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States With the Most Smokers

24/7 Wall St. logo 24/7 Wall St. 11/9/2018 Hristina Byrnes

a hand holding an object in his hand © VichienPetchmai / iStock

The good news is that tobacco smoking is declining globally, including in the United States. The bad news is that about 16% of the adults in the country still smoke regularly, and more than 16 million Americans suffer from a smoking-related condition.

What makes cigarettes so addictive is the nicotine in the tobacco. “Cigarettes are the most efficient drug-delivery device ever made,” said Adam Goldstein, M.D., M.P.H, director of Tobacco Intervention Programs at the University of North Carolina School of Medicine . “Nicotine is the hardest addiction to quit.” It enters the nervous system within seconds, attaching itself to receptors in the brain that release dopamine, which is commonly knowns as “the feel good hormone,” Goldstein explained.

On average, 11.7% of Americans smoke every day, according to data from the Centers for Disease Control and Prevention (CDC). Cigarette smoking is highest in the South and Midwest.

There appears to be a connection between the number of people in a state who smoke and the tax on cigarettes -- the higher the percentage of smokers, the lower the tax.

Adverse smoking-related health outcomes are also more common in the states with the highest smoking rates. The three states with the highest smoking rates -- West Virginia, Kentucky and Arkansas -- are the same three states with the highest incidence of heart disease, the highest lung cancer death rates, and highest rates of heart attack history. All three states are in the top five of states with the most residents who have had a stroke and report being in poor health.

To identify the states with the highest percentage of smokers, 24/7 Wall St. reviewed data from the CDC’s Behavioral Risk Factor Surveillance System data. Respondents are people over 18 years of age who report smoking at least every day in 2017. The additional data about the rate of lung cancer deaths are from 2015 and the excise tax rates are as of Jan. 1, 2018. The measure of people in poor health includes adults who report 14 or more days in the last month during which they felt sick.

a herd of sheep grazing on a lush green hillside © CodyHaskell / Getty Images

50. Utah
> Adults who smoke every day: 6.0%
> Lung cancer deaths per 100,000 people: 19.1 (the lowest)
> Cigarette excise tax: $1.70 (22nd highest)
> Adults reporting poor health 3.6% (6th lowest)

a large mountain in the background © chensiyuan (talk · contribs) / Wikimedia Commons

49. California
> Adults who smoke every day: 6.4%
> Lung cancer deaths per 100,000 people: 30.0 (4th lowest)
> Cigarette excise tax: $2.87 (9th highest)
> Adults reporting poor health 4.0% (16th lowest)

a large body of water with a mountain in the background © Thinkstock

48. Hawaii
> Adults who smoke every day: 8.0%
> Lung cancer deaths per 100,000 people: 31.9 (5th lowest)
> Cigarette excise tax: $3.20 (5th highest)
> Adults reporting poor health 3.5% (3rd lowest)

a bridge over a body of water with a city in the background © espiegle / Getty Images

47. New Jersey
> Adults who smoke every day: 8.4%
> Lung cancer deaths per 100,000 people: 35.0 (12th lowest)
> Cigarette excise tax: $2.70 (10th highest)
> Adults reporting poor health 4.6% (23rd highest)

a view of a city with tall buildings in the background © SeanPavonePhoto / Getty Images

46. Connecticut
> Adults who smoke every day: 8.4%
> Lung cancer deaths per 100,000 people: 34.7 (10th lowest)
> Cigarette excise tax: $4.35 (the highest)
> Adults reporting poor health 3.7% (9th lowest)

a house in the middle of a lush green field © DenisTangneyJr / Getty Images

45. Massachusetts
> Adults who smoke every day: 8.6%
> Lung cancer deaths per 100,000 people: 39.1 (18th lowest)
> Cigarette excise tax: $3.51 (4th highest)
> Adults reporting poor health 3.5% (5th lowest)

a large building © Thinkstock

44. New York
> Adults who smoke every day: 8.9%
> Lung cancer deaths per 100,000 people: 36.2 (13th lowest)
> Cigarette excise tax: $4.35 (the highest)
> Adults reporting poor health 4.5% (25th lowest)

a large body of water with a city in the background © Thinkstock

43. Washington
> Adults who smoke every day: 9.1%
> Lung cancer deaths per 100,000 people: 38.6 (17th lowest)
> Cigarette excise tax: $3.03 (8th highest)
> Adults reporting poor health 4.2% (18th lowest)

