• For the first time in two decades, cigarette sales in the U.S. increased between 2020 and 2021.
• Research suggests that the COVID-19 pandemic increased smoking behaviors, as evidenced by a growth in sales during the pandemic.
• Smoking is responsible for 80 percent to 90 percent of lung cancer cases in the U.S.

After years of steady decline, U.S. cigarette sales spiked by an estimated 14.1 percent between 2020 and 2021 during the COVID-19 pandemic, according to a recent study. The trend has sparked concern among members of the health care community, as the increase in cigarette sales could lead to new cases of lung cancer and worse outcomes in the future.

Cigarette smoking remains the primary risk factor for developing lung cancer. In the U.S., 80 percent to 90 percent of lung cancer cases are attributed to smoking cigarettes. In an interview with Endeavor, Dr. Matthew Schabath — a lung cancer epidemiologist at Moffitt Cancer Center — expressed concern that the recent uptick in cigarette sales could lead to higher cancer rates. “For many of these cancers we’ve seen firsthand, the reductions in cancer incidence rates over the last several decades attributed to drastic reductions in cigarette consumption,” Dr. Schabath told Endeavor. “Reversing the public health successes of the decline in cancer incidence rates and cigarette consumption rates would be disappointing and tragic.”

Anxiety associated with the pandemic may have contributed to the increase in cigarette sales, according to some medical experts. Feelings of boredom due to restricted activities may have also been a contributor, according to a study from last October. The study found that people who smoke “reported smoking more frequently, driven by COVID-19-related stress, time at home, and boredom.” The study also found that many people who were attempting to quit smoking “found the stress of COVID-19 unbearable without tobacco use.”

U.S. Cigarette Sales Jumped an Estimated 14.1 Percent

For the study, researchers compared the expected rates of cigarette sales in the U.S. for March 2020 until June 2021 with the actual rates. They found that sales of cigarettes had declined before the pandemic (from 2007 until 2020), but then increased between 2020 and 2021. The study authors found that approximately 0.34 more packages per capita were sold during the pandemic than were expected based on pre-pandemic sales — 14.1 percent higher than expected.

“This study shows that increases in cigarette sales went beyond the first 3 months of the COVID-19 pandemic and persisted in the 16 months after its onset in March 2020,” according to the study. “This finding is also consistent with anecdotal claims by the tobacco industry about halting the long-term decline in cigarette sales during the COVID-19 pandemic.”

Researchers noted their study provides only a partial picture of cigarette consumption in the U.S. during the pandemic. They said that the numbers reflect overall consumption, not individual consumption, and that they did not take into account cigarette sales beyond legal retail sales. They also noted there was no control group.

Cigarettes and Lung Cancer Risks

Researchers have found that quitting smoking lowers a person’s risk of lung cancer. It can also improve a person’s outcomes after a lung cancer diagnosis.

People living with newly diagnosed lung cancer who quit smoking live a median of 22 months longer than those who did not quit, according to research from the National Cancer Institute. They also have a longer lapse between diagnosis and disease progression: 5.7 years for those who quit compared to 3.9 years who continued.

Quitting can be difficult, however: One recent study found that more than half of people continue to smoke after undergoing lung cancer surgery. The Centers for Disease Control and Prevention (CDC) provides smoking cessation resources.