The good news is that tobacco smoking is declining globally, including in the United States. The bad news is that about 16% of the adults in the country still smoke regularly, and more than 16 million Americans suffer from a smoking-related condition.

What makes cigarettes so addictive is the nicotine in the tobacco. “Cigarettes are the most efficient drug-delivery device ever made,” said Adam Goldstein, M.D., M.P.H, director of Tobacco Intervention Programs at the University of North Carolina School of Medicine. “Nicotine is the hardest addiction to quit.” It enters the nervous system within seconds, attaching itself to receptors in the brain that release dopamine, which is commonly knowns as “the feel good hormone,” Goldstein explained.

On average, 11.7% of Americans smoke every day, according to data from the Centers for Disease Control and Prevention (CDC). Cigarette smoking is highest in the South and Midwest.

There appears to be a connection between the number of people in a state who smoke and the tax on cigarettes — the higher the percentage of smokers, the lower the tax.

Adverse smoking-related health outcomes are also more common in the states with the highest smoking rates. The three states with the highest smoking rates — West Virginia, Kentucky and Arkansas — are the same three states with the highest incidence of heart disease, the highest lung cancer death rates, and highest rates of heart attack history. All three states are in the top five of states with the most residents who have had a stroke and report being in poor health.

To identify the states with the highest percentage of smokers, 24/7 Wall St. reviewed data from the CDC’s Behavioral Risk Factor Surveillance System data. Respondents are people over 18 years of age who report smoking at least every day in 2017. The additional data about the rate of lung cancer deaths are from 2015 and the excise tax rates are as of Jan. 1, 2018. The measure of people in poor health includes adults who report 14 or more days in the last month during which they felt sick.

Click here to see the states with the most smokers.

50. Utah
> Adults who smoke every day: 6.0%
> Lung cancer deaths per 100,000 people: 19.1 (the lowest)
> Cigarette excise tax: $1.70 (22nd highest)
> Adults reporting poor health 3.6% (6th lowest)

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49. California
> Adults who smoke every day: 6.4%
> Lung cancer deaths per 100,000 people: 30.0 (4th lowest)
> Cigarette excise tax: $2.87 (9th highest)
> Adults reporting poor health 4.0% (16th lowest)

48. Hawaii
> Adults who smoke every day: 8.0%
> Lung cancer deaths per 100,000 people: 31.9 (5th lowest)
> Cigarette excise tax: $3.20 (5th highest)
> Adults reporting poor health 3.5% (3rd lowest)

47. New Jersey
> Adults who smoke every day: 8.4%
> Lung cancer deaths per 100,000 people: 35.0 (12th lowest)
> Cigarette excise tax: $2.70 (10th highest)
> Adults reporting poor health 4.6% (23rd highest)

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46. Connecticut
> Adults who smoke every day: 8.4%
> Lung cancer deaths per 100,000 people: 34.7 (10th lowest)
> Cigarette excise tax: $4.35 (the highest)
> Adults reporting poor health 3.7% (9th lowest)

45. Massachusetts
> Adults who smoke every day: 8.6%
> Lung cancer deaths per 100,000 people: 39.1 (18th lowest)
> Cigarette excise tax: $3.51 (4th highest)
> Adults reporting poor health 3.5% (5th lowest)

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44. New York
> Adults who smoke every day: 8.9%
> Lung cancer deaths per 100,000 people: 36.2 (13th lowest)
> Cigarette excise tax: $4.35 (the highest)
> Adults reporting poor health 4.5% (25th lowest)

43. Washington
> Adults who smoke every day: 9.1%
> Lung cancer deaths per 100,000 people: 38.6 (17th lowest)
> Cigarette excise tax: $3.03 (8th highest)
> Adults reporting poor health 4.2% (18th lowest)

42. Texas
> Adults who smoke every day: 9.3%
> Lung cancer deaths per 100,000 people: 35.0 (12th lowest)
> Cigarette excise tax: $1.41 (24th lowest)
> Adults reporting poor health 5.4% (14th highest)

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41. Maryland
> Adults who smoke every day: 9.3%
> Lung cancer deaths per 100,000 people: 37.7 (15th lowest)
> Cigarette excise tax: $2.00 (14th highest)
> Adults reporting poor health 3.6% (8th lowest)

40. Colorado
> Adults who smoke every day: 9.7%
> Lung cancer deaths per 100,000 people: 27.7 (2nd lowest)
> Cigarette excise tax: $0.84 (14th lowest)
> Adults reporting poor health 3.5% (2nd lowest)

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39. Rhode Island
> Adults who smoke every day: 9.8%
> Lung cancer deaths per 100,000 people: 46.9 (13th highest)
> Cigarette excise tax: $4.25 (3rd highest)
> Adults reporting poor health 4.5% (24th highest)