a herd of cattle grazing on a lush green field © Thinkstock

42. Texas
> Adults who smoke every day: 9.3%
> Lung cancer deaths per 100,000 people: 35.0 (12th lowest)
> Cigarette excise tax: $1.41 (24th lowest)
> Adults reporting poor health 5.4% (14th highest)

a group of people standing on a lush green field © Thinkstock

41. Maryland
> Adults who smoke every day: 9.3%
> Lung cancer deaths per 100,000 people: 37.7 (15th lowest)
> Cigarette excise tax: $2.00 (14th highest)
> Adults reporting poor health 3.6% (8th lowest)

a person riding a snowboard down a snow covered mountain © Thinkstock

40. Colorado
> Adults who smoke every day: 9.7%
> Lung cancer deaths per 100,000 people: 27.7 (2nd lowest)
> Cigarette excise tax: $0.84 (14th lowest)
> Adults reporting poor health 3.5% (2nd lowest)

a bridge over a body of water © DenisTangneyJr / Getty Images

39. Rhode Island
> Adults who smoke every day: 9.8%
> Lung cancer deaths per 100,000 people: 46.9 (13th highest)
> Cigarette excise tax: $4.25 (3rd highest)
> Adults reporting poor health 4.5% (24th highest)

a train is coming down the mountain © huddleston / Flickr

38. Minnesota
> Adults who smoke every day: 9.9%
> Lung cancer deaths per 100,000 people: 37.0 (14th lowest)
> Cigarette excise tax: $3.04 (7th highest)
> Adults reporting poor health 3.0% (the lowest)

a view of a city at sunset © mdesigner125 / Getty Images

37. Arizona
> Adults who smoke every day: 10.2%
> Lung cancer deaths per 100,000 people: 34.5 (9th lowest)
> Cigarette excise tax: $2.00 (14th highest)
> Adults reporting poor health 5.0% (17th highest)

a large body of water with a mountain in the background © Thinkstock

36. Idaho
> Adults who smoke every day: 10.5%
> Lung cancer deaths per 100,000 people: 34.4 (8th lowest)
> Cigarette excise tax: $0.57 (7th lowest)
> Adults reporting poor health 4.3% (21st lowest)

a bridge over a body of water with a city in the background © Thinkstock

35. Illinois
> Adults who smoke every day: 10.5%
> Lung cancer deaths per 100,000 people: 43.4 (20th highest)
> Cigarette excise tax: $1.98 (19th highest)
> Adults reporting poor health 3.7% (10th lowest)

a large body of water with a mountain in the background © Thinkstock

34. New Mexico
> Adults who smoke every day: 10.8%
> Lung cancer deaths per 100,000 people: 29.5 (3rd lowest)
> Cigarette excise tax: $1.66 (24th highest)
> Adults reporting poor health 6.4% (9th highest)

a group of palm trees with a building in the background © Meinzahn / iStock

33. Florida
> Adults who smoke every day: 10.9%
> Lung cancer deaths per 100,000 people: 40.0 (21st lowest)
> Cigarette excise tax: $1.34 (22nd lowest)
> Adults reporting poor health 5.4% (15th highest)

a house covered in snow © leonaruth / iStock

32. Nebraska
> Adults who smoke every day: 11.1%
> Lung cancer deaths per 100,000 people: 41.4 (24th lowest)
> Cigarette excise tax: $0.64 (11th lowest)
> Adults reporting poor health 3.6% (7th lowest)

a lit up city at night © Thinkstock

31. Nevada
> Adults who smoke every day: 11.1%
> Lung cancer deaths per 100,000 people: 41.7 (25th highest)
> Cigarette excise tax: $1.80 (20th highest)
> Adults reporting poor health 4.4% (22nd lowest)

a house next to a body of water © Thinkstock

30. Virginia
> Adults who smoke every day: 11.2%
> Lung cancer deaths per 100,000 people: 41.2 (23rd lowest)
> Cigarette excise tax: $0.30 (2nd lowest)
> Adults reporting poor health 4.2% (19th lowest)

a boat is docked next to a body of water © mdgmorris / Getty Images

29. Delaware
> Adults who smoke every day: 11.2%
> Lung cancer deaths per 100,000 people: 46.5 (14th highest)
> Cigarette excise tax: $2.10 (13th highest)
> Adults reporting poor health 4.9% (20th highest)

a train going down a track in the city © Thinkstock

28. Georgia
> Adults who smoke every day: 11.5%
> Lung cancer deaths per 100,000 people: 42.2 (24th highest)
> Cigarette excise tax: $0.37 (3rd lowest)
> Adults reporting poor health 4.8% (21st highest)

a snow covered mountain with Crater Lake National Park in the background © TrongNguyen / iStock

