- Smoking remains the leading cause of preventable death in the U.S.
- Utah has the lowest adult smoking rate at 6%, West Virginia highest at 20.4%.
- Secondhand smoke leads to over 40,000 adult deaths yearly in the U.S.
Smoking rates have been dropping for years, but the habit remains the leading cause of preventable death and disability in the United States, responsible when combined with secondhand smoke for about 1 in 5 deaths, according to the Centers for Disease Control and Prevention.
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“Smoking harms nearly every organ of the body,” according to the CDC’s National and State Tobacco Control Program, which adds that the habit is bad for smokers’ health in general.
More than 16 million Americans have one or more diseases caused by smoking, responsible for $170 billion in direct medical costs that CDC officials say would be saved “if we could prevent youth from starting to smoke and help every person who smokes to quit.”
Secondhand smoke is believed to contribute to more than 40,000 deaths among nonsmoking adults and 400 infant deaths each year, per the CDC.
States with the highest and lowest cigarette use
With smoking rates dropping, who’s still smoking?
According to state fact sheets that looked at 2023 CDC data, Utah has the lowest rate of adult smokers at 6%. Among high school youth in 2021, 9.5% said they currently used a tobacco product, while 1.9% said they smoked cigarettes.
West Virginia has the highest rate of adult smokers at 20.4%. In West Virginia in 2021, 27% of high school youth said they were currently using any tobacco products, including e-cigarettes, while 7.6% said they were smoking cigarettes.
An analysis by VisualCapitalist reported that smoking rates for adults were highest across Appalachia and the South, while several states in the West and Northeast have seen smoking drop to the single digits.
VisualCapitalist reported that “Utah’s exceptionally low rate is often attributed to cultural and religious influences, along with longstanding public health efforts.”
Anti-smoking messaging and action has also reduced smoking. The CDC reported that Utah has more than 35,000 smoke-free housing units in 18 counties and “has developed a toolkit and signage to assist communities/property management companies that voluntarily adopt smoke-free housing.”
The highest smoking rates, after West Virginia, are found in Kentucky, Tennessee, Oklahoma, Louisiana, Mississippi, Missouri, Alaska, South Dakota, Ohio and Arizona. In those states at least 15% of adults smoke.
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In contrast, the states with the lowest rates of smoking, besides Utah, are Connecticut, California, Washington, Hawaii, Maryland, New Jersey, New York, Rhode Island, District of Columbia and Massachusetts — all with fewer than 10% of adults smoking.
Reasons to kick the habit
The CDC noted that smoking affects more than the smoker; there’s no safe level of exposure to secondhand smoke. “It causes stroke, lung cancer and coronary heart disease in adults.”
The World Health Organization also keeps stats on tobacco use, its purview global, and reported last June that tobacco kills up to half of users who don’t quit. More than 7 million people worldwide die each year, including about 1.6 million who didn’t smoke but are exposed to it secondhand.
Per the international public health giant, “The tobacco epidemic is one of the biggest public health threats the world has ever faced, responsible for over 7 million deaths annually as well as disability and long-term suffering from tobacco-related diseases.”
The WHO adds that all tobacco forms are bad for health and that roughly 80% of the 1.3 billion tobacco users live in low- and middle-income countries.
Smoking among U.S. youth
The CDC reports that smoking or using tobacco in any form typically begins in adolescence and adds that 9 out of 10 adults who regularly smoke cigarettes first tried tobacco before they were 18.
“In 2024, approximately 2 in 5 students who had ever used a tobacco product currently use them,” the public health organization reported. It added that flavorings can make tobacco products more appealing to young people.
In 2024, 8.1% of U.S. middle school and high school students used a tobacco product. For 5.9%, the product was e-cigarettes, which has been the tobacco product of choice for youths since 2014. In that survey, 1 of every 29 middle school students said they’d used an e-cigarette in the last 30 days, while 1 in 13 high school students said that.
Overall among the surveyed youths, 1.8% used nicotine pouches and 1.4% used cigarettes. At lower rates, the students used cigars, smokeless tobacco, other oral nicotine products, heated tobacco products, hookahs and pipe tobacco.