Smoking is the prevalence of adults who smoke cigarettes regularly. It is defined as the percentage of adults who self-report smoking at least 100 cigarettes in their lifetime and who currently smoke. The 2013 ranks are based on self-report data from CDC’s 2012 Behavioral Risk Factor Surveillance System (BRFSS). Because of the 2011 change in BRFSS methodology, smoking prevalence from the 2012 Edition onward cannot be directly compared to estimates from previous years (see Methodology).
Smoking has a very well documented adverse impact on overall health. It is the leading cause of preventable death in the United States. Each year, approximately 443,000 people die from cigarette smoking or exposure to secondhand smoke, and another 8.6 million suffer from a serious smoking-related illness. Smoking damages nearly every organ in the body and causes respiratory disease, heart disease, stroke, cancer, preterm birth, low birthweight, and premature death. On average, smokers lose an average of 13 to 14 years of life because of their smoking. Annually in the United States, $96 billion in direct medical expenses and $97 billion in lost productivity are attributed to smoking.
Smoking not only puts smokers themselves at increased risk for negative health consequences, but also those who are exposed to secondhand smoke, as it has serious effects on the population causing respiratory infections in children and heart disease and lung cancer in adults. Smoking is a lifestyle behavior that can be influenced by support from the community and/or clinical intervention. Cessation at any age, even in a longtime smoker, can have profound benefits on current health status and long term outcomes. When smokers quit, the risk of a heart attack drops sharply after just 1 year; stroke risk can fall to about the same as a nonsmoker’s after 2 to 5 years; risks for cancer of the mouth, throat, esophagus, and bladder are cut in half after 5 years; and the risk for dying of lung cancer drops by half after 10 years. Smokers who quit—even at an advanced age—will decrease their risk for heart attacks and strokes within 5 years and those who quit before age 35 reduce their risk of premature death to almost the same level as non-smokers.
A wide variety of interventions are effective in leading to smoking cessation at the individual and community levels. Policy efforts such as excise taxes and smoking bans have been pursued over the past several decades and have been effective in increasing cessation, preventing non-smokers from starting, and decreasing smoking related health problems., Due to the widespread negative health effects of secondhand smoke, reducing the prevalence of smoking and creating smoke-free environments can have a profound impact on the entire community. For examples on how communities put prevention to work in tobacco use prevention and control, see CDC’s Division of Community Health’s resource center. For resources to help smokers quit, Smokefree.gov provides free, accurate, evidence-based information and professional assistance to help support the immediate and long-term needs of people trying to quit smoking.
The percentage of adults who currently smoke varies from a low of 10.6 percent in Utah to 28.2 percent in West Virginia and 28.3 percent in Kentucky. In the United States, 19.6 percent of adults currently smoke, down from 21.2 percent in 2012. Smoking prevalence significantly decreased in 17 states between the 2012 and 2013 Edition (p=0.05). For smoking prevalence by state and age, gender, race/ethnicity, urbanicity, income or education level, see Health Disparities within States.
 Agaku I, King B, Dube SR. Current cigarette smoking among adults—United States, 2011. MMWR. 2012;61(44):889.
 US Department of Health and Human Services. The health consequences of smoking: A report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.
 US Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006.
 Chaloupka FJ. Effectiveness of tax and price policies in tobacco control. Tob Control. 2011;20(3):235.
 Naiman A. Association of anti-smoking legislation with rates of hospital admission for cardiovascular and respiratory conditions. CMAJ. 2010;182(8):761.
 Healthy People 2020. 2020 Topics & Objectives – Objectives A-Z http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx. US Department of Health and Human Services. Updated March 8, 2013. Accessed October 22, 2013.
The measures tracked by America's Health Rankings are those actions that can affect the future health of the population. For a state to improve the health of its population, efforts must focus on these measures, these determinants of health.
|District of Columbia||0||19.6||View Actions|
|New Hampshire||11||17.2||View Actions|
|New Jersey||13||17.3||View Actions|
|New Mexico||24||19.3||View Actions|
|New York||5||16.2||View Actions|
|North Carolina||33||20.9||View Actions|
|North Dakota||34||21.2||View Actions|
|Rhode Island||14||17.4||View Actions|
|South Carolina||38||22.5||View Actions|
|South Dakota||37||22.0||View Actions|
|West Virginia||49||28.2||View Actions|