Despite the well-known detriments of cigarettes, smoking is perhaps one of the hardest habits to kick. According to U.S. surgeon general reports, nicotine — the chemical responsible for releasing dopamine in a smoker’s brain — has long been considered as addictive as cocaine and heroin.
Understandably, many smokers have tried to quit. The latest data from the Centers for Disease Control and Prevention (CDC) indicates that more than half of current U.S. smokers in 2020 attempted to kick the habit, in spite of how difficult doing so may be.
Notably, the rate of smokers who've attempted to quit is higher in some states than others. Our analysis indicates that access to health insurance may play a role.
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- 16.1% of American adults 18 or older were current tobacco smokers in 2020, according to the latest CDC data. That figure is down 24.4% from 21.3% in 2011.
- West Virginia, Kentucky and Arkansas had the highest rate of current smokers in 2020. Meanwhile, Utah had the lowest, followed by California. New Jersey and Maryland tied for third.
- More than half (54.7%) of those current smokers in 2020 said they tried to quit smoking in the past year. That figure is down 5.4% from 57.8% in 2011.
- The percentage of adult smokers who tried to quit was highest in Connecticut (64.9%), Alabama (64.6%) and the District of Columbia (63.6%). Smokers were least likely to try to quit smoking in Kentucky (46.6%), Maine (48.5%) and Arkansas (49.1%).
- By gender, a slightly higher rate of women (56.5%) who were current smokers in 2020 said they tried to quit in the past year than men (53.3%). The most significant difference was in New Hampshire, where 62.2% of women and 49.3% of men tried to quit — a difference of 12.9 percentage points.
Who’s considered a smoker, and what counts as an attempt to quit?
To estimate the rate of adult smokers and their attempts to quit, ValuePenguin researchers analyzed the CDC’s Behavioral Risk Factor Surveillance System (BRFSS), a self-reported survey. The CDC uses the following definitions in its survey:
- Current smokers: Adults in the survey population who actively smoke, or former smokers who’ve abstained for one year or less.
- Smokers who’ve attempted to quit: Number of current cigarette smokers (as defined above) who quit smoking for one day or longer during the 12 months before the survey.
ValuePenguin researchers analyzed the survey data to rank the states where current adult smokers tried to stop smoking. Researchers also ranked the states with the highest and lowest rate of adult smokers. To determine how these rates have changed over time, researchers compared 2020 data — the latest available — to that from 2011.
The percentage of U.S. adult smokers declined between 2011 and 2020
As of 2020, 16.1% of American adults 18 or older identified as current tobacco smokers — down from 21.3% in 2011. That’s a decline of 24.4%.
Rate of U.S. smokers by year
% of smoking adults
Source: ValuePenguin analysis of Behavioral Risk Factor Surveillance System (BRFSS) data.
ValuePenguin health insurance expert Nick VinZant attributes the decline to various factors.
"Fewer people are smoking for three reasons: awareness, cost and societal acceptance," he says. "People are more aware of the health impact smoking can have, health care costs for smokers are higher and smoking isn’t viewed as 'cool' like it once was."
This comes after the U.S.'s decades-long campaign to shed light on the harmful effects of tobacco, which is the leading cause of preventable disease and death in the nation, according to the Office of the Surgeon General. The CDC reports that 16 million Americans live with smoking-related diseases, while 480,000 deaths result from smoking each year.
Meanwhile, the CDC reports that a 10% increase in tobacco product prices reduces overall cigarette consumption by 3% to 5%. As part of a public health campaign against cigarettes, federal and state legislation has increasingly enforced heavy taxes since the mid-1980s. Federal and state excise taxes now account for 44.3% of the average retail price of cigarettes.
Where smoking is most (and least) prevalent
Before getting into the rate of smokers who’ve attempted to quit, let’s look at where smoking was most prevalent. By state, West Virginia had the highest rate of adult smokers, accounting for 24.0% of the state’s population in 2020. That’s followed by Kentucky (22.2%) and Arkansas (21.6%).
But why is the rate of smoking so high in these states?
Societal culture plays a big role, according to VinZant. West Virginia and Kentucky don't have any provisions on statewide smoking bans in private workplaces, bars or restaurants. Arkansas bans smoking in private workplaces but allows smoking in designated restaurant areas. It seems, VinZant says, that smoking is more socially acceptable in these states than in others.