38. Minnesota
> Adults who smoke every day: 9.9%
> Lung cancer deaths per 100,000 people: 37.0 (14th lowest)
> Cigarette excise tax: $3.04 (7th highest)
> Adults reporting poor health 3.0% (the lowest)

37. Arizona
> Adults who smoke every day: 10.2%
> Lung cancer deaths per 100,000 people: 34.5 (9th lowest)
> Cigarette excise tax: $2.00 (14th highest)
> Adults reporting poor health 5.0% (17th highest)

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36. Idaho
> Adults who smoke every day: 10.5%
> Lung cancer deaths per 100,000 people: 34.4 (8th lowest)
> Cigarette excise tax: $0.57 (7th lowest)
> Adults reporting poor health 4.3% (21st lowest)

35. Illinois
> Adults who smoke every day: 10.5%
> Lung cancer deaths per 100,000 people: 43.4 (20th highest)
> Cigarette excise tax: $1.98 (19th highest)
> Adults reporting poor health 3.7% (10th lowest)

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34. New Mexico
> Adults who smoke every day: 10.8%
> Lung cancer deaths per 100,000 people: 29.5 (3rd lowest)
> Cigarette excise tax: $1.66 (24th highest)
> Adults reporting poor health 6.4% (9th highest)

33. Florida
> Adults who smoke every day: 10.9%
> Lung cancer deaths per 100,000 people: 40.0 (21st lowest)
> Cigarette excise tax: $1.34 (22nd lowest)
> Adults reporting poor health 5.4% (15th highest)

32. Nebraska
> Adults who smoke every day: 11.1%
> Lung cancer deaths per 100,000 people: 41.4 (24th lowest)
> Cigarette excise tax: $0.64 (11th lowest)
> Adults reporting poor health 3.6% (7th lowest)

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31. Nevada
> Adults who smoke every day: 11.1%
> Lung cancer deaths per 100,000 people: 41.7 (25th highest)
> Cigarette excise tax: $1.80 (20th highest)
> Adults reporting poor health 4.4% (22nd lowest)

30. Virginia
> Adults who smoke every day: 11.2%
> Lung cancer deaths per 100,000 people: 41.2 (23rd lowest)
> Cigarette excise tax: $0.30 (2nd lowest)
> Adults reporting poor health 4.2% (19th lowest)

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29. Delaware
> Adults who smoke every day: 11.2%
> Lung cancer deaths per 100,000 people: 46.5 (14th highest)
> Cigarette excise tax: $2.10 (13th highest)
> Adults reporting poor health 4.9% (20th highest)

28. Georgia
> Adults who smoke every day: 11.5%
> Lung cancer deaths per 100,000 people: 42.2 (24th highest)
> Cigarette excise tax: $0.37 (3rd lowest)
> Adults reporting poor health 4.8% (21st highest)

27. Oregon
> Adults who smoke every day: 11.5%
> Lung cancer deaths per 100,000 people: 38.6 (17th lowest)
> Cigarette excise tax: $1.33 (21st lowest)
> Adults reporting poor health 4.9% (19th highest)

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26. Wisconsin
> Adults who smoke every day: 11.7%
> Lung cancer deaths per 100,000 people: 39.9 (20th lowest)
> Cigarette excise tax: $2.52 (12th highest)
> Adults reporting poor health 4.2% (20th lowest)

25. Vermont
> Adults who smoke every day: 11.8%
> Lung cancer deaths per 100,000 people: 41.5 (25th lowest)
> Cigarette excise tax: $3.08 (6th highest)
> Adults reporting poor health 3.9% (14th lowest)

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24. New Hampshire
> Adults who smoke every day: 11.9%
> Lung cancer deaths per 100,000 people: 43.4 (20th highest)
> Cigarette excise tax: $1.78 (21st highest)
> Adults reporting poor health 3.5% (5th lowest)

23. North Carolina
> Adults who smoke every day: 11.9%
> Lung cancer deaths per 100,000 people: 45.6 (16th highest)
> Cigarette excise tax: $0.45 (5th lowest)
> Adults reporting poor health 5.3% (16th highest)

22. Montana
> Adults who smoke every day: 12.2%
> Lung cancer deaths per 100,000 people: 39.2 (19th lowest)
> Cigarette excise tax: $1.70 (22nd highest)
> Adults reporting poor health 4.5% (25th highest)

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21. Kansas
> Adults who smoke every day: 12.2%
> Lung cancer deaths per 100,000 people: 44.4 (19th highest)
> Cigarette excise tax: $1.29 (20th lowest)
> Adults reporting poor health 4.5% (25th lowest)

20. South Carolina
> Adults who smoke every day: 12.5%
> Lung cancer deaths per 100,000 people: 45.0 (18th highest)
> Cigarette excise tax: $0.57 (7th lowest)
> Adults reporting poor health 6.0% (10th highest)

