It was in 1964 that the Surgeon General’s Report on Smoking and Health linked for the first time smoking and adverse health outcomes. The pivotal report aimed to shift public opinion on smoking by identifying the dangers of tobacco use. While the smoking rate has fallen precipitously in the last 50 years — dropping from 42.4% in 1965 to 17.1% in 2016 — tobacco use remains the leading cause of preventable disease and death in the United States.

According to the Office on Smoking and Health, every day nearly 4,000 young people under 18 years old try smoking for the first time. Today, 36.5 million, or about 17.1% of adults, are smokers. Approximately 16 million live with a serious illness caused by smoking.

These trends vary considerably across the country, with residents of some states much more likely to smoke than residents of other states. To highlight and help understand this variation, 24/7 Wall St. reviewed the adult smoking rate in each state from the Centers for Disease Control and Prevention.

Click here to see the states smoking the most cigarettes.
Click here to see our detailed findings and methodology.

1. Utah
> Adult smoking rate: 8.8%
> Lung cancer diagnoses per 100,000 people: 25.6 (the lowest)
> State cigarette excise tax: $1.70 per pack (19th highest)
> Median household income: $65,977 (11th highest)

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2. California
> Adult smoking rate: 11.0%
> Lung cancer diagnoses per 100,000 people: 42.0 (3rd lowest)
> State cigarette excise tax: $0.87 per pack (17th lowest)
> Median household income: $67,739 (9th highest)

3. Hawaii
> Adult smoking rate: 13.1%
> Lung cancer diagnoses per 100,000 people: 43.7 (5th lowest)
> State cigarette excise tax: $3.20 per pack (5th highest)
> Median household income: $74,511 (5th highest)

4. Connecticut
> Adult smoking rate: 13.4%
> Lung cancer diagnoses per 100,000 people: 59.2 (25th lowest)
> State cigarette excise tax: $3.65 per pack (3rd highest)
> Median household income: $73,433 (6th highest)

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5. Massachusetts
> Adult smoking rate: 13.6%
> Lung cancer diagnoses per 100,000 people: 61.5 (22nd highest)
> State cigarette excise tax: $3.51 per pack (4th highest)
> Median household income: $75,297 (4th highest)

6. Maryland
> Adult smoking rate: 13.7%
> Lung cancer diagnoses per 100,000 people: 55.4 (17th lowest)
> State cigarette excise tax: $2.00 per pack (11th highest)
> Median household income: $78,945 (the highest)

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7. New Jersey
> Adult smoking rate: 14.0%
> Lung cancer diagnoses per 100,000 people: 55.4 (17th lowest)
> State cigarette excise tax: $2.70 per pack (9th highest)
> Median household income: $76,126 (3rd highest)

8. Washington
> Adult smoking rate: 14.0%
> Lung cancer diagnoses per 100,000 people: 55.4 (17th lowest)
> State cigarette excise tax: $3.02 per pack (7th highest)
> Median household income: $67,106 (10th highest)

9. New York
> Adult smoking rate: 14.2%
> Lung cancer diagnoses per 100,000 people: 57.5 (22nd lowest)
> State cigarette excise tax: $4.35 per pack (the highest)
> Median household income: $62,909 (14th highest)

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10. Texas
> Adult smoking rate: 14.3%
> Lung cancer diagnoses per 100,000 people: 51.7 (10th lowest)
> State cigarette excise tax: $1.41 per pack (25th lowest)
> Median household income: $56,565 (25th highest)

11. Rhode Island
> Adult smoking rate: 14.4%
> Lung cancer diagnoses per 100,000 people: 69.6 (8th highest)
> State cigarette excise tax: $3.75 per pack (2nd highest)
> Median household income: $60,596 (18th highest)

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12. Idaho
> Adult smoking rate: 14.5%
> Lung cancer diagnoses per 100,000 people: 48.8 (8th lowest)
> State cigarette excise tax: $0.57 per pack (8th lowest)
> Median household income: $51,807 (15th lowest)

