Randall Freeman, MD, MPH, FACPM
Vice Chair, ACPM Science and Translation Committee
Men’s health is multi-factorial and encompasses multiple body systems, including the heart, lungs, nervous system, gastrointestinal and metabolic systems, skeletal and reproductive systems to name a few. But there is one health hazard that impacts all of these various systems … a largely voluntary hazardous exposure that persists pervasively, defying the best efforts of the public health community to eradicate it. That hazard is tobacco use.
Of course, there have been some significant successes that can’t be overlooked. From the heydays of the “Marlboro Man” to the present day, smoking rates among U.S. adults have fallen 73%, decreasing from 42.6% in 1965 to 11.6% in 2022, according to the American Lung Association.[1] The 2023-2024 National Health Interview Survey (NHIS) found that cigarette smoking prevalence among U.S. adults declined from 10.8% of the population in 2023 to 9.9% in 2024, although usage prevalence of other tobacco products remained unchanged, and 18.8% of adults (47.4 million people) used some sort of tobacco product.[2]
Since this article is specifically about men’s health, in honor of June Men’s Health Month, it’s especially pertinent the NHIS data showed men reported almost twice the prevalence (24.1%) of all tobacco use compared to women (13.9%).[3] Perhaps this is unsurprising, considering some research suggests smoking neurologically activates men’s reward pathways more than women’s.[4] And while in the U.S., sociocultural norms have encouraged overall decrease in tobacco use, worldwide over 80% of tobacco users are men;[5] and in the U.S., some populations of recent immigrants may still reflect higher rates of smoking than the general population.[6] Thus, we as men must still encourage each other, influence each other, and educate each other about the harms of tobacco use.
I know: Writing an article about tobacco cessation for a Preventive Medicine audience, is like “preaching to the choir.” Of course, Preventive Medicine physicians don’t smoke — you can read just the tiniest bit of irony into that remark. But what about your fathers, your grandfathers, your uncles, your cousins, your nephews, your husbands, your sons, your patients? Are we still encouraging them to stop using tobacco, or have we given up on these few remaining hold-outs in a world that’s slowly going smoke-free?
In my occupational medicine practice, the vast majority of my patients that still use tobacco in any form are men. I try to remember to end my clinical visit with them by encouraging them to visit the Employee Assistance Program for tobacco cessation information. Sometimes I forget, and I confess sometimes I’m rushing and just skip over it. Yesterday I chatted with the supervisor of the Employee Assistance Program, and she told me that over the past year or two only four employees have gone into her office looking for tobacco cessation help. This started to make me wonder whether it’s even worth it to keep bringing this topic up with my patients … but then I started writing this Men’s Health article. And now, whether anyone else gets something out of this article, I’m also “preaching” to myself. We must, and I must continue to encourage the men we talk to, hang out with, work with and medically treat to join the ranks of the tobacco-free. Especially during this month, this Men’s Health Month, let’s keep pushing it!
[1] American Lung Association. Overall Smoking Trends. https://www.lung.org/research/trends-in-lung-disease/tobacco-trends-brief/overall-smoking-trends, Accessed 3 June 2026.
[2] Agaku I. Tobacco product use among US adults, 2023–2024. NEJM Evidence. Published online March 10, 2026. doi:10.1056/EVIDpha2500339
[3] Agaku I. Tobacco product use among US adults, 2023–2024. NEJM Evidence. Published online March 10, 2026. doi:10.1056/EVIDpha2500339
[4] NIDA. 2020, January 1. Are there sex differences in tobacco smoking?. Retrieved from https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/are-there-sex-differences-in-tobacco-smoking on 2026, June 3
[5] World Health Organization. (2025). WHO global report on trends in prevalence of tobacco use 2000–2024 and projections 2025–2030. Geneva: World Health Organization. https://www.who.int/publications/i/item/9789240116276
[6] Saw A, Paterniti D, Fung LC, Tsoh JY, Chen MS Jr, K Tong E. Social Environmental Influences on Smoking and Cessation: Qualitative Perspectives Among Chinese-Speaking Smokers and Nonsmokers in California. J Immigr Minor Health. 2017 Dec;19(6):1404-1411. doi: 10.1007/s10903-016-0358-6. PMID: 26872641; PMCID: PMC5052086.