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19. Iowa
> Adults who smoke every day: 12.6%
> Lung cancer deaths per 100,000 people: 45.1 (17th highest)
> Cigarette excise tax: $1.36 (23rd lowest)
> Adults reporting poor health 3.8% (11th lowest)

18. Maine
> Adults who smoke every day: 13.2%
> Lung cancer deaths per 100,000 people: 50.3 (9th highest)
> Cigarette excise tax: $2.00 (14th highest)
> Adults reporting poor health 4.1% (17th lowest)

17. Oklahoma
> Adults who smoke every day: 13.3%
> Lung cancer deaths per 100,000 people: 54.0 (6th highest)
> Cigarette excise tax: $1.03 (16th lowest)
> Adults reporting poor health 6.8% (7th highest)

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16. North Dakota
> Adults who smoke every day: 13.3%
> Lung cancer deaths per 100,000 people: 34.4 (8th lowest)
> Cigarette excise tax: $0.44 (4th lowest)
> Adults reporting poor health 4.0% (16th lowest)

15. Pennsylvania
> Adults who smoke every day: 13.4%
> Lung cancer deaths per 100,000 people: 43.0 (22nd highest)
> Cigarette excise tax: $2.60 (11th highest)
> Adults reporting poor health 4.9% (18th highest)

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14. Michigan
> Adults who smoke every day: 13.6%
> Lung cancer deaths per 100,000 people: 45.9 (15th highest)
> Cigarette excise tax: $2.00 (14th highest)
> Adults reporting poor health 5.6% (12th highest)

13. South Dakota
> Adults who smoke every day: 13.7%
> Lung cancer deaths per 100,000 people: 40.3 (22nd lowest)
> Cigarette excise tax: $1.53 (25th lowest)
> Adults reporting poor health 3.8% (13th lowest)

12. Alabama
> Adults who smoke every day: 13.7%
> Lung cancer deaths per 100,000 people: 49.0 (11th highest)
> Cigarette excise tax: $0.68 (12th lowest)
> Adults reporting poor health 7.1% (6th highest)

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11. Wyoming
> Adults who smoke every day: 14.0%
> Lung cancer deaths per 100,000 people: 32.2 (6th lowest)
> Cigarette excise tax: $0.60 (9th lowest)
> Adults reporting poor health 4.4% (23rd lowest)

10. Alaska
> Adults who smoke every day: 14.6%
> Lung cancer deaths per 100,000 people: 42.5 (23rd highest)
> Cigarette excise tax: $2.00 (14th highest)
> Adults reporting poor health 3.8% (12th lowest)

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9. Louisiana
> Adults who smoke every day: 15.0%
> Lung cancer deaths per 100,000 people: 50.5 (8th highest)
> Cigarette excise tax: $1.08 (17th lowest)
> Adults reporting poor health 7.3% (5th highest)

8. Indiana
> Adults who smoke every day: 15.8%
> Lung cancer deaths per 100,000 people: 50.2 (10th highest)
> Cigarette excise tax: $1.00 (15th lowest)
> Adults reporting poor health 5.6% (11th highest)

7. Tennessee
> Adults who smoke every day: 16.0%
> Lung cancer deaths per 100,000 people: 54.3 (5th highest)
> Cigarette excise tax: $0.62 (10th lowest)
> Adults reporting poor health 6.7% (8th highest)

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6. Missouri
> Adults who smoke every day: 16.2%
> Lung cancer deaths per 100,000 people: 51.1 (7th highest)
> Cigarette excise tax: $0.17 (the lowest)
> Adults reporting poor health 5.5% (13th highest)

5. Mississippi
> Adults who smoke every day: 16.4%
> Lung cancer deaths per 100,000 people: 54.7 (4th highest)
> Cigarette excise tax: $0.68 (13th lowest)
> Adults reporting poor health 8.0% (3rd highest)

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4. Ohio
> Adults who smoke every day: 16.5%
> Lung cancer deaths per 100,000 people: 49.0 (11th highest)
> Cigarette excise tax: $1.60 (25th highest)
> Adults reporting poor health 4.7% (22nd highest)

3. Arkansas
> Adults who smoke every day: 16.7%
> Lung cancer deaths per 100,000 people: 57.1 (3rd highest)
> Cigarette excise tax: $1.15 (18th lowest)
> Adults reporting poor health 7.5% (4th highest)

2. Kentucky
> Adults who smoke every day: 19.4%
> Lung cancer deaths per 100,000 people: 64.3 (the highest)
> Cigarette excise tax: $0.60 (9th lowest)
> Adults reporting poor health 8.0% (2nd highest)

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1. West Virginia
> Adults who smoke every day: 20.0%
> Lung cancer deaths per 100,000 people: 57.3 (2nd highest)
> Cigarette excise tax: $1.20 (19th lowest)
> Adults reporting poor health 8.7% (the highest)

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