Lockdown

The National Alliance on Mental Illness noted that the mental health issues tied to pandemic experiences may be driving factors in the increased use of tobacco, alcohol and other substances. The stress, anxiety and depression stemming from forced isolation, fearful uncertainty and a departure from normal routines can propel some people into unhealthy coping mechanisms such as smoking. 

These same mental health issues are also believed to contribute to the decrease in helpline calls, as people may feel less compelled to seek help during emotionally overwhelming times. Traditionally, nearly half of quitline callers tend to have behavioral health conditions.

Lack of Public Smoking Hindrances

With the majority of the American workforce required to isolate and adapt to working from home, the pandemic created a situation where people were not faced with smoking regulations common in public spaces. The freedom from both official nonsmoking mandates and potential negative public perception of smokers may have made it easier for some people to pick up the habit at home.

“Pantry Loading” Purchases

During the early days of the escalating pandemic in the U.S., stockpiling household necessities such as toilet paper became major news. Some financial reporters also noted seeing a surge in cigarette sales at that time as well. Tobacco manufacturer Altria reported in April 2020 that its first-quarter sales had jumped as a result of what they termed “pantry loading” of bulk purchases. 

Risks of Combining COVID-19 and Cigarettes

Early in the evolution of the COVID-19 virus, smoking was identified as a risk factor that could potentially increase the severity of symptoms due to reduced lung function and impaired immune systems. 

When the vaccine rollout began, a few states listed smoking or a history of smoking as medical conditions that could qualify someone to receive a COVID-19 vaccination ahead of others. This frustrated many of those who felt that smoking is a personal choice, not something that should move a person’s vaccination priority up. Such comments echo the blame often placed on smokers for developing lung cancer. Some people responded to this feedback by pointing out that nicotine is one of the most addictive substances on Earth.

The pandemic has also had a disproportionate impact on smoking disparities in minority populations. As explained recently by Delmonte Jefferson, executive director at The Center for Black Health & Equity, “African Americans have more of the circumstances that make it harder to survive this COVID-19 pandemic — deep-rooted poverty, preexisting medical conditions and issues, less access to health care, less stable employment. COVID-19 did not cause these racial disparities … [but it is] exposing existing inequities in our health care, education, traditional employment and our social systems.”

Strategies for Halting the Rise of Smoking

Tobacco tax revenue leaders by state

With the dangers of evolving COVID variants, quitting smoking has never been more important in order to decrease associated risk factors. Experts suggest strategies at both the legislative and personal levels.

Increasing Excise Taxes

The CDC has concluded that the more states spend on comprehensive tobacco control programs, the greater their chance of reducing smoking. Taxes on cigarettes applied at the local, state and federal levels have long been used to help fund such programs. Excise taxes are fees levied on goods at the moment of manufacture rather than at the moment of sale. Increasing excise taxes on cigarettes can help buoy these programs at a time when they are needed most. 

California leads the states that bring in the most tobacco tax revenue, having collected $1,979,149,000 in 2019. The other four states bringing in over $1 billion are Texas, Pennsylvania, Florida and New York. The large populations of these states undoubtedly play a part in their annual tobacco tax revenue totals.

Currently, both New York and Connecticut are tied for the highest cigarette tax rates in the country at $4.35 per 20-pack. Conversely, Missouri has the lowest rate in the country, charging the 19.6% of the state’s population who smoke only $0.17 per 20-pack of cigarettes.

Tailored Cessation Treatment Plans

Some medical professionals suggest developing personalized smoking cessation treatment plans to better meet the needs of today’s smokers by combining medications, counseling and support. Insurance coverage that includes a mix of these elements is key to helping reduce tobacco use, according to Anne DiGiulio, national director of lung health policy at the American Lung Association.

The unprecedented global impact of COVID-19 has revealed itself in many unanticipated ways. A recent rise in cigarette usage is one shift that could create long-term health risks for millions of Americans and the community at large.

Methodology:

In order to document the increase of smoking in America over the past few years, our researchers analyzed data from a variety of sources to create a comprehensive overview of the trend. Sources include:

  • CDC records of current cigarette-smoking adults in the U.S.
  • North American Quitline Consortium call reports tracking usage of its smoking cessation helpline
  • CDC-reported current cigarette and tobacco tax rates in every state
  • Urban-Brookings Tax Policy Center state and local tobacco tax revenue totals
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