If the United States smoked at the same rate as the state of Utah, which has the nation’s lowest smoking rate, there would be nearly 22 million fewer smokers in this country, based on data collected by 24/7 Wall St. from the Centers for Disease Control and Prevention.

Though the U.S. smoking rate has declined considerably from half a century ago, nearly 39 million Americans over the age of 18, or 15.5% of the population, still smoke, according to the CDC.

Smoking rates vary between states, from nearly 25% in Kentucky and West Virginia to 9% in Utah. Utah is the only state whose smoking rate is less than 10%. Similarly, the lung cancer diagnosis rate ranges from 91.4 cases per 100,000 people in Kentucky and 77.6 cases per 100,000 people in West Virginia — the highest in the nation — to just 25.6 cases per 100,000 people in Utah, the lowest.

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Smoking-related illnesses cost the U.S. economy $300 billion a year, according to CDC estimates. About $170 billion of that total are direct medical care costs. Most of the remainder are expenses related to lost productivity as a result of premature death and exposure to secondhand smoke.

24/7 Wall St. examined smoking rates in the United States that were provided by the CDC to determine how many fewer smokers there would be in this country if the smoking rate was the same as Utah’s. While it would be difficult to replicate Utah’s conditions in other states, decisions such as enacting more stringent smoking laws, as well as raising excise taxes on a pack of cigarettes, will undoubtedly lower smoking rates, and lead to more positive health outcomes.

“The relationship between smoking rates and lung cancer rates is about as strong, clear and well supported by scientific evidence as anything in epidemiology,” said Jonathan Foulds, a professor of public health sciences and psychiatry at Penn State University, College of Medicine. “We also now have enough data to accurately predict the effects on other smoking-caused diseases from the lung cancer and smoking rates,” he said.

If the overall U.S. smoking rate was the same as Utah’s, the number of people smoking in this country would drop to 16,713,448. In Kentucky, the number of smokers would plunge to 478,149 from 839,209. In West Virginia, that number would slide to 206,830 from 360,566.

Two factors likely contribute to Utah’s low smoking rate. One is that more than 60% of state residents identify as Mormons. That religion forbids the use of any tobacco products because they are addictive and will damage the body and shorten lives.

Utah also has very strict smoking laws. The Utah Indoor Clean Air Act prohibits smoking in almost all government and privately owned buildings in the state. In addition, Utah has a law that addresses secondhand smoke in multiple dwellings such as apartment buildings.

Other states have taken strong actions to reduce smoking, such as lifting excise taxes on the purchase of cigarettes, and the result has been a decline in smoking rates in those states.

The five states with 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 imposes a nation-leading $4.35 tax on a pack of cigarettes and has the ninth-lowest adult smoking rate at 14.2%. In contrast, West Virginia, levies the sixth-lowest excise tax on tobacco at 55 cents per pack, and has an adult smoking rate near 25%.

Relentless anti-smoking messages from medical organizations and the U.S. government, as well as behavioral and pharmacological treatments, have led to a sustained drop in smoking in this country. In the mid-1960s, 42% of adults regularly smoked cigarettes, more than double the rate today.

“Increases in the real price of cigarettes, mass-media education campaigns, and the tightening of smoking in all public places all reduce smoking and lung cancer and all other smoking-related diseases,” said Foulds.

There also is a strong correlation between smoking rates and affluence. The five states with the highest smoking rates — Kentucky, West Virginia, Mississippi, Arkansas and Louisiana — have five of the six lowest median household incomes among the 50 states. Kentucky also is one of the biggest tobacco-growing states, and the state has a strong cultural and economic relationship to the crop.

“The local culture is relevant, but there are a bunch of inter-related aspects,” said Foulds. “Politicians in that state (Kentucky) get supported by local industry, and so are less likely to pass tax increases or fund tobacco-control measures.”

Because most smokers begin smoking before the age of 18 — about 4,000 under 18 try smoking for the first time each day — the Food and Drug Administration (FDA) has focused on the addictive components of nicotine and the disproportionate impact it has on children and teenagers. Last year, the FDA announced a regulatory plan to explore lowering the nicotine level in cigarettes. Research indicates nicotine keeps people smoking even though they want to quit.

The positive effects of a lower smoking rate in the United States would be almost immediate and far-reaching. The three leading causes of death in America are heart disease, cancer, and chronic lower respiratory disease. These causes are responsible for about half of all deaths in the country each year, and smoking increases the risk to all three.

The CDC says smoking is the leading cause of preventable deaths in the United States, leading tot 480,000 deaths, or about one-fifth of all preventable deaths. Smoking also causes 90% of all lung cancer deaths.

Will the U.S. smoking rate fall as low as Utah’s? No. But a drop to somewhere in between would cut the smoking population by millions and save lives and untold billions of dollars in medical costs and lost work.

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