Article

Why falling smoking rates don’t tell the whole story

Cigarette use is declining, but nicotine and cannabis remain common among workers — creating new risks and opportunities for labor and trust funds.

4-minute read

Table of contents

In 1965, a staggering 42.4%1 of Americans smoked. Now that number is 9.1% — the lowest in recorded history.2 The public health campaign against smoking is clearly winning, but the full story is more complicated. 

Nicotine hasn’t disappeared — it’s diversified. Adult e-cigarette use has nearly doubled since 2020.3 Nicotine pouch sales, meanwhile, have almost tripled in 2 years — moving from a category that barely existed a decade ago to the fastest growing nicotine product.4 Cannabis is following a similar path. In 2013, just 7% of Americans smoked marijuana. 10 years later, that number reached 15%.5

These trends matter more for labor and trust funds than for just about anyone else. The reason is simple: They represent the industries with some of the highest nicotine and cannabis use.

Why labor and trust populations feel the impact differently

Start with cigarettes. Construction workers smoke at rates nearly double that of other workers. And yet, they have the lowest access to cessation programs of any occupation — 14% to 29%.6

Cannabis use is also concentrated in industries marked by physically demanding work, irregular schedules and high injury risk. Compared to an all-industry average of 10.8% for past-30-day cannabis use, the heaviest-use sectors include accommodation and food services (20.7%), arts and entertainment (17.5%) and construction (15.9%).7

The reasons why aren’t hard to understand. Many fund members’ jobs contribute to chronic pain, musculoskeletal injury, disrupted sleep and high stress. A cigarette becomes part of a routine break. An edible helps someone sleep through back pain after a long shift. For members, these feel like practical fixes for everyday problems. For funds, they become long-term drivers of cost.

And the costs are very real. Smoking can add $8,156 per member in health care spend and lost productivity.8 Cannabis use can contribute to up to $17,000 in yearly claims per member, driven by higher emergency department visits, mental health utilization and absenteeism.9 And when cannabis is used on the job, the risk of a workplace injury almost doubles.10

For many members, quitting or reducing their use is a goal. That’s an opportunity for fund leaders to offer nicotine cessation and cannabis programs that are proactive and confidential with low-friction outreach — the kind that meets members where they are instead of waiting for a hand to go up. Research shows that certain program characteristics are especially useful for boosting member participation: 

  • Personal invitations
  • Virtual or on-site offerings 
  • Programs that are folded into existing benefits instead of bolted on11

For labor and trust populations especially, that combination — personal, convenient and built into the plan — can help meet members’ needs, control costs and improve outcomes.

Willpower isn’t a strategy

For many of the members who want to quit or cut back, their first instinct is to do it on their own. The evidence says that’s hard to do. About two-thirds of adults want to quit smoking, about half (53%) try it, and less than 10% succeed — at least on their first attempt.12 The gap between wanting to quit and actually quitting is where a structured program earns its keep.

A clinically built program supplies what willpower can’t: trained coaches who understand withdrawal, easy access to nicotine replacement therapy (NRT) products that blunt cravings, and structured check-ins that keep members going. The Quit For Life program, offered by Optum, offers personalized coaching, ships NRT products directly to members’ doors and provides phone, app and text support to keep help within reach. At the six-month mark, participants have a 52% quit rate.

The same approach can be taken with cannabis — with a few key distinctions. Many members rely on cannabis to manage pain, anxiety and sleep. Rather than wanting to quit entirely, they often simply want to use less. Cannabis Healthy Use is built for that reality — using cognitive behavioral therapy, motivational interviewing and mindfulness to help members meet a goal they set themselves. 

Many cannabis users don't think they have an addiction problem — and many are right, making substance abuse programs a poor fit. Support and guidance can be exactly what’s needed for the 70% who don’t have a cannabis use disorder.13

The right model meets members where they are. Support comes by phone or text, available around the clock. Check-ins land at 5 a.m. on the way to the site or 10 p.m. when cravings spike. 

Reaching the population

The number of cigarette smokers keeps dropping, but nicotine and cannabis haven’t gone anywhere. Instead, they’ve spread into pouches, vapes and edibles, and they’re commonplace among union workers. Members want help quitting or cutting back, but they’re unlikely to bring it up on their own.

Reaching them doesn’t take a new playbook. It takes a program built for the full spectrum of needs — reduction for the member cutting back, cessation for the one ready to quit, treatment for the few who need it — delivered on the member’s schedule and in confidence. When done right, labor and trust funds can offer programs that help their members be safer, healthier and more present.

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Sources:

  1. Campaign for Tobacco Free Kids. U.S. Adult Cigarette Smoking Rate Falls to Historic Low, But Decimation of Federal Infrastructure Threatens Further Progress. March 18, 2026.
  2. Centers for Disease Control and Prevention. National Center for Health Statistics Survey Early Release Program. Accessed June 2026.
  3. Centers for Disease Control and Prevention. National Center for Health Statistics Survey Early Release Program. Accessed June 2026.
  4. Truth Initiative. Monitoring a Changing Tobacco Product Market in the United States. Jan. 5, 2026.
  5. Gallup. What Percentage of Americans Smoke Marijuana? Nov. 1, 2024.
  6. Asfar T, Lee DJ, Salloum RG, LeLaurin JH, Kobetz E, Pradhananga N, De Dios Despaux RA, McCollister KE, Oluwole O, Corbin L, Laine J, Bursac Z. Empowering safety managers to champion the implementation of smoking cessation services in the construction industry: Protocol for a sequential multiple assignment randomized trial. PLoS One. 2025 Jun 9;20(6):e0324717. DOI: 10.1371/journal.pone.0324717. PMID: 40489501; PMCID: PMC12148188.
  7. Evoy R, Victoroff T. Prevalence of Cannabis Use Among US Workers in 15 States, 2016-2020. Am J Public Health. 2024 Nov;114(S8):S645-S653. DOI: 10.2105/AJPH.2024.307788. PMID: 39442027; PMCID: PMC11499688.
  8. Austin George Cross, Usmaan Zunnu Rain, Eric Makhni, Peter Watson & Charles Bloom. (2026) In-network multidisciplinary digital care improves outcomes in Medicare advantage members with musculoskeletal diagnoses. Frontiers in Digital Health 8.
  9. RVO Health internal claims analysis.
  10. Carnide N, Landsman V, Lee H, Frone MR, Furlan AD, Smith PM. Workplace and non-workplace cannabis use and the risk of workplace injury: Findings from a longitudinal study of Canadian workers. Can J Public Health. 2023 Dec;114(6):947-955. DOI: 10.17269/s41997-023-00795-0. Epub 2023 Jul 31. PMID: 37523062; PMCID: PMC10661545.
  11. Poole NL, Nagelhout GE, Magnée T, de Haan-Bouma LCI, Barendregt C, van Schayck OCP, van den Brand FA. A qualitative study assessing how reach and participation can be improved in workplace smoking cessation programs. Tob Prev Cessat. 2023 Mar 24;9:07. DOI: 10.18332/tpc/161589. PMID: 36968254; PMCID: PMC10037216.
  12. VanFrank B, Malarcher A, Cornelius ME, Schecter A, Jamal A, Tynan M. Adult Smoking Cessation - United States, 2022. MMWR Morb Mortal Wkly Rep. 2024 Jul 25;73(29):633-641. DOI: 10.15585/mmwr.mm7329a1. PMID: 39052529; PMCID: PMC11290909.
  13. Center for Disease Control and Prevention. Cannabis Stats and Facts. March 7, 2025.

 

Published: July 31, 2026

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