CDC data reveals that 61.1% of the U.S. population is covered by 100% smoke-free indoor air policies in bars, restaurants and worksites. There are just 12 states that don’t have statewide bans in any of these three locations — notably, half of these states appear among the 10 states with the highest rate of smokers.
The top-ranking states also have some of the lowest statewide cigarette taxes. While state excise taxes on cigarettes range from 17 cents a pack to $4.94 throughout the U.S., West Virginia charges just $1.20 a pack in excise taxes. Meanwhile, Arkansas charges $1.15 a pack and Kentucky charges $1.10.
On the other end of the list, Utah (8.3%) had the lowest rate of current smokers in 2020, followed by California (9.0%). Meanwhile, New Jersey and Maryland tied for third at 11.1%.
In contrast to the states with the highest rate of adult smokers, all four have statewide bans on indoor smoking in bars, restaurants and worksites. These states also charge more in excise taxes. Utah charges $1.70 a pack, while California charges $2.87 and New Jersey charges $2.70. Maryland even charges a significantly higher $3.75 a pack.
Full rankings: States with the highest rates of current smokers as of 2020
% of adults smoking
Source: ValuePenguin analysis of BRFSS data.
More than half of current smokers in 2020 said they tried to quit in the past year — here’s which states ranked highest
When it comes to the states with the highest rate of smokers who’ve attempted to quit, Connecticut ranked at the top. Among the adult smokers in the state, 64.9% tried to quit in the past year as of 2020. That’s followed by Alabama (64.6%) and the District of Columbia (63.6%).
Generally, the states where smokers were more likely to quit are among those with the lowest uninsured rates. Nationally, just 8% of Americans have no health insurance. Meanwhile, the uninsured rate is 4.7% in Connecticut and 3.8% in the District of Columbia. Alabama is an exception here — with an uninsured rate of 9.3%, the state is higher than the national rate.
Meanwhile, smokers were least likely to try to quit smoking in Kentucky (46.6%), Maine (48.5%) and Arkansas (49.1%). Two of these states have significant uninsured rates: In Kentucky, 9.1% are uninsured, while 9.9% are in Arkansas. Here, Maine is an exception, with an uninsurance rate of just 7.1%, though that’s the middle of the pack in the U.S.
It’s also worth noting that a slightly higher rate of women (56.5%) who were current smokers in 2020 said they tried to quit in the past year than men (53.3%). Women also have lower uninsured rates:
- The uninsured rate for men is 9.0% (a percentage point higher than the national average)
- The uninsured rate for women is 7.0% (a percentage point lower than the average)
Among those who attempted to quit smoking, New Hampshire saw the biggest disparity between male and female smokers. In New Hampshire, 62.2% of women and 49.3% tried to stop — a difference of 12.9 percentage points.
Full rankings: States with the highest rate of smokers who tried to quit
% of adults who tried to quit smoking
|3||District of Columbia||63.6%|
Source: ValuePenguin analysis of BRFSS data.
Experts say health insurance plays a role
From your first cigarette to potentially your last, health insurance plays an important role in the rate of smokers today. In fact, data from the CDC indicates that current cigarette smoking is highest among adults insured by Medicaid, as well as adults who are uninsured. In contrast, the rate of cigarette smoking is lowest among adults with private insurance.
"People with private insurance are less likely to smoke because private insurance companies offer big premium discounts to nonsmokers," VinZant says. "Under the Affordable Care Act, health insurance companies can charge smokers up to 50% more than non-smokers."
Meanwhile, insurance providers can also play a big role in your attempt to quit. "Under the ACA, most insurers are required to have free programs that can help you quit," VinZant says. "These programs can include counseling, pharmaceuticals that can help you stop smoking and nicotine replacement therapies like gums or patches."
In addition, Medicaid covers smoking cessation in many states. The Centers for Medicare and Medicaid Services (CMS) allows states to claim a 50% match for the cost of counseling provided to Medicaid enrollees — and many states have even more comprehensive coverage plans for smoking cessation products.
ValuePenguin researchers analyzed Behavioral Risk Factor Surveillance System (BRFSS) data from the U.S. Centers for Disease Control and Prevention (CDC) to rank the states where current adult smokers 18 years and older tried to stop smoking for one day or longer in the past 12 months. We also ranked the states with the highest and lowest rates of adult smokers.
Data is from 2020 — the latest available.