13. Arizona
> Adult smoking rate: 14.7%
> Lung cancer diagnoses per 100,000 people: 47.1 (7th lowest)
> State cigarette excise tax: $2.00 per pack (11th highest)
> Median household income: $53,558 (20th lowest)

14. Minnesota
> Adult smoking rate: 15.2%
> Lung cancer diagnoses per 100,000 people: 52.3 (11th lowest)
> State cigarette excise tax: $3.00 per pack (8th highest)
> Median household income: $65,599 (13th highest)

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15. Virginia
> Adult smoking rate: 15.3%
> Lung cancer diagnoses per 100,000 people: 57.5 (22nd lowest)
> State cigarette excise tax: $0.30 per pack (2nd lowest)
> Median household income: $68,114 (8th highest)

16. Florida
> Adult smoking rate: 15.5%
> Lung cancer diagnoses per 100,000 people: 57.0 (20th lowest)
> State cigarette excise tax: $1.34 per pack (23rd lowest)
> Median household income: $50,860 (13th lowest)

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17. Colorado
> Adult smoking rate: 15.6%
> Lung cancer diagnoses per 100,000 people: 42.2 (4th lowest)
> State cigarette excise tax: $0.84 per pack (15th lowest)
> Median household income: $65,685 (12th highest)

18. Illinois
> Adult smoking rate: 15.8%
> Lung cancer diagnoses per 100,000 people: 65.6 (15th highest)
> State cigarette excise tax: $1.98 per pack (16th highest)
> Median household income: $60,960 (16th highest)

19. Oregon
> Adult smoking rate: 16.2%
> Lung cancer diagnoses per 100,000 people: 53.0 (13th lowest)
> State cigarette excise tax: $1.32 per pack (22nd lowest)
> Median household income: $57,532 (21st highest)

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20. Nevada
> Adult smoking rate: 16.5%
> Lung cancer diagnoses per 100,000 people: 51.7 (10th lowest)
> State cigarette excise tax: $1.80 per pack (17th highest)
> Median household income: $55,180 (24th lowest)

21. New Mexico
> Adult smoking rate: 16.6%
> Lung cancer diagnoses per 100,000 people: 38.6 (2nd lowest)
> State cigarette excise tax: $1.66 per pack (21st highest)
> Median household income: $46,748 (7th lowest)

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22. Iowa
> Adult smoking rate: 16.7%
> Lung cancer diagnoses per 100,000 people: 63.3 (19th highest)
> State cigarette excise tax: $1.36 per pack (24th lowest)
> Median household income: $56,247 (25th lowest)

23. Nebraska
> Adult smoking rate: 17.0%
> Lung cancer diagnoses per 100,000 people: 56.9 (19th lowest)
> State cigarette excise tax: $0.64 per pack (12th lowest)
> Median household income: $56,927 (22nd highest)

24. Vermont
> Adult smoking rate: 17.0%
> Lung cancer diagnoses per 100,000 people: 61.3 (23rd highest)
> State cigarette excise tax: $3.08 per pack (6th highest)
> Median household income: $57,677 (20th highest)

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25. Wisconsin
> Adult smoking rate: 17.1%
> Lung cancer diagnoses per 100,000 people: 57.9 (23rd lowest)
> State cigarette excise tax: $2.52 per pack (10th highest)
> Median household income: $56,811 (24th highest)

26. Kansas
> Adult smoking rate: 17.2%
> Lung cancer diagnoses per 100,000 people: 60.1 (25th highest)
> State cigarette excise tax: $1.29 per pack (21st lowest)
> Median household income: $54,935 (23rd lowest)

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27. Delaware
> Adult smoking rate: 17.7%
> Lung cancer diagnoses per 100,000 people: 67.3 (12th highest)
> State cigarette excise tax: $1.60 per pack (22nd highest)
> Median household income: $61,757 (15th highest)