27. Oregon
> Adults who smoke every day: 11.5%
> Lung cancer deaths per 100,000 people: 38.6 (17th lowest)
> Cigarette excise tax: $1.33 (21st lowest)
> Adults reporting poor health 4.9% (19th highest)

a close up of a lush green field © Thinkstock

26. Wisconsin
> Adults who smoke every day: 11.7%
> Lung cancer deaths per 100,000 people: 39.9 (20th lowest)
> Cigarette excise tax: $2.52 (12th highest)
> Adults reporting poor health 4.2% (20th lowest)

a view of a city © Sean Pavone / Shutterstock.com

25. Vermont
> Adults who smoke every day: 11.8%
> Lung cancer deaths per 100,000 people: 41.5 (25th lowest)
> Cigarette excise tax: $3.08 (6th highest)
> Adults reporting poor health 3.9% (14th lowest)

a view of a body of water surrounded by trees © DenisTangneyJr / Getty Images

24. New Hampshire
> Adults who smoke every day: 11.9%
> Lung cancer deaths per 100,000 people: 43.4 (20th highest)
> Cigarette excise tax: $1.78 (21st highest)
> Adults reporting poor health 3.5% (5th lowest)

a wooden bench overlooking a body of water © garytog / Getty Images

23. North Carolina
> Adults who smoke every day: 11.9%
> Lung cancer deaths per 100,000 people: 45.6 (16th highest)
> Cigarette excise tax: $0.45 (5th lowest)
> Adults reporting poor health 5.3% (16th highest)

a statue in front of a building © Thinkstock

22. Montana
> Adults who smoke every day: 12.2%
> Lung cancer deaths per 100,000 people: 39.2 (19th lowest)
> Cigarette excise tax: $1.70 (22nd highest)
> Adults reporting poor health 4.5% (25th highest)

a body of water with a city in the background © Thinkstock

21. Kansas
> Adults who smoke every day: 12.2%
> Lung cancer deaths per 100,000 people: 44.4 (19th highest)
> Cigarette excise tax: $1.29 (20th lowest)
> Adults reporting poor health 4.5% (25th lowest)

a street lined with palm trees and a building in the background © Thinkstock

20. South Carolina
> Adults who smoke every day: 12.5%
> Lung cancer deaths per 100,000 people: 45.0 (18th highest)
> Cigarette excise tax: $0.57 (7th lowest)
> Adults reporting poor health 6.0% (10th highest)

a train on a lush green field © Ron_Thomas / Getty Images

19. Iowa
> Adults who smoke every day: 12.6%
> Lung cancer deaths per 100,000 people: 45.1 (17th highest)
> Cigarette excise tax: $1.36 (23rd lowest)
> Adults reporting poor health 3.8% (11th lowest)

a boat is docked in the water © Thinkstock

18. Maine
> Adults who smoke every day: 13.2%
> Lung cancer deaths per 100,000 people: 50.3 (9th highest)
> Cigarette excise tax: $2.00 (14th highest)
> Adults reporting poor health 4.1% (17th lowest)

a close up of a sign © Thinkstock

17. Oklahoma
> Adults who smoke every day: 13.3%
> Lung cancer deaths per 100,000 people: 54.0 (6th highest)
> Cigarette excise tax: $1.03 (16th lowest)
> Adults reporting poor health 6.8% (7th highest)

a train on a track with smoke coming out of it © Thinkstock

16. North Dakota
> Adults who smoke every day: 13.3%
> Lung cancer deaths per 100,000 people: 34.4 (8th lowest)
> Cigarette excise tax: $0.44 (4th lowest)
> Adults reporting poor health 4.0% (16th lowest)

a plane sitting on top of a grass covered field © Thinkstock

15. Pennsylvania
> Adults who smoke every day: 13.4%
> Lung cancer deaths per 100,000 people: 43.0 (22nd highest)
> Cigarette excise tax: $2.60 (11th highest)
> Adults reporting poor health 4.9% (18th highest)

an old brick building on a city street © TheCrimsonRibbon / iStock

14. Michigan
> Adults who smoke every day: 13.6%
> Lung cancer deaths per 100,000 people: 45.9 (15th highest)
> Cigarette excise tax: $2.00 (14th highest)
> Adults reporting poor health 5.6% (12th highest)

a large green field with trees in the background with Badlands National Park in the background © Thinkstock

