Smoking and Cancer: 10 States Where Tobacco Kills the Most People

loose cigarettes, smoking tied to cancer

Smoking cigarettes leads to higher rates of cancer deaths in some states | Matt Cardy/Getty Images

Thinking about lighting up? You might want to reconsider. Cigarettes are to blame for 29% of all cancer deaths in the United States, a study by researchers at the American Cancer Society found. In some tobacco-friendly Southern states, up to 40% of cancer deaths in men can be linked to smoking.

The authors of the study, which was published in JAMA Internal Medicine, analyzed state-by-state data to find out where smoking took the biggest toll. Overall, they found that more than 167,000 people have died of cancer attributable to cigarette smoking since 2014. (In addition to lung cancer, researchers also looked at 11 other smoking-related cancers, including pancreatic, liver, kidney, esophageal, and stomach cancers.)

Smoking caused at least 20% of cancer deaths in every U.S. state except Utah, but the mortality rate was much higher in some states than in others, particularly in the South. Men accounted for 62% of deaths, and African-Americans were more likely than whites or Hispanics to die from smoking-related cancers.

Smoking and cancer in the US

Though some of the variation in cancer mortality could be due to demographic differences, most of the disparity is related to a lack of strong anti-smoking laws, low cigarette taxes, and poor funding for anti-smoking programs in some states, the authors of an accompanying opinion piece argued. Among the 10 states with the highest rates of tobacco-related cancer, none had comprehensive smoke-free air laws and the average cigarette tax was less than $1 per pack. In the 10 states with the lowest prevalence, cigarettes are taxed at nearly $2 per pack, on average, and eight had smoke-free air laws. Not coincidentally, the authors argued, the states with a high percentage of smoking-related cancer deaths are also states where the tobacco industry has a strong presence.

New or enhanced anti-smoking initiatives, such as higher cigarette taxes and stronger smoking bans, could help curb some of the cancer deaths caused by smoking. But after a period of success in the 1990s and early 2000s, efforts to put new smoking regulations in place have stalled, which could mean regional disparities in smoking-related cancers will get worse before they get better, the authors worried.

“More than ever, evidence-based policy changes are needed to ‘unstick’ stalled states and to eliminate disparities in smoking prevalence and the burdens of tobacco-related disease and mortality,” they wrote.

When it comes to efforts to curb smoking rates and shrink the number of people dying of smoking-related cancer, these 10 states are in the greatest need of intervention.

10. Nevada

casino smoking protest

A man protests for smoke free casinos | Gabriel Bouys/AFP/Getty Images

Share of cancer deaths caused by smoking: 30.9%

Smoking causes close to 31% of cancer deaths in Nevada. Only 17.5% of Nevada adults smoke, according to the Centers for Disease Control and Prevention, significantly lower than many other states, and cigarettes are taxed at $1.80 per pack, which is higher than the national average, according to the Campaign for Tobacco-Free Kids. But smoking is still permitted in bars, casinos, and enclosed areas of restaurants.

9. Oklahoma

hand holding a cigarette

A man holding a cigarette | Spencer Platt/Getty Images

Share of cancer deaths caused by smoking: 31.1%

Nearly 2,500 Oklahomans have died of smoking-related cancers since 2014. Smoking was to blame for 36% of cancer deaths in men and 25% of cancer deaths in women. The state has relatively weak smoking regulations and cities are prohibited from passing more restrictive anti-smoking laws.

8. Alabama

packs of cigarettes

Cigarettes for sale | Mario Tama/Getty Images

Share of cancer deaths caused by smoking: 31.3%

Roughly 31% of the 10,180 cancer deaths in Alabama since 2014 can be blamed on smoking. About 21% of the population smokes, according to the CDC. The cigarette tax is 67.5 cents per pack. The state’s weak tobacco laws earned it an F rating in all four categories graded by the American Lung Association.

7. Missouri

gateway arch

The Gateway Arch in St Louis, Missouri | Jamie Squire/Getty Images

Share of cancer deaths caused by smoking: 31.3%

At 17 cents per pack, Missouri has the lowest cigarette taxes in the U.S. About 22% of adults smoke. The ALA gave the state an F for its lax anti-smoking laws, but did note that stronger local smoking ordinances protect nearly a quarter of the population from secondhand smoke.

6. Alaska

man smoking

A man smokes a cigarette in Shishmaref, Alaska | Andrew Burton/Getty Images

Share of cancer deaths caused by smoking: 31.4%

Alaska has the second-highest rate of smoking-related cancer deaths among women, at 27.5%. That’s likely because smoking prevalence among men and women in Alaska is roughly the same, the study’s authors noted. (In most states, men are more likely to smoke than women.) Smoking rates are also high (42%) among Native Americans and Alaskan Natives, who make up 15% of the state’s total population.

5. Louisiana

bourbon street

A man smoking a cigarette on Bourbon Street in New Orleans, Louisiana | Mario Tama/Getty Images

Share of cancer deaths caused by smoking: 32.6%

Roughly one-third of the 9,350 cancer deaths in Louisiana since 2014 can be linked to smoking. Twenty-two percent of the population smokes and the cigarette tax is $1.08 per pack.

4. West Virginia

autumn in west virginia

Fall color in West Virginia | Mladen Antonov/AFP/Getty Images

Share of cancer deaths caused by smoking: 32.6%

West Virginia is tied with Louisiana for its share of smoking-related cancer deaths. Nearly 26% of the adult population smokes, one of the highest rates in the country. There are few statewide restrictions on smoking, though many local jurisdictions have smoking bans in place. But lawmakers in the state have actually tried (without success) to make it easier for country officials to overturn those bans, the Charleston Gazette-Mail reported.

3. Tennessee

Camel cigarettes

Camel cigarettes | Justin Sullivan/Getty Images

Share of cancer deaths caused by smoking: 32.9%

In Tennessee, a third of all cancer deaths are attributable to smoking, including 39% of cancer deaths in men. The tax on cigarettes is 62 cents per pack. Twenty-two percent of all adults smoke.

2. Arkansas

Crushing out a cigarette in a ashtray

Putting out a cigarette in an ashtray |

Share of cancer deaths caused by smoking: 33.5%

Smoking-related cancers have killed 2,175 Arkansans since 2014. Forty percent of cancers in men can be blamed on cigarettes. Arkansas also has the fourth-highest share of smoking-related cancers deaths in women. Roughly one-quarter of the population smokes, one of the highest rates in the nation.

1. Kentucky

man smoking in tobacco field

A migrant worker smokes a cigarette during a tobacco harvest in Kentucky | Luke Sharrett/Getty Images

Share of cancer deaths caused by smoking: 34%

Kentucky leads the nation in the share of cancer deaths caused by cigarettes, with 3,452 people dying since 2014. Twenty-nine percent of cancer mortality in women is related to smoking, the highest share in the country. Twenty-six percent of the population smokes and cigarette taxes are 60 cents per pack.

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