28. Georgia
> Adult smoking rate: 17.9%
> Lung cancer diagnoses per 100,000 people: 63.0 (21st highest)
> State cigarette excise tax: $0.37 per pack (3rd lowest)
> Median household income: $53,559 (21st lowest)

29. North Carolina
> Adult smoking rate: 17.9%
> Lung cancer diagnoses per 100,000 people: 67.3 (12th highest)
> State cigarette excise tax: $0.45 per pack (5th lowest)
> Median household income: $50,584 (12th lowest)

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30. New Hampshire
> Adult smoking rate: 18.0%
> Lung cancer diagnoses per 100,000 people: 60.9 (24th highest)
> State cigarette excise tax: $1.78 per pack (18th highest)
> Median household income: $70,936 (7th highest)

31. Pennsylvania
> Adult smoking rate: 18.0%
> Lung cancer diagnoses per 100,000 people: 63.2 (20th highest)
> State cigarette excise tax: $1.60 per pack (22nd highest)
> Median household income: $56,907 (23rd highest)

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32. South Dakota%
> Adult smoking rate: 18.1
> Lung cancer diagnoses per 100,000 people: 56.3 (18th lowest)
> State cigarette excise tax: $1.53 per pack (25th highest)
> Median household income: $54,467 (22nd lowest)

33. Montana
> Adult smoking rate: 18.5%
> Lung cancer diagnoses per 100,000 people: 52.8 (12th lowest)
> State cigarette excise tax: $1.70 per pack (19th highest)
> Median household income: $50,027 (11th lowest)

34. Alaska
> Adult smoking rate: 19.0%
> Lung cancer diagnoses per 100,000 people: 54.5 (14th lowest)
> State cigarette excise tax: $2.00 per pack (11th highest)
> Median household income: $76,440 (2nd highest)

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35. Wyoming
> Adult smoking rate: 19.0%
> Lung cancer diagnoses per 100,000 people: 45.2 (6th lowest)
> State cigarette excise tax: $0.60 per pack (10th lowest)
> Median household income: $59,882 (19th highest)

36. Oklahoma
> Adult smoking rate: 19.6%
> Lung cancer diagnoses per 100,000 people: 69.5 (9th highest)
> State cigarette excise tax: $1.03 per pack (19th lowest)
> Median household income: $49,176 (9th lowest)

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37. Maine
> Adult smoking rate: 19.8%
> Lung cancer diagnoses per 100,000 people: 72.1 (6th highest)
> State cigarette excise tax: $2.00 per pack (11th highest)
> Median household income: $53,079 (19th lowest)

38. North Dakota
> Adult smoking rate: 19.8%
> Lung cancer diagnoses per 100,000 people: 58.4 (24th lowest)
> State cigarette excise tax: $0.44 per pack (4th lowest)
> Median household income: $60,656 (17th highest)

39. South Carolina
> Adult smoking rate: 20.0%
> Lung cancer diagnoses per 100,000 people: 64.2 (17th highest)
> State cigarette excise tax: $0.57 per pack (8th lowest)
> Median household income: $49,501 (10th lowest)

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40. Michigan
> Adult smoking rate: 20.4%
> Lung cancer diagnoses per 100,000 people: 63.4 (18th highest)
> State cigarette excise tax: $2.00 per pack (11th highest)
> Median household income: $52,492 (18th lowest)

41. Indiana
> Adult smoking rate: 21.1%
> Lung cancer diagnoses per 100,000 people: 68.6 (11th highest)
> State cigarette excise tax: $1.00 per pack (18th lowest)
> Median household income: $52,314 (16th lowest)

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42. Alabama
> Adult smoking rate: 21.5%
> Lung cancer diagnoses per 100,000 people: 65.0 (16th highest)
> State cigarette excise tax: $0.68 per pack (13th lowest)
> Median household income: $46,257 (5th lowest)

43. Missouri
> Adult smoking rate: 22.1%
> Lung cancer diagnoses per 100,000 people: 71.9 (7th highest)
> State cigarette excise tax: $0.17 per pack (the lowest)
> Median household income: $51,746 (14th lowest)

