Trends in cigarette consumption across the United States, with projections to 2035

Objectives To project US state-specific cigarette consumption incorporating historical state trends, assess the potential for states to reach an ideal target, and identify state-specific targets. Methods Using 70 years (1950–2020) of annual state-specific per capita cigarette consumption (packs per capita; ppc) from the Tax Burden on Tobacco (N=3,550), trends were summarized via linear regression and inequity across states assessed using the Gini coefficient. Autoregressive Integrated Moving Average (ARIMA) models provided state-specific forecasts for 2021–2035. A mixed-effects model calibrated a consumption threshold approximating 5% adult smoking prevalence (≈13 ppc). Results Since 1980, average US per capita consumption declined 3.3% per year (SD 1.1%), with substantial variation across states. Inequity reached its lowest level in 1984 (Gini=0.09) and then increased 2.8% per year (95% CI: 2.5%, 3.1%) through 2020; it is projected to grow 48.1% (95% PI: 35.3%, 64.2%) from 2020 to 2035 to Gini=0.35 (95% PI: 0.32, 0.39). ARIMA forecasts suggest only 12 states have a ≥50% chance of reaching ≤13 ppc by 2035, though all states can make progress.