States With the Most Smokers

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Detailed Findings & Methodology

To help curb tobacco use (and the eventual health care cost burden) many state governments levy heavy excise taxes on tobacco — a tax the consumer pays when buying cigarettes. The states with the highest excise tax on tobacco products tend to have some of the country’s lowest smoking rates, which suggests these taxes may be effective in lowering the smoking rate.

The five states charging the highest cigarette taxes — New York, Rhode Island, Connecticut, Massachusetts, and Hawaii — are also among the states with the lowest adult smoking rates. New York, for example, which imposes a nation-leading tax on cigarettes of $4.35 per pack, has the ninth lowest adult smoking rate at 14.2%. West Virginia, by contrast, which levies the sixth lowest excise tax on tobacco at 55 cents per pack, leads the nation with nearly 25% of adults reporting a smoking habit.

The United States spends around $170 billion a year to treat tobacco-related illnesses, including lung cancer, stroke, diabetes, and cardiovascular diseases. Cigarette smoke contains more than 7,000 chemicals, of which 69 are known carcinogens. As a result, smoking is the leading cause of cancer.

Utah, the state with the lowest smoking rate, also has the lowest incidence of lung cancer in the country. By contrast, the states with the three highest cancer diagnosis rates — Kentucky, West Virginia, and Arkansas — also have the top three adult smoking rates.

The association between smoking and household income is well documented through years of research. Gallup surveys have found that approximately 34% of individuals earning $6,000 to $11,999 annually smoke, while only 13% of people with incomes of at least $90,000 per year say the same.

This pattern can also be observed at the state level. Median household incomes exceed the national median in 15 of the 25 states with the lowest smoking rates. Among the 25 states with higher smoking rates, median incomes exceed the national median in only five.

To identify the states with the highest adult smoking rates, 24/7 Wall St. reviewed the rate of adult smokers by state from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. Cancer deaths and cancer diagnoses per capita came from the 2016 America’s Health Rankings annual report from the United Health Foundation. Premature death rates — deaths before the age of 75 — per capita are from the County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. State cigarette excise taxes were obtained from the Tax Foundation. The median household income in each state came from the U.S. Census Bureau’s 2016 American Community Survey.