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Antismoking efforts are hard to avoid nowadays. Cigarette packaging got graphic new warning labels (though they'll soon be replaced thanks to a big-tobacco lawsuit), and 38 states have at least some restrictions as to where a person can light up. (New York State has even banned smoking in public parks.) But despite this increased regulation, plenty of Americans continue to smoke—like chimneys.
Using government data on smoking (and quitting) rates, smoking bans and restrictions, cigarette taxes and sales, and deaths attributable to smoking, Health.com identified the 10 states where people are most likely to literally smoke themselves to death. Here they are, in alphabetical order.
The Heart of Dixie has one of the highest youth smoking rates in America. The CDC reports that in 2011, nearly 23 percent of kids in grades 9 through 12 were smokers. To curb this alarming trend, several colleges have restricted tobacco use on campus, including Troy University, Miles College, and Auburn University.
Smoking culture continues off college campuses, however. Residents are still allowed to light up in workplaces, restaurants, and bars, and cigarette taxes are among the lowest in the nation.
Roughly 27 percent of adults in Arkansas smoke (compared to just over 20 percent nationwide), and in the most recent government surveys, less than 3 percent of smokers had managed to quit within the previous 12 months.
The tobacco smoke hangs so thick over the Natural State that Governor Mike Beebe has made secondhand smoke a statewide priority. In July 2011, for instance, a law went into effect prohibiting an adult from smoking in a car with children under the age of 14, broadening a 2006 law that banned smoking in the car with kids under 6. Only six other states—California, Louisiana, Illinois, Oregon, Utah, and Maine—have similar laws.
States, not just people, can be addicted to tobacco. Tobacco production is an important industry in Kentucky, which along with North Carolina generates two-thirds of the nation's tobacco harvest. (In 2012 Kentucky farmers grew about 150 million pounds.)
People aren't necessarily more likely to smoke if they live in a tobacco-growing state, but Kentuckians are certainly doing their part to help the local economy. The state has the nation's second-highest adult smoking rate, as well the highest rate of smoking-related deaths. Most alarming of all, Kentucky is encouraging more smokers: The smoking rate among high schoolers is the highest in the U.S.
Alcohol use and smoking are closely linked, so in a state known for its love of partying and drive-through liquor stores, it's not surprising that more than one in four Louisiana adults also smokes.
Like many people, Louisiana residents apparently love to light up when they have a drink in hand. Despite multiple attempts, State Senator Rob Marionneaux has been unable to win support for his proposed ban on smoking in Louisiana bars. The state currently prohibits smoking in restaurants, public buildings, and most work sites, but opponents worry the ban would hurt bars' profits.
Mississippi is one of only two states nationwide without any restrictions on smoking at child-care facilities. The state has banned smoking in government buildings and on college campuses, but proposals for a broader ruling haven't been met with much approval.
Supporters were looking to ban smoking in restaurants and nongovernment buildings, but the proposal fell apart in March of 2011. Opponents argued that the government shouldn't tell private businesses how to operate. But it may be even more simple: Some residents told local newscasters they wouldn't want to stop lighting up when they're out and about.
The federal government slaps a $1.01 tax on every pack of cigarettes sold in the U.S., but taxes—and therefore prices—still vary widely from state to state. The average pack of cigarettes costs more than $10 in New York, thanks to the country's heftiest per-pack tax ($4.35)—three times higher than the national average. In Missouri, meanwhile, the average pack retails for just $4.50 because the state taxes a mere $0.17 per pack.
The Show-Me State is passing up a proven way to reduce smoking, especially among young people. A 10 percent price hike can reduce the amount of cigarettes consumed by about 4 percent, according to the Centers for Disease Control and Prevention (CDC).
The rates of smoking and smoking-related deaths in Oklahoma rank high nationally, and very few smokers are quitting. But there may be change on the horizon: In April 2013, a new state law gave communities local control over smoking in public parks and municipal facilities. The measure also banned use of all tobacco products in all state-owned buildings.
As the birthplace of the original Marlboro Man, Oklahoma has made a small but lasting contribution to the smoking scourge. Darrell Winfield, the child of farmers, was discovered by Marlboro in 1968 and was featured in the majority of the brand's advertisements over the next two decades.
South Carolina has the nation's lowest smoking-cessation rate. In the most recent government survey, only about 2 percent of smokers had successfully quit for at least a year (compared to a high of 7 percent in Vermont), which isn't surprising given that South Carolina has a measly $0.57 cigarette tax and no smoking restrictions in restaurants, bars, private work sites, and retail stores.
These factors can discourage quitting. Fewer than one in 10 smokers successfully kick the habit without medicine or other aids. Roadblocks to quitting can include cravings, nicotine withdrawal symptoms, weight gain, lack of support, stress, alcohol, and living with a smoker.
The Great Smoky Mountains couldn't have a better home. Although Tennessee's smoking rate isn't exceptionally high by national standards, the Volunteer State ranks among the worst in the number of packs sold per capita and the rate of smoking-related deaths. And in 2007, state spending for smoking cessation and other control programs was the third lowest, at only 3 percent of the CDC's recommended amount.
As in many southern states, tobacco is a lucrative crop in Tennessee. Twenty-one states produce tobacco in the U.S., and many farmers depend on it to make a living, despite growing additional crops.
The Mountain State is home to the second-highest percentage of adult smokers in the country, with 28.6 percent of adults lighting up.
Not only are the most adults smoking in West Virginia, but they're also smoking the most. The average West Virginian smoker buys 113 packs a year, compared to just 23 packs per person sold in Washington, D.C.
All those cigarettes aren't without consequence: West Virginia has the second highest rate (after Kentucky) of deaths attributable to lung cancer, which, in roughly 90 percent of cases, is caused by smoking.