The 10 States with the Highest Smoking Rates

Despite the fact that doctors — and the general public – have been aware of the hazardous health effects of smoking for decades, nearly 1 in 5 Americans still smokes, according to a poll from Gallup.

Nationally, 19.7% of Americans smoked in 2013, down from 21.1% in 2008. In Rhode Island, North Dakota, Alaska, Illinois, and Nevada, the smoking rate dropped by 4% or more over that 5-year span.

Gallup found Utah had the lowest smoking rate of any state, 12.2%. Gallup notes that Utah’s low rate appears largely tied to religion. The Church of Jesus Christ of Latter Day Saints prohibits smoking, and the Gallup poll found just 5% of Mormons break that prohibition.

After Utah, California (15%), Minnesota (15.8%), Massachusetts (16.3%), and New Jersey (16.9%) round out the Top 5 on the list of states with the lowest smoking rates.

That’s a big deal because according to the Centers for Disease Control and Prevention, smoking remains the most prevalent preventable cause of the death in the US, responsible for about 1 in 5 deaths each year.

Public smoking policy appears to play a large role. Gallup notes that 9 of the 10 states with the lowest smoking rates ban smoking in worksites, restaurants and bars.

What follows are the 10 states with the highest smoking rates, according to Gallup. Supplemental data is from the Campaign for Tobacco-Free Kids, unless otherwise noted.

Smoking Rate: 23.2%

Michigan bans smoking in workplaces, bars, and restaurants, and yet its smoking rate remains above the national average. According to the Campaign for Tobacco-Free Kids, more than 16,000 adults die each year in Michigan as a result of smoking. Healthcare costs as a result of smoking totaled $4.59 billion per year, according to the group, about one-quarter of that cost is shouldered by the Medicaid program.

Smoking Rate: 23.6%

Tennessee has a workplace smoking ban, and allows smoking in restaurants only in designated areas. The state has no ban on smoking in bars. The Campaign for Tobacco-Free Kids says 11,400 Tennessee adults die each year from smoking, costing the state about $2.67 billion in healthcare costs. The state and federal governments spend about $597 per household each year in smoking-related expenditures.

Smoking Rate: 24.1%

Louisiana bans smoking in workplaces and restaurants, but not in bars. Smoking-related health problems cost the stat $1.89 billion each year, about one-third of which is paid by Medicaid. The tobacco industry spends about $215 million in marketing in the state each year.

Smoking Rate: 24.7%

Indiana’s high school smoking rate — 18.1% – is almost as high as the national adult smoking rate. The Campaign for Tobacco-Free Kids estimates 151,000 children in Indiana under the age of 18 will eventually die prematurely due to smoking. The state spends about $2.93 billion each year on smoking-related healthcare costs. Indiana bans smoking in workplaces and restaurants, but not in bars.

Smoking Rate: 24.7%

Missouri has no bans on smoking in workplaces, bars, or restaurants. Instead, each venue is required or allowed to set aside a designated smoking area. About 11,000 adults will die of smoking-related causes each year, and overall smoking-related healthcare will cost the state more than $3 billion each year. The Campaign for Tobacco-Free Kids also estimates smoking costs the state $2.5 billion in lost productivity annually.

Smoking Rate: 25.0%

Ohio is one of only 2 states in the Top 10 that bans smoking in workplaces, restaurants, and bars, and yet it continues to have a smoking rate well above the national average. More than 20,000 people die each year as a result of smoking, and smoking-related healthcare costs the state $5.64 billion per year, according to the Campaign for Tobacco-Free Kids. The industry is believed to spend nearly $400 million each year marketing cigarettes and other tobacco products in Ohio.

Smoking Rate: 25.2%

Oklahoma allows smoking in designated areas in workplaces, and requires restaurants to have separately ventilated areas if they allow smoking. However, the Campaign for Tobacco-Free Kids estimates 18.5% of high school students in the state smoke. About 7,500 Oklahomans die each year as a result of smoking.

Smoking Rate: 27.0%

Mississippi has no statewide bans on smoking. Nonetheless, a relatively low number — just 5,400 – of the state’s residents die each year from smoking-related causes. Smoking-related healthcare costs in the state total $1.23 billion each year, and smoking-related productivity losses totaled an estimated $1.49 billion.

Smoking Rate: 29.9%

West Virginia doesn’t ban smoking in public places. Smoking costs the state about $1 billion in healthcare costs each year, and another $1 billion in lost productivity, according to the Campaign for Tobacco-Free Kids. Smoking-related government spending equals about $600 annually per household in West Virginia. The tobacco industry spends $120.4 million marketing its products in the state each year.

Smoking Rate: 30.2%

North Carolina may be the top tobacco-producing state in the nation, but it’s Kentucky that has the highest rate of smokers. In fact, Kentucky’s just behind North Carolina when it comes to tobacco production. That may be why the state has no bans on smoking in public places. An estimated 8,300 Kentucky residents will die as a result of smoking each year. Healthcare for smokers costs about $192 million per year.