Cigarette and Electronic Cigarette Use Among Adults by Urbanization Level: United States, 2024

NCHS Health E-Stat 115, March 2026

by Inderbir Sohi, M.S.P.H., and Amanda E. Ng., Ph.D., M.P.H.

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Cigarette smoking is the leading preventable contributor to disease and death in the United States, and, along with secondhand smoke exposure, causes various cancers and diseases (1). Electronic cigarette (or e-cigarette) use has been attributed to several respiratory, neurological, and cardiovascular effects (2). Although cigarette use has decreased among U.S. adults, e-cigarette use has increased (3,4). Previous research has shown that the prevalence of cigarette smoking is higher in rural areas compared with urban areas (5), but less data on e-cigarette use by urbanization level are available.

This Health E-Stat reports the percentage of U.S. adults age 18 and older who used cigarettes or e-cigarettes by urbanization level.

In 2024, 9.9% of all adults used cigarettes and 7.0% used e-cigarettes. The percentage of adults who used cigarettes increased with decreasing urbanization level, from 8.0% each in large central and large fringe metropolitan counties to 15.4% in nonmetropolitan counties (Figure 1, Table 1). Patterns were similar by age group. Across all urbanization levels, the percentage of adults who used cigarettes increased from ages 18-24 to ages 45-64, and then decreased among those age 65 and older. The percentage of adults who used e-cigarettes increased with decreasing urbanization level, from 6.1% in large central metropolitan counties to 9.2% in nonmetropolitan counties (Figure 2, Table 2). Patterns were also generally similar by age group.