It’s tempting to believe smoking is largely a problem of the past. But, according to the Centers for Disease Control and Prevention (CDC), approximately 25 million U.S. adults still smoke cigarettes, and cigarette smoking remains the leading cause of preventable disease and death in the United States. As a public health scientist and former regulator at the U.S. Food & Drug Administration (FDA), I’ve seen how much progress is possible—and how quickly that progress can stall when policy and communication lag behind the evidence.
Today’s smokers are not faceless statistics. They are people managing daily routines and responsibilities—often while juggling work, family, and limited time or support to make changes. If our public conversation assumes smoking will simply disappear with time, we risk overlooking the urgency of helping adults who need practical, evidence-based options now.
In Washington, it can feel as though smoking will keep declining on its own as demographics shift. However, in many communities, the challenge is present tense: people who have made multiple attempts to quit are still smoking. And 25 million adults still use combustible cigarettes, the most harmful way to consume nicotine. The public recognizes the unfinished work: in a recent national survey by Povaddo, LLC, an independent research firm, and commissioned by PMI, 79% of respondents said more must be done to reduce smoking-related harm.
The primary cause of smoking-related diseases is the high levels of harmful chemicals created by burning tobacco, not from nicotine itself. Therefore, for Americans who smoke, quitting all tobacco and nicotine is the best outcome. Nicotine is addictive and not risk-free, but for adults who continue to smoke , completely switching from cigarettes to appropriately regulated smoke-free products that avoid combustion can reduce exposure to the many and high levels of [CO1] harmful constituents. That risk continuum should be reflected in how we communicate, regulate, and enforce.
A practical path forward starts with a clear national objective: accelerate the decline of cigarette smoking in the United States. First, public communication about relative risk should be more direct and evidence based. Right now, confusion is widespread: 52% of adults surveyed incorrectly believe nicotine causes cancer, and 73% mistakenly believe all tobacco and nicotine products are equally harmful. Second, FDA’s premarket review and authorization process for smoke-free products should be timely, predictable, and transparent so that adult smokers have access to products that have met the statutory public health standard. Finally, credibility depends on enforcement: consistent action against illicit products that evade FDA review and sustained compliance efforts to prevent underage sales.
Youth prevention should also be central to this discussion. According to FDA & CDC’s National Youth Tobacco Survey, youth cigarette smoking is at an all-time low. Those are encouraging indicators, but they are not a reason for complacency. Preventing youth initiation and reducing adult smoking-related disease are not competing goals if policy is designed well. That means strong age verification, routine compliance checks, meaningful penalties for violations, and coordinated action to disrupt illicit supply—alongside a regulated pathway that helps adult smokers move away from combustible cigarettes.
The United States has made real progress in reducing smoking, and that progress should continue. With clearer, accurate public communication about relative risk, a modern and transparent science-based pathway to authorize smoke-free products for adults who would otherwise keep smoking, and strong youth protections paired with robust action against illicit products, we can finish the job of putting cigarettes behind us for good.
Dr. Matt Holman is the VP & Chief Science & Regulatory Strategy Officer for PMI U.S. Dr. Homan is the former Chief Scientist at the FDA’s Center for Tobacco Products.
