Across all 50 states, the same 5 disparities in cigarette smoking persist

Across the country, data show a consistent pattern of disparities in cigarette smoking, highlighting the relationship between tobacco use and various socioeconomic and health factors.

The CDC’s interactive tool on state tobacco-related disparities allows users to easily access these data, which include smoking prevalence by state and filters for demographics such as age, race, disability, income, education, and more. The tool incorporates data from the Behavioral Risk Factor Surveillance System (BRFSS), the nation’s system of telephone surveys that collect information on health-related risk behaviors, chronic health conditions, and use of preventive services.

While smoking prevalence can vary widely in different parts of the country – 12 Midwestern and Southern states have 50% higher smoking prevalence – the same demographic factors influence disparities regardless of location. These five socioeconomic and health factors must be addressed to help all Americans enjoy healthy lives free from nicotine addiction.

Mental health

Across all 50 states, data show smoking prevalence was higher among respondents who reported severe mental distress compared to respondents who reported no mental distress. The tobacco industry has historically marketed smoking as a form of stress relief and targeted groups that are economically and socially marginalized, including people with mental health conditions, which has played a role in higher tobacco use among this population. Quit smoking programs that recognize the challenges that may exist for people with mental health conditions are needed to help this population quit.

Disability

Smoking prevalence was also higher among respondents who reported having a disability compared to those who did not. According to the data, “having any disability” refers to an adult who self-reported having difficulty with hearing, vision, cognition, mobility, self-care, or independent living. This trend in smoking prevalence among people with disabilities points to potential gaps in health care access and/or targeted quitting support for individuals with disabilities.

Education

Access to education, which is often dependent on factors such as income, disability status, and mental health, is part of the pattern as well. Across the country, smoking prevalence was higher among respondents who reported not graduating college.

Income

Tobacco use is also highly related to socioeconomic status. In all 50 states, smoking prevalence was higher among respondents who reported making less than $20,000 annually. Low-income individuals and communities often have limited access to resources and programs to help them quit smoking. On top of that, the tobacco industry has a long history of targeting low-income communities, including by handing out free cigarettes to children in housing projects, issuing tobacco coupons with food stamps, and exploring giveaways of financial products like prepaid debit cards.

Employment status

Lastly, employment status proved to be a consistent predictor of smoking habits, with smoking prevalence higher among respondents who reported being unemployed. Smoking prevalence related to employment status may be related to other factors, such as disability and mental health status and could also reflect the impact of stress caused by financial insecurity.

To address disparities in tobacco use, broader socioeconomic inequities must be remedied

These consistent disparities across all states underscore the wide-reaching consequences of the social, economic, and health inequalities facing our country. To tackle disparities in smoking prevalence, these broader societal factors must be addressed.

Greater funding for public education campaigns and quitting programs, tailored to these demographics, are needed, and are extremely effective especially when paired with higher taxes on tobacco products. Increased access to mental health resources is also essential as studies show that counseling, combined with cessation medications, can triple a smoker’s chances of quitting.

By addressing these broader societal factors, policymakers and health professionals may be better equipped to reduce smoking prevalence and improve the overall health of our nation.