The Toll of Tobacco in the United… | Campaign for Tobacco-Free Kids
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Despite enormous progress in reducing smoking, tobacco use is still the leading cause of preventable death in the United States and imposes a terrible toll on families, businesses and government. Tobacco kills more than 480,000 people annually – more than AIDS, alcohol, car accidents, illegal drugs, murders and suicides combined. Tobacco costs the U.S. over $241 billion in health care expenditures and more than $365 billion in lost productivity each year.


The Toll of Tobacco in the U.S.

High school students who are current (past month) smokers (2023)

1.9% or 290,000 [Boys: 2.3%, Girls 1.5%]

High school students who are current e-cigarette users (2023)


High school males who are current cigar smokers (2023)


High school students who are current tobacco users (2023)


High school and middle school students who are current tobacco users (2023)


Kids (under 18) who try smoking for the first time each day


Kids (under 18) who try e-cigarettes for the first time each day


Kids (3-11) exposed to secondhand smoke

38.1% [Black: 66.2%, White: 38.1%]

Adults in the U.S. who smoke (2022)

11.6% [Men: 13.2% Women: 10.0%]

Deaths and Disease in the U.S. from Tobacco Use

People who die each year from their own cigarette smoking or exposure to secondhand smoke.

approx. 480,000+

People in the U.S. who currently suffer from smoking-caused illness

16 million+

Smoking kills more people than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides combined, with thousands more dying from spit tobacco use. Of all the kids who become new regular, daily smokers each year, almost a third will ultimately die from it. In addition, smokers lose a decade of life because of their smoking.

Tobacco-Related Monetary Costs in the U.S.

Total annual public and private health care expenditures caused by smoking: Approximately $241.4 Billion

  • Annual Federal and state government smoking-caused Medicaid payments: $72.7 billion
    [Federal share: $42.1 billion per year. States’ share: $30.66 billion]
  • Federal government smoking-caused Medicare expenditures each year: $61.1 billion
  • Other federal government tobacco-caused health care costs (e.g. through VA health care): $21.8 billion

Annual health care expenditures solely from secondhand smoke exposure: $6.5 billion

Additional smoking-caused health costs caused by tobacco use include annual expenditures for health and developmental problems of infants and children caused by mothers smoking or being exposed to second-hand smoke during pregnancy or by kids being exposed to parents smoking after birth. Also not included above are costs from smokeless or spit tobacco use, adult secondhand smoke exposure, or pipe/cigar smoking.

Productivity losses from smoking-caused premature death each year: $179.9 billion

Productivity losses from smoking-caused illness each year: $184.9 billion


[Productivity losses are from smoking-caused shortened work lives and illness that may impact the ability to work, including absenteeism, non-productivity at work, and inability to work due to disability.]


Other non-healthcare costs from tobacco use include residential and commercial property losses from smoking-caused fires, tobacco-related cleaning & maintenance, and expenditures through Social Security Survivors Insurance for kids who have lost at least one parent from a smoking-caused death.

  • Taxpayers yearly fed/state tax burden from smoking-caused gov't spending: $1,234 per household
  • Smoking-caused health costs and productivity losses per pack sold in U.S. (low estimate): $51.52 per pack
  • Weighted average retail price per pack in the U.S. (including sales tax): $8.39

Tobacco Industry Advertising & Political Influence

  • Annual tobacco industry spending on marketing its products nationwide: $8.6 billion ($23.5 million each day)
  • Annual e-cigarette company spending on marketing its products nationwide: $859.4 million

Research studies have found that kids are three times as sensitive to tobacco advertising than adults and are more likely to be influenced to smoke by cigarette marketing than by peer pressure; and that a third of underage experimentation with smoking is attributable to tobacco company advertising and promotion.

  • Tobacco company PAC contributions to federal candidates/parties, 2022 election cycle: More than $1.1 million.
  • Annual tobacco industry expenditures lobbying Congress in 2022: $45.9 million

Sources: Toll of Tobacco in the United States

Last updated April 23, 2024