Breathe Easy: States with the Greatest Decline in Smoking

When it comes to breaking this bad habit, some states have gone above and beyond for the sake of public health.

Perhaps one of the most significant shifts in the cultural paradigm during the twenty-first century has been the perception of smoking. For most of U.S. history, smoking was glamorized and accepted as a societal norm. In 2009, however, the Tobacco Regulation Law was passed, allowing the FDA to regulate tobacco manufacturers. As a result, the negative health outcomes of smoking are now regularly taught in schools and must be disclosed on cigarette packets. f This recent scrutiny of tobacco companies, especially in their efforts to appeal to young people by selling candy and fruit-flavored cigarette products (which were banned as of 2009), demonstrates a move towards contending with corporations in order to improve public health.

Even more recently, the coronavirus pandemic has heightened anxiety surrounding the effects of smoking. As COVID-19 primarily affects respiratory function, some studies indicate that smokers are at a higher risk of experiencing debilitating and sometimes fatal symptoms of the virus.

Smoking also comes at a cost. Not only are tobacco products notoriously expensive, but health insurance for smokers is quite costly. In fact, insurers can charge smokers up to 50 percent more in premium costs compared to non-smokers due to a practice called tobacco rating. The surcharge of premium expenses for smokers varies from state to state, but nonetheless, smokers in most cases will pay noticeably more for their insurance.

With the influx of regulations on tobacco companies over the past twenty or so years — it wasn’t until 2000 that smoking on airplanes was officially banned across all American aircraft — the prevalence of smoking across the country has fluctuated. Curious to see which states experienced the greatest reductions in smoking within this time frame, the research team at Insurify[/feelink] crunched the numbers to identify the states with the most significant drops in cigarette use over the past decade.

Insights

• National averages. Across the United States, the smoking rate decreased by 19.85 percent over the past decade. Counterintuitively, attempts to quit smoking also decreased by 2.4 percent during this time period. Statewide annual cigarette sales between 2011 and 2018 totaled $332,228,603 on average.

• Smoking rates dropped, but cigarette sales did not follow. While the United States experienced an overall decline in smoking over the past decade, this did not correspond to a decrease in cigarette sales over the same time period. The proportion of smokers to the greater population gradually but steadily decreased between 2011 and 2018. On the other hand, while cigarette sales experienced a downwards dip of approximately $18 million in 2015, by 2018 sales bounced back to the same level as the beginning of the decade. Cigarette sales and smoking rates are thus not significantly correlated, as they followed different trajectories over time.

• The decrease in smoking is not correlated with an increase in cessation. It’s logical to assume that the overall decrease in smoking rates in the U.S. over the past decade are the result of more people quitting the habit altogether. However, the change in smoking rates over the last decade has no significant association with the change in cessation rates throughout the same time period. In fact, while smoking rates declined, cessation rates — the rate at which smokers attempted to quit — additionally decreased, albeit at a lower rate. This seemingly counterintuitive finding suggests that the drop in smokers may not necessarily be due to more people quitting, but that fewer individuals are picking up the habit in the first place.

Methodology

The data scientists at Insurify, a platform to compare Medicare Advantage plans, examined data from the Centers for Disease Control and Prevention (CDC) State Tobacco Activities Tracking and Evaluation (STATE) System initiative. The CDC’s data comes from the BRFSS Survey Data project, which is an ongoing, state-based surveillance system that collects information about modifiable risk factors for chronic diseases and other leading causes of death, including smoking rates.

To identify the states with the greatest drops in smoking rates over the past decade, Insurify’s analysts looked at the proportion of people who identified as current smokers, or people who reported ever smoking at least 100 cigarettes and who currently smoke every day or on some days, between 2011 and 2018. The states with the greatest decrease in the ratio of smokers to nonsmokers between 2011 and 2018 were identified. The relative change in cessation amongst smokers was found by taking the percent change in the share of everyday smokers who quit smoking for one day or more between 2011 and 2018.

Data regarding statewide spending on tobacco products came from the CDC’s National Center for Chronic Disease Prevention and Health Promotion’s Office on Smoking and Health. Annual cigarette sales were taken from the most recent data available from 2018.

States with the Greatest Decrease in Smoking

10. Nevada

• Relative decrease in smoking population: -38.91%

• Relative change in cessation attempts amongst smokers: -3.73% (attempts to quit decreased)

• Average annual cigarette sales: $126,627,476

Nevada kicks off the rankings with a reduction in smoking that eclipses the national average by 49 percent. Throughout the past decade, Nevada’s cigarette sales were also below average by 62 percent. While cessation rates in Nevada decreased over time as well — meaning that fewer smokers attempted to quit — the Silver State’s decreased smoking rate is worthy of recognition.