13. South Dakota
> Adults who smoke every day: 13.7%
> Lung cancer deaths per 100,000 people: 40.3 (22nd lowest)
> Cigarette excise tax: $1.53 (25th lowest)
> Adults reporting poor health 3.8% (13th lowest)

a view of a city © SeanPavonePhoto / Getty Images

12. Alabama
> Adults who smoke every day: 13.7%
> Lung cancer deaths per 100,000 people: 49.0 (11th highest)
> Cigarette excise tax: $0.68 (12th lowest)
> Adults reporting poor health 7.1% (6th highest)

a close up of a rock mountain © Sierralara / Getty Images

11. Wyoming
> Adults who smoke every day: 14.0%
> Lung cancer deaths per 100,000 people: 32.2 (6th lowest)
> Cigarette excise tax: $0.60 (9th lowest)
> Adults reporting poor health 4.4% (23rd lowest)

a large body of water with a mountain in the background © Thinkstock

10. Alaska
> Adults who smoke every day: 14.6%
> Lung cancer deaths per 100,000 people: 42.5 (23rd highest)
> Cigarette excise tax: $2.00 (14th highest)
> Adults reporting poor health 3.8% (12th lowest)

a small boat in a body of water with a city in the background © Thinkstock

9. Louisiana
> Adults who smoke every day: 15.0%
> Lung cancer deaths per 100,000 people: 50.5 (8th highest)
> Cigarette excise tax: $1.08 (17th lowest)
> Adults reporting poor health 7.3% (5th highest)

a house covered in snow © MelissaAnneGalleries / iStock

8. Indiana
> Adults who smoke every day: 15.8%
> Lung cancer deaths per 100,000 people: 50.2 (10th highest)
> Cigarette excise tax: $1.00 (15th lowest)
> Adults reporting poor health 5.6% (11th highest)

a view of a city © Thinkstock

7. Tennessee
> Adults who smoke every day: 16.0%
> Lung cancer deaths per 100,000 people: 54.3 (5th highest)
> Cigarette excise tax: $0.62 (10th lowest)
> Adults reporting poor health 6.7% (8th highest)

a view of a large body of water with Gateway Arch in the background © amolson7 / Shutterstock.com

6. Missouri
> Adults who smoke every day: 16.2%
> Lung cancer deaths per 100,000 people: 51.1 (7th highest)
> Cigarette excise tax: $0.17 (the lowest)
> Adults reporting poor health 5.5% (13th highest)

a view of a city © Thinkstock

5. Mississippi
> Adults who smoke every day: 16.4%
> Lung cancer deaths per 100,000 people: 54.7 (4th highest)
> Cigarette excise tax: $0.68 (13th lowest)
> Adults reporting poor health 8.0% (3rd highest)

a view of a city street © aceshot / iStock

4. Ohio
> Adults who smoke every day: 16.5%
> Lung cancer deaths per 100,000 people: 49.0 (11th highest)
> Cigarette excise tax: $1.60 (25th highest)
> Adults reporting poor health 4.7% (22nd highest)

a body of water with a city in the background © Thinkstock

3. Arkansas
> Adults who smoke every day: 16.7%
> Lung cancer deaths per 100,000 people: 57.1 (3rd highest)
> Cigarette excise tax: $1.15 (18th lowest)
> Adults reporting poor health 7.5% (4th highest)

a brown and white horse grazing on a lush green field © Thinkstock

2. Kentucky
> Adults who smoke every day: 19.4%
> Lung cancer deaths per 100,000 people: 64.3 (the highest)
> Cigarette excise tax: $0.60 (9th lowest)
> Adults reporting poor health 8.0% (2nd highest)

a close up of a road © Thinkstock

1. West Virginia
> Adults who smoke every day: 20.0%
> Lung cancer deaths per 100,000 people: 57.3 (2nd highest)
> Cigarette excise tax: $1.20 (19th lowest)
> Adults reporting poor health 8.7% (the highest)

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