State-Specific Prevalence of Current Cigarette Smoking and Smokeless Tobacco Use Among Adults Aged ≥18 years –United States, 2011-2013
May 22, 2015 / Vol. 64 / No. 19
This report provides the most recent state-specific estimates of prevalence and relative percent change (RPC) in current cigarette smoking, current smokeless tobacco use, and concurrent cigarette smoking and smokeless tobacco use among US adults using data from the 2011-2013 Behavioral Risk Factor Surveillance System (BRFSS). States vary widely in prevalence of cigarette smoking, smokeless tobacco, and concurrent use of both products. From 2011 to 2013, there was a statistically significant decline in current cigarette smoking prevalence overall and in 26 states. During the same period, use of smokeless tobacco significantly increased in four states—Louisiana, Montana, South Carolina, and West Virginia, while significant declines were observed in two states—Ohio and Tennessee. Additionally, the concurrent use of cigarette smoking and smokeless tobacco significantly increased in five states (Delaware, Idaho, Nevada, New Mexico and West Virginia). The use of more than one tobacco product is concerning because adults who use both cigarettes and smokeless tobacco have higher levels of nicotine dependence and are less likely to report planning to quit than those who exclusively smoke cigarettes. While multiple components of tobacco control prevention and policy have had an effect on reducing cigarette smoking overall and within most states, the varied prevalence and increases in smokeless tobacco use across states highlights the importance of targeted population-based interventions focused on reducing the use of all tobacco products.
These findings highlight the importance of sustained comprehensive state tobacco control programs funded at CDC recommended levels, which can accelerate progress toward reducing tobacco-related disease and deaths by promoting evidence-based population-level interventions. These interventions include increasing the price of tobacco products, implementing comprehensive smoke-free laws, conducting hard-hitting mass media campaigns, restricting tobacco advertising and promotion, controlling access to tobacco products, and promoting cessation assistance for smokers to quit. Evidence-based, statewide tobacco control programs that are comprehensive, sustained, and accountable have been shown to reduce smoking rates, as well as tobacco-related diseases and deaths. However, during 2015, despite combined tobacco revenue of more than $25 billion from settlement payments and tobacco taxes for all states, states will spend only $490.4 million (1.9%) on comprehensive tobacco control programs, representing <15% of the CDC-recommended level of funding for all states combined. Full implementation of comprehensive tobacco control programs at CDC-recommended funding levels could reduce tobacco use and change social norms regarding the acceptability of tobacco use in the United States.
Current cigarette smoking among US adults, 2011-2013
- Current cigarette smoking among adults declined significantly in 26 states from 2011-2013.
- In the remaining 25 states (including the District of Columbia), there were no significant changes in current cigarette smoking among adults from 2011-2013.
- Current cigarette smoking among adults ranged from 11.8% in Utah to 29.0% in Kentucky in 2011, and from 10.3% in Utah to 27.3% in West Virginia in 2013.
Current smokeless tobacco use among US adults, 2011-2013
- Current smokeless tobacco use among adults declined in Ohio and Tennessee from 2011-2013.
- Current smokeless tobacco use among adults increased in Louisiana, Montana, South Carolina, and West Virginia from 2011-2013.
- In the remaining 45 states (including the District of Columbia), there were no significant changes in smokeless tobacco use among adults from 2011-2013.
- Current smokeless tobacco use ranged from 1.4% in California and Rhode Island to 9.8% in Wyoming in 2011 and from 1.5% in California, the District of Columbia, and Massachusetts to 9.4% in West Virginia in 2013.
Concurrent use of cigarettes and smokeless tobacco use among US adults, 2011-2013
- Concurrent use of cigarettes and smokeless tobacco among adults increased in Delaware, Idaho, Nevada, New Mexico and West Virginia from 2011-2013.
- In the remaining 46 states (including the District of Columbia), there were no significant changes in the concurrent use of cigarettes and smokeless tobacco among adults from 2011-2013.
- Concurrent use of cigarettes and smokeless tobacco among adults ranged from 2.0% in Nevada to 12.5% in Utah in 2011, and from 3.1% in Vermont to 13.5% in Idaho in 2013.