44. Tennessee
> Adult smoking rate: 22.1%
> Lung cancer diagnoses per 100,000 people: 73.8 (5th highest)
> State cigarette excise tax: $0.62 per pack (11th lowest)
> Median household income: $48,547 (8th lowest)

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45. Ohio
> Adult smoking rate: 22.5%
> Lung cancer diagnoses per 100,000 people: 67.0 (14th highest)
> State cigarette excise tax: $1.60 per pack (22nd highest)
> Median household income: $52,334 (17th lowest)

46. Mississippi
> Adult smoking rate: 22.7%
> Lung cancer diagnoses per 100,000 people: 73.9 (4th highest)
> State cigarette excise tax: $0.68 per pack (14th lowest)
> Median household income: $41,754 (the lowest)

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47. Louisiana
> Adult smoking rate: 22.8%
> Lung cancer diagnoses per 100,000 people: 68.8 (10th highest)
> State cigarette excise tax: $0.86 per pack (16th lowest)
> Median household income: $45,146 (4th lowest)

48. Arkansas
> Adult smoking rate: 23.6%
> Lung cancer diagnoses per 100,000 people: 77.4 (3rd highest)
> State cigarette excise tax: $1.15 per pack (20th lowest)
> Median household income: $44,334 (3rd lowest)

49. Kentucky
> Adult smoking rate: 24.5%
> Lung cancer diagnoses per 100,000 people: 91.4 (the highest)
> State cigarette excise tax: $0.60 per pack (10th lowest)
> Median household income: $46,659 (6th lowest)

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50. West Virginia
> Adult smoking rate: 24.8%
> Lung cancer diagnoses per 100,000 people: 77.6 (2nd highest)
> State cigarette excise tax: $0.55 per pack (6th lowest)
> Median household income: $43,385 (2nd lowest)

Detailed Findings & Methodology

To help curb tobacco use (and the eventual health care cost burden) many state governments levy heavy excise taxes on tobacco — a tax the consumer pays when buying cigarettes. The states with the highest excise tax on tobacco products tend to have some of the country’s lowest smoking rates, which suggests these taxes may be effective in lowering the smoking rate.

The five states charging the highest cigarette taxes — New York, Rhode Island, Connecticut, Massachusetts, and Hawaii — are also among the states with the lowest adult smoking rates. New York, for example, which imposes a nation-leading tax on cigarettes of $4.35 per pack, has the ninth lowest adult smoking rate at 14.2%. West Virginia, by contrast, which levies the sixth lowest excise tax on tobacco at 55 cents per pack, leads the nation with nearly 25% of adults reporting a smoking habit.

The United States spends around $170 billion a year to treat tobacco-related illnesses, including lung cancer, stroke, diabetes, and cardiovascular diseases. Cigarette smoke contains more than 7,000 chemicals, of which 69 are known carcinogens. As a result, smoking is the leading cause of cancer.

Utah, the state with the lowest smoking rate, also has the lowest incidence of lung cancer in the country. By contrast, the states with the three highest cancer diagnosis rates — Kentucky, West Virginia, and Arkansas — also have the top three adult smoking rates.

The association between smoking and household income is well documented through years of research. Gallup surveys have found that approximately 34% of individuals earning $6,000 to $11,999 annually smoke, while only 13% of people with incomes of at least $90,000 per year say the same.

This pattern can also be observed at the state level. Median household incomes exceed the national median in 15 of the 25 states with the lowest smoking rates. Among the 25 states with higher smoking rates, median incomes exceed the national median in only five.

To identify the states with the highest adult smoking rates, 24/7 Wall St. reviewed the rate of adult smokers by state from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. Cancer deaths and cancer diagnoses per capita came from the 2016 America’s Health Rankings annual report from the United Health Foundation. Premature death rates — deaths before the age of 75 — per capita are from the County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. State cigarette excise taxes were obtained from the Tax Foundation. The median household income in each state came from the U.S. Census Bureau’s 2016 American Community Survey.

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