State-Specific Prevalence of Current Cigarette Smoking and Smokeless Tobacco Use Among Adults Aged ≥18 years – United States, 2011-2013

May 22, 2015 / Vol. 64 / No. 19

MMWR Introduction

This report provides the most recent state-specific estimates of prevalence and relative percent change (RPC) in current cigarette smoking, current smokeless tobacco use, and concurrent cigarette smoking and smokeless tobacco use among US adults using data from the 2011-2013 Behavioral Risk Factor Surveillance System (BRFSS). States vary widely in prevalence of cigarette smoking, smokeless tobacco, and concurrent use of both products. From 2011 to 2013, there was a statistically significant decline in current cigarette smoking prevalence overall and in 26 states. During the same period, use of smokeless tobacco significantly increased in four states—Louisiana, Montana, South Carolina, and West Virginia, while significant declines were observed in two states—Ohio and Tennessee. Additionally, the concurrent use of cigarette smoking and smokeless tobacco significantly increased in five states (Delaware, Idaho, Nevada, New Mexico and West Virginia). The use of more than one tobacco product is concerning because adults who use both cigarettes and smokeless tobacco have higher levels of nicotine dependence and are less likely to report planning to quit than those who exclusively smoke cigarettes. While multiple components of tobacco control prevention and policy have had an effect on reducing cigarette smoking overall and within most states, the varied prevalence and increases in smokeless tobacco use across states highlights the importance of targeted population-based interventions focused on reducing the use of all tobacco products.

These findings highlight the importance of sustained comprehensive state tobacco control programs funded at CDC recommended levels, which can accelerate progress toward reducing tobacco-related disease and deaths by promoting evidence-based population-level interventions. These interventions include increasing the price of tobacco products, implementing comprehensive smoke-free laws, conducting hard-hitting mass media campaigns, restricting tobacco advertising and promotion, controlling access to tobacco products, and promoting cessation assistance for smokers to quit. Evidence-based, statewide tobacco control programs that are comprehensive, sustained, and accountable have been shown to reduce smoking rates, as well as tobacco-related diseases and deaths. However, during 2015, despite combined tobacco revenue of more than $25 billion from settlement payments and tobacco taxes for all states, states will spend only $490.4 million (1.9%) on comprehensive tobacco control programs, representing <15% of the CDC-recommended level of funding for all states combined. Full implementation of comprehensive tobacco control programs at CDC-recommended funding levels could reduce tobacco use and change social norms regarding the acceptability of tobacco use in the United States.