The 10 States Most Addicted to Smoking

Leaders of the pack

Antismoking efforts are hard to avoid nowadays. Cigarette packaging will get graphic new warning labels in 2012, and 38 states have at least some restrictions as to where a person can light up. (New York State has even banned smoking in public parks.) But despite this increased regulation, plenty of Americans continue to smoke—like chimneys.

Using government data on smoking (and quit) rates, smoking bans and restrictions, cigarette taxes and sales, and deaths attributable to smoking, Health.com identified the 10 states where people are most likely to literally smoke themselves to death. Here they are, in alphabetical order.

Arkansas

Roughly 23% of adults in Arkansas smoke (compared to just over 19% nationwide), and in the most recent government surveys, less than 3% of smokers had managed to quit within the previous 12 months.

The tobacco smoke hangs so thick over the Natural State that Governor Mike Beebe has made secondhand smoke a statewide priority. In July 2011, for instance, a law went into effect prohibiting an adult from smoking in a car with children under the age of 14, broadening a 2006 law that banned smoking in the car with kids under 6. Only three other states—California, Louisiana, and Maine—have similar laws.

Indiana

If you believe it’s every person’s right to breathe cancer-causing secondhand smoke while eating, drinking, and working, Indiana’s the place for you.

The Hoosier State is among the top three most lenient states in the country when it comes to restricting where residents can smoke. There are no rules about smoking in restaurants, bars, private work sites, or recreational facilities, which earned the state an “F” grade for smoke-free air from the American Lung Association (ALA).

Kentucky

States, not just people, can be addicted to tobacco. Tobacco production is an important industry in Kentucky, which along with North Carolina generates two-thirds of the nation’s tobacco harvest. (Last year Kentucky farmers grew about 140 million pounds.)

People aren’t necessarily more likely to smoke if they live in a tobacco-growing state, but Kentuckians are certainly doing their part to help the local economy. The state has the nation’s second-highest adult smoking rate, as well the highest rate of smoking-related deaths. Most alarming of all, Kentucky is encouraging more smokers: The smoking rate among high schoolers is the highest in the U.S.

Louisiana

Alcohol use and smoking are closely linked, so in a state known for its love of partying and drive-through liquor stores, it’s not surprising that more than one in five Louisiana adults also smokes.

Like many people, Louisiana residents apparently love to light up when they have a drink in hand. Despite multiple attempts, State Senator Rob Marionneaux has been unable to win support for his proposed ban on smoking in Louisiana bars. The state currently prohibits smoking in restaurants, public buildings, and most work sites, but opponents worry the ban would hurt bars’ profits.

Mississippi

Mississippi is one of only three states nationwide without any restrictions on smoking at child-care facilities. While the state has banned smoking in government buildings and on college campuses, a recent proposal for a broader ruling didn’t meet with much approval.

Supporters were looking to ban smoking in restaurants and nongovernment buildings, but the proposal fell apart in March. Opponents argued that the government shouldn’t tell private businesses how to operate. But it may be even more simple: Some residents told local newscasters they wouldn’t want to stop lighting up when they’re out and about.

Missouri

The federal government slaps a $1 tax on every pack of cigarettes sold in the U.S., but taxes—and therefore prices—still vary widely from state to state. The average pack of cigarettes costs more than $10 in New York, thanks to the country’s heftiest per-pack tax ($4.35)—three times higher than the national average. In Missouri, meanwhile, the average pack retails for just $4.50 because the state taxes a mere $0.17 per pack.

The Show-Me State is passing up a proven way to reduce smoking, especially among young people. A 10% price hike can reduce the amount of cigarettes consumed by about 4%, according to the Centers for Disease Control and Prevention (CDC).

Oklahoma

The rates of smoking and smoking-related deaths in Oklahoma rank high nationally, and very few smokers are quitting. But there may be change on the horizon: A state legislator is gathering support for a bill that would allow towns and cities to pass stricter antismoking laws, and so far there has been little opposition to his proposal.

As the birthplace of the original Marlboro Man, Oklahoma has made a small but lasting contribution to the smoking scourge. Darrell Winfield, the child of farmers, was discovered by Marlboro in 1968 and was featured in the majority of the brand’s advertisements over the next two decades.

South Carolina

South Carolina has the nation’s lowest smoking-cessation rate. In the most recent government survey, only about 2% of smokers had successfully quit for at least a year (compared to a high of 7% in Vermont), which isn’t surprising given that South Carolina has a measly $0.57 cigarette tax and no smoking restrictions in restaurants, bars, private work sites, and retail stores.

These factors can discourage quitting. Fewer than 1 in 10 smokers successfully kick the habit without medicine or other aids. Roadblocks to quitting can include cravings, nicotine withdrawal symptoms, weight gain, depression, lack of support, stress, alcohol, and living with a smoker.

Tennessee

The Great Smoky Mountains couldn’t have a better home. Although Tennessee’s smoking rate isn’t exceptionally high by national standards, the Volunteer State ranks among the worst in the number of packs sold per capita and the rate of smoking-related deaths. And in 2007, state spending for smoking cessation and other control programs was the third lowest, at only 3% of the CDC’s recommended amount.

As in many southern states, tobacco is a lucrative crop in Tennessee. Twenty-one states produce tobacco in the U.S., and many farmers depend on it to make a living, despite growing additional crops.

West Virginia

The Mountain State is home to the highest percentage of adult smokers in the country, with nearly 27% of adults lighting up.

Not only are the most adults smoking in West Virginia, but they’re also smoking the most. The average West Virginian smoker buys 113 packs a year, compared to just 23 packs per person sold in Washington, D.C.

All those cigarettes aren’t without consequence: West Virginia has the second highest rate (after Kentucky) of deaths attributable to lung cancer, which, in roughly 90% of cases, is caused by smoking.