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For more than 20 years, the Campaign for Tobacco-Free Kids has led the fight to reduce tobacco use and its deadly consequences in the United States.

Our work has contributed to enormous progress. Since 1996, the U.S. has reduced youth smoking by 84 percent and adult smoking by 43 percent, and more than 194 million Americans – over 60% of the U.S. population – are now protected from harmful secondhand smoke.

But tobacco use is still the No. 1 cause of preventable death in the U.S. It kills more than 480,000 Americans and costs the nation over $225 billion in health care bills each year. Without strong action now, 5.6 million kids alive today will ultimately die from smoking.

Now our progress is threatened by the skyrocketing epidemic of youth e-cigarette use.

Among high school students, e-cigarette use declined to 19.6% in 2020, after increasing an alarming 135% from 2017 to 2019 (from 11.7% to 27.5%). E-cigarette use remains a public health crisis, with 3.6 million kids using e-cigarettes in 2020. Current use remains at about the same level as it was in 2018 when the U.S. Surgeon General first called youth e-cigarette use an “epidemic.”

Our progress shows that we can win the fight against tobacco and create the first tobacco-free generation – but only if we act fast to end the youth e-cigarette epidemic and elected leaders fully implement proven strategies that reduce tobacco use and save lives.

In the U.S., the Campaign for Tobacco-Free Kids works at the national, state and local levels to put these solutions in place.

Toll of Tobacco in the U.S.

480,000+: Annual tobacco-related deaths in U.S.

$170 billion:Annual tobacco-related health care costs in U.S.

13.7%: Adults who smoke

4.6%:High school students who smoke

19.6%:High school students who use e-cigarettes

 5.4%: High school males who smoke cigars

Learn more about the Toll of Tobacco in the U.S. and each state


Congress and the Administration must provide strong leadership in the fight against tobacco use. This includes supporting effective FDA regulation of all tobacco products and fully funding the CDC’s tobacco prevention and cessation programs.


Tobacco takes a huge toll in health, lives and dollars in every state. State and local governments can reduce tobacco use, save lives and save money by implementing proven solutions.