The role of employment status in cigarette smoking trends among U.S. adults from 2019 to 2023

Smoking remains a leading cause of preventable morbidity and mortality. While global smoking rates have declined, the COVID-19 pandemic reshaped labor market dynamics, potentially affecting smoking trends. This study examines smoking prevalence by employment status from 2019 through 2023 in the United States. We analyzed data from the 2019–2023 National Health Interview Survey (NHIS). The sample included 146,184 adults, with eligibility including current smoker status. Employment status was classified into seven categories: employed, unemployed, retired, unable to work, homemaker, student, or other. Weighted prevalence estimates and 95% confidence intervals were calculated annually. Between 2019 and 2023, smoking prevalence declined from 14.0% to 10.8%. The highest smoking rates were among individuals unable to work due to health or disability, with prevalence declining from 29.2% to 25.4%. Smoking prevalence decreased from 26.6% to 15.4% among unemployed adults and from 13.8% to 10.3% among employed adults. Retired adults maintained a stable prevalence of approximately 8.8%. The decline in smoking reflects progress in tobacco control; however, disparities persist, particularly among those unable to work due to health reasons. Targeted cessation support is needed for vulnerable groups, and future research should examine how remote work and digital interventions affect smoking.