Are We “The United States of Smoking”?

Oct 16, 2014 by

[This post was originally published in March 2014]

On March 14, 2014, The Washington Post online published an article by Reid Wilson entitled “The United States of smoking: The state with the most tobacco farms smokes most often”. Although much in this article is factually true and is instructive, I object to the title, on two grounds.


The first problem concerns the epithet “the United States of smoking”. Even if used jokingly, it implies some sort of unity in the smoking patterns in the US. This is, however, far from the truth. The prevalence of smoking differs more than twofold between Utah, with 12.2% of its population smoking, and Kentucky, whose corresponding figure is 30.2%. More importantly, the country is becoming more heterogeneous in this respect, with some states and regions of the country smoking as much, if not more, and others smoking significantly less. In 1998, only one state, Utah, had a figure lower than 15%, while twelve states exceeded 25%. All but seven states, moreover, found themselves in the “20% smokers or more” category. By 2003, the situation has changed radically, with many states, particularly in the western half of the country, drastically reducing the prevalence of smoking. The number of states in the “less than 20%” category doubled over this period. The trend continues; in the next five years, the number of states with more than 20% of their people still smoking decreased by half. Yet, several states—Indiana, Kentucky, and West Virginia—continued to smoke heavily, with figures of 25% or more.


By 2013, the picture had became more heterogeneous still: with five states falling into the “25%+” category, and 29 states in the “below 20%” grouping.. While on the national level the prevalence of smoking continues to decrease,, in some cases substantially, some states have experienced the reverse trend. For example, in 2008, between 20 and 25% of residents in Mississippi smoked, but by 2013 this figure had increased to 27%. Similar figures apply to Oklahoma. Thus, the country has become one of “Disunited states, some smoking, others not so much”.



My second problem is with the subtitle: “the state with the most tobacco farms smokes most often”. This happens to be true, as “there are more than 16,000 tobacco farms in the United States, about half of them in Kentucky”. Kentucky is also the only state where the prevalence of smoking remains above 30%. However, the implication of this title—repeated in the text of the article itself (“So perhaps it’s little wonder that Kentucky residents are more likely to smoke than residents of any other state”)—is that the presence of numerous tobacco farms generally correlates or even causes increased prevalence of smoking. This pattern does not hold on the global scale, however, as discussed in my two earlier posts (see here and here) and as can be seen from the two maps, reproduced on the left, one from the smoking_rate_map_GCfascinating Tobacco Atlas produced by the American Cancer Society and the World Lung Foundation and the other one created by me. The first map shows that the world’s leading producers of tobacco, as measured by the land devoted to growing tobacco rather than the number of individual tobacco farms, are the United States, Brazil, India, China, and Indonesia. (It should be mentioned, however, that India has a very high rate of smokeless tobacco use.) Yet of all these countries are in medium or low categories in terms of the smoking rate, ranging from less than 750 cigarettes smoked per adult per year in Brazil and India to the annual rate of “1,500-1,749” per adult in China. Conversely, countries in the highest smoking category, such as Russia, Ukraine, Belarus, and Serbia, where an average adult smokes over 2,000 cigarettes annually, grow very little tobacco. Thus, growing tobacco does not directly lead to higher rates of use.

Reductions in the smoking rate stem from a variety of policies, but banning smoking in public places seems to be particularly effective. As Wilson points out,

“all 10 of the states with the lowest percentage of smokers ban smoking in the workplace, restaurants and bars. On the other hand, the three states with the highest percentage of smokers — Kentucky, West Virginia and Mississippi — have no statewide smoking bans at all”.


The same point was made in 2010 in the Center for Disease Control’s VitalSigns report, which presents the two maps reproduced on the left. It should be noted, however, that the correlation does not always hold. For example, of the five states that had banned smoking in two of three locations (bars, restaurants, and workplaces) by 2010, three—Louisiana, North Carolina, and Nevada—still have a relatively high prevalence of smoking: 24.1, 20.5, and 20.3%, respectively. Similarly, even in some states where smoking is banned in all three types of locations, such as Michigan and Ohio, the prevalence of smoking remains relatively high. Nor is the absence of comprehensive smoking bans a prerequisite for high prevalence of smoking: of the 21 states that had “less comprehensive laws or no restrictions”, four exhibit low prevalence of smoking (16% or less): California, Idaho, Connecticut, and Rhode Island.

The prevalence of tobacco smoking in any given state (or country) is clearly a complex issues. As a result, it is best to regard simple correlations with some skepticism.

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