9. Minnesota

• Relative decrease in smoking population: -39.84%

• Relative change in cessation attempts amongst smokers: -3.93% (attempts to quit decreased)

• Average annual cigarette sales: $487,212,081

The ninth state on the list may have a great number of lakes — they don’t call it the Land of 10,000 Lakes for nothing — but its number of smokers has dwindled significantly over the past decade. Minnesota’s reduction in smoking rates exceeds the nationwide mean by 51 percent. Given that the state’s annual cigarette sales were in fact 32 percent higher than the national average and the quitting-attempt rate decreased over time as well, Minnesota’s sizable drop in smoking may come as a surprise, but a welcome one at that.

8. Pennsylvania

• Relative decrease in smoking population: -40.56%

• Relative change in cessation attempts amongst smokers: -4.50% (attempts to quit decreased)

• Average annual cigarette sales: $1,121,621,302

Pennsylvania is eighth in the rankings for its steep drop in smoking rates since 2011. Its share of smokers declined at a rate that exceeds the national average by 52 percent. Interestingly, Pennsylvania has particularly high cigarette sales and fewer attempts at quitting than the rest of the country. However, Pennsylvania’s ability to lower its smoking rates by nearly 41 percent is a testament to its investment in public health.

7. California

• Relative decrease in smoking population: -41.97%

• Relative change in cessation attempts amongst smokers: 1.33% (attempts to quit increased)

• Average annual cigarette sales: $945,452,088

The Golden Coast comes with a remarkable reduction in smoking rates to match. The frequency of smoking in California dropped 53 percent faster than the rest of the United States over the last decade. California is the first state on the list with an uptick in cessation rates, meaning that more Californians committed to quitting smoking compared to the rest of the nation. Despite exceeding average statewide cigarette sales by 65 percent, California is a true beacon when it comes to tobacco elimination.

6. Washington

• Relative decrease in smoking population: -44.95%

• Relative change in cessation attempts amongst smokers: -19.2% (attempts to quit decreased)

• Average annual cigarette sales: $398,272,252

Another west coast standout, Washington comes in sixth for its stellar record on smoking reduction over the past decade. With a decline in its smoking rates 56 percent greater than the U.S. average — especially surprising given that attempts to quit decreased by nearly 20 percent in the state — Washington saw one of the most impressive cutbacks in its residents’ smoking patterns in the twenty-first century.

5. Maryland

• Relative decrease in smoking population: -46.35%

• Relative change in cessation attempts amongst smokers: 1.9% (attempts to quit increased)

• Average annual cigarette sales: $371,004,196

Maryland comes in fifth for its reduction in smoking rates over the past ten years. Residents in the Old Line State decreased their smoking at a rate which exceeded the national average by 58 percent. Maryland’s annual cigarette sales hover just above the national average, but unlike the rest of the nation, cessation rates in the state increased over time. Props to this mid-Atlantic champion for its success in tobacco-related harm reduction within the last decade.

4. Hawaii

• Relative decrease in smoking population: -46.40%

• Relative change in cessation attempts amongst smokers: -12.1% (attempts to quit decreased)

• Average annual cigarette sales: $120,569,131

Hawaii can boast not only beautiful natural landscapes and idyllic beachfronts, but also prominent accomplishments in its public health outcomes. The Aloha State’s smoking rates declined 58 percent faster than the national average over the past decade. While Hawaii’s cessation rate fell below the national average, meaning that the volume of smokers attempting to quit decreased over time, Hawaii’s significant reduction in smoking is likely due to fewer individuals picking up the habit.

3. Vermont

• Relative decrease in smoking population: -47.51%

• Relative change in cessation attempts amongst smokers: -4.23% (attempts to quit decreased)

• Average annual cigarette sales: $68,439,325

Vermont rounds out the final three states with a reduction in smoking that exceeds the national average by 59 percent. It seems that residents of the Green Mountain State are taking a stand in the name of public health by making strident efforts to minimize the prevalence of smoking. Cigarette sales in Vermont fell 80 percent below the national average, even as attempts to quit smoking declined over time.

2. New York

• Relative decrease in smoking population: -50.00%

• Relative change in cessation attempts amongst smokers: -11.3% (attempts to quit decreased)

• Average annual cigarette sales: $ 1,314,252,092

The Empire State has earned its place as a national leader in smoking reduction. By 2018, its volume of smokers was half of what it was in 2011 — a reduction which was a full 61 percent greater than the national average. While New York’s quitting attempts fell by 11.3 percent and its cigarette sales exceeded the national average by 75 percent during this period, reducing their percentage of smokers by 50 percent is no small feat.

1. Utah

• Relative decrease in smoking population: -60.87%

• Relative change in cessation attempts amongst smokers: 3.11% (attempts to quit increased)

• Average annual cigarette sales: $99,401,189

Topping off the rankings is Utah, a state whose smoking rate declined 68 percent faster than average between 2011 and 2018. Unlike many other states, Utah’s attempts to quit smoking actually increased over this same time period. Additionally, cigarette sales in Utah fell 71 percent below the nationwide mean. According to the American Lung Association, Utah invests $5.03 per smoker with its state-run quit line, which is a full 57 percent greater than the national average of $2.21. The Beehive State certainly takes tobacco regulation seriously, and these efforts should not go unrecognized.

If you have questions or comments about this article, please contact insights@insurify.com.