Cigarette smoking remains a persistent public health issue across the United States, with certain states exhibiting significantly higher rates of tobacco use.
These disparities reflect various social, economic and cultural factors that contribute to the prevalence of smoking in different regions.
Newsweek has created this map to show the states with the most cigarette smokers.
The data, gathered by World Population Review from 2021-2022, only includes individuals aged 18 and above.
Percentages are sourced from the National Survey on Drug Use and Health, which calculates percentages by comparing the number of individuals smoking to overall population totals.
West Virginia tops the list as the state with the highest smoking rates, as approximately 28.19% of adults in West Virginia smoke. The state’s deep-rooted cultural acceptance of smoking and its economic challenges have made it difficult to reduce tobacco use.
According to the Centers for Disease Control and Prevention (CDC), “people living below the poverty level and people having lower levels of educational attainment have higher rates of cigarette smoking than the general population.”
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Michael A. Tynan, policy team lead at the CDC’s Office on Smoking and Health, told Newsweek that where you live can “influence smoking behaviors.”
“This includes tobacco-related policies, practices and conditions, which vary across the country. For example, nearly two-thirds of the population live in a state or community with a comprehensive smoke-free policy that prohibits smoking in all indoor areas.
“Smoke-free laws serve multiple purposes. They not only protect people from exposure to secondhand smoke, but also change social norms regarding the acceptability of smoking. Additionally, these laws prompt people to quit smoking and prevent youth and young adults from initiation.
“Tobacco excise taxes can also impact tobacco product prices and thereby influence behavior, and tobacco excise tax rates vary across the country. We know that increasing the price of cigarettes reduces the demand for cigarettes, reducing youth initiation, reducing overall consumption of tobacco products, and decreasing the prevalence of tobacco use.”
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Kentucky is another state with alarmingly high smoking rates, with about 24.99% of its adult population identified as smokers. The state’s history of tobacco farming has contributed to a cultural norm where smoking is more widely accepted and less stigmatized.
Additionally, Kentucky’s relatively low cigarette taxes and the widespread availability of tobacco products have made it easier for individuals to purchase cigarettes and continue smoking. West Virginia and Kentucky experience high levels of poverty and limited public health infrastructure.
Factors such as lower socioeconomic status, limited access to healthcare and less aggressive public health campaigns lead to higher smoking rates.
On the other side of the spectrum, states in the western United States generally report lower smoking rates. Utah, for example, has the lowest smoking rate in the nation, with only about 10.56% of adults smoking.
California also has relatively low rates, hovering at around 10.95%. It has implemented high cigarette taxes, comprehensive smoke-free laws and extensive public health campaigns aimed at reducing smoking rates.
While some states have made significant strides in reducing tobacco use, others continue to struggle.
Dr. Vinayak Prasad, the unit head of No Tobacco at WHO, told Newsweek: “Many factors impact the smoking prevalence in different populations, including the implementation of effective tobacco control measures. WHO encourages all countries, including the USA, to implement comprehensive policies that are known to reduce tobacco use, such as smoking bans in indoor public areas, tobacco advertising bans, and graphic health warnings.
“Ideally, tobacco control measures should be implemented and well-enforced in all jurisdictions. If the data show that some populations are using tobacco at higher rates than others, then this information can help inform public health decisions and point to where more efforts are needed.”
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