State Tobacco: State Estimates of Substance Use from the 2002 NSDUH

Tobacco is the second most commonly used substance in the United States next to alcohol. The National Survey on Drug Use and Health (NSDUH) includes a series of questions on the use of several tobacco products, including cigarettes, smokeless tobacco, cigars, and pipe tobacco. This chapter includes State estimates on past month use of cigarettes, past month use of tobacco, and the perceptions of risk of heavy use of cigarettes. Differences in estimates for cigarettes and tobacco represent persons who do not smoke cigarettes, but who use one of the other forms of tobacco (chewing tobacco, snuff, cigars, or pipe tobacco).

4.1. Tobacco

Approximately 71.5 million Americans aged 12 or older used a tobacco product in the past month in 2002, a prevalence rate of about 30 percent (Office of Applied Studies [OAS], 2003b). The State with the highest prevalence rate for persons aged 12 or older in 2002 was Arkansas (39.9 percent) (Table A.10). Of the top 10 tobacco-using States, 5 were in the South: Arkansas, Kentucky, Mississippi, North Carolina, and West Virginia (Figure 4.1). Utah had the lowest rate in the Nation for all persons aged 12 or older (22.0 percent).

Four States (Arkansas, Kentucky, Missouri, and West Virginia) were in the groups with the highest use of tobacco for all of the three age groups: 12 to 17, 18 to 25, and 26 or older (Figures 4.2 to 4.4). In the lowest fifth for these age groups, three States were common: California, Hawaii, and Utah (which had the lowest prevalence rates in all three age groups).

4.2. Cigarettes

For cigarettes, many States with high past month prevalence rates were the same as those that displayed high rates for past month tobacco use. For example, in 2002 for persons aged 12 or older, eight of the States that ranked in the highest fifth for past month cigarette use also ranked in the highest fifth for tobacco use (Figures 4.1 and 4.5).

Three States fell into the highest fifth for past month cigarette use in all three age groups: Kentucky, Missouri, and North Carolina (Figures 4.6 to 4.8). Kentucky reported the highest current rate of cigarette use in the Nation (33.8 percent), and Utah reported the lowest rate in the Nation (18.9 percent) for all persons aged 12 or older (Table A.11). Most (six) of the States in the highest fifth for all persons aged 12 or older were in the South (Arkansas, Delaware, Kentucky, Louisiana, Mississippi, and North Carolina); most of the States in the lowest fifth were in the West (California, Hawaii, New Mexico, Utah, and Washington). In the top fifth, only four States that were in the top fifth for use of cigarettes among persons aged 12 or older also were in the top fifth among youths aged 12 to 17 (Indiana, Kentucky, Missouri, and North Carolina). By contrast, seven States in the bottom fifth among persons aged 12 or older also were in the bottom fifth among youths aged 12 to 17.

4.3. Perceptions of Risk of Heavy Cigarette Use

States with high prevalence rates for cigarettes often reported low rates of perceived risk for heavy cigarette use (i.e., smoking one or more packs a day). For those aged 12 or older, six of the States ranked in the lowest fifth for perceptions of great risk of smoking one or more packs of cigarettes a day also were ranked in the highest fifth for past month cigarette use: Arkansas, Indiana, Kentucky, Louisiana, Mississippi, and Missouri (Figures 4.5 and 4.9). Similarly, of the 10 States with the highest rates of perceived risk of heavy smoking, 7 States fell into the lowest fifth for reported past month cigarette use for all persons aged 12 or older.

The link between rates of perceptions of risk and rates of actual use of cigarettes was not as strong among youths aged 12 to 17 as among persons aged 12 or older. In the 12 to 17 age group, only four States (Kentucky, North Carolina, South Dakota, and West Virginia) with low perceived (great) risk of smoking one or more packs of cigarettes a day also were ranked in the highest fifth for past month cigarette use (Figures 4.6 and 4.10).

Figure 4.1 Percentages Reporting Past Month Use of Any Tobacco Product among Persons Aged 12 or Older, by State: 2002