4. Tobacco Use

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 tobacco, past month use of cigarettes, and the perceptions of risk of heavy use of cigarettes, using 2004 and 2005 NSDUH data. Heavy use of cigarettes is defined as smoking one or more packs of cigarettes per day. Most tobacco users are cigarette smokers. However, differences in past month prevalence estimates for cigarettes and tobacco (about 4 percent nationally) represent persons who do not smoke cigarettes, but who use one of the other forms of tobacco (chewing tobacco, snuff, cigars, or pipe tobacco) (Table s B.13 and B.14). Nationally, both the percentage of tobacco use and the percentage of cigarette use in the past month were stationary between 2003-2004 and 2004-2005 for the total population aged 12 or older (Table s C.13 and C.14). However, there were significant declines for both measures among youths aged 12 to 17 and among persons aged 18 to 25 in past month cigarette use.

4.1 Tobacco

Nationally among persons aged 12 or older, the rate for past month use of tobacco in 2004-2005 was 29.3 percent (Table B.13). The State with the highest prevalence rate for tobacco use among persons aged 12 or older was West Virginia (40.9 percent). California had the lowest rate in the Nation for tobacco use among all persons aged 12 or older (21.2 percent). Kentucky, Missouri, Montana, Oklahoma, and West Virginia ranked in the highest fifth for all three age groups (12 to 17, 18 to 25, and 26 or older) and among all persons 12 or older (Figures 4.1 to 4.4).

Although the percentage of persons aged 12 or older using tobacco in the past month was stationary between 2003-2004 and 2004-2005, the prevalence rate among youths aged 12 to 17 declined slightly from 14.4 to 13.8 percent during the same period (Table C.13). Kentucky, Louisiana, Michigan, and North Dakota showed declines in the 12 to 17 age group. Two States showed decreases in past month tobacco use in at least one of the other age groups between 2003-2004 and 2004-2005. Colorado's rate declined in the 26 or older age group, while South Dakota's rate declined in the 18 to 25 age group. Also, Colorado's rate in the 12 or older population fell from 30.7 to 27.0 percent, and South Dakota's declined from 35.3 to 32.2 percent for persons 12 or older during those years. Across all three age groups, only two States displayed increases in past month tobacco use. Both Tennessee and Utah had increases among persons aged 18 to 25, from 45.3 to 49.4 percent and from 26.0 to 29.6 percent, respectively.

4.2 Cigarettes

In 2004-2005, the national rate for past month use of cigarettes among persons aged 12 or older was 24.9 percent (Table B.14). Because cigarettes are the major tobacco product, States ranked high for past month tobacco use tended also to be ranked high for past month cigarette use. In fact, 8 of the 10 States in the highest fifth for past month use of tobacco also were in the highest fifth for past month cigarette use among persons aged 12 or older (Figures 4.1 and 4.5). Similarly, 8 of the 10 States ranked in the lowest fifth were the same for both measures. Four of the five States that ranked in the highest fifth for past month tobacco use in all three age groups (12 to 17, 18 to 25, and 26 or older) also were ranked in the highest fifth for cigarette use in all three age groups: Kentucky, Missouri, Oklahoma, and West Virginia (Figures 4.2 to 4.4 and 4.6 to 4.8). West Virginia had the highest rate of past month cigarette use in the Nation (32.4 percent), and California had the lowest rate (18.3 percent) for all persons aged 12 or older (Table B.14).

Although the national rate for past month use of cigarettes among persons aged 12 or older remained almost the same between 2003-2004 (25.2 percent) and 2004-2005 (24.9 percent), the 12 to 17 age group and the 18 to 25 age group both had significant declines, from 12.0 to 11.3 percent and from 39.9 to 39.3 percent, respectively (Table C.14). The decreases among the youths were primarily observed in the Midwest and the South. Although there were a few declines among States in past month cigarette use in the other age groups, most of them occurred among youths aged 12 to 17. Alaska, Louisiana, North Dakota, Ohio, and Texas had significant decreases among youths. Across the age groups and across all States, Tennessee had the only significant increase in past month cigarette use among persons aged 18 to 25 (from 38.5 percent in 2003-2004 to 43.9 percent in 2004-2005).

4.3 Perceptions of Risk of Heavy Cigarette Use

States with high prevalence rates for cigarette use tended to have low rates of perceived risk of heavy cigarette use (i.e., smoking one or more packs a day). Five of the States (Kentucky, Missouri, Oklahoma, South Carolina, and West Virginia) that 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 among persons aged 12 or older (Figures 4.5 and 4.9). Kentucky had the lowest rate of perception of great risk for heavy cigarette use (66.0 percent), and Utah had the highest rate (78.8 percent) for persons aged 12 or older (Table B.15).

The rates of perception of great risk of smoking one or more packs of cigarettes a day increased from 72.8 percent in 2003-2004 to 74.4 percent in 2004-2005 among persons 12 or older. Also, during the same period, in all age groups and in all four census regions and nationally within those age groups (except for persons 26 or older in the Midwest region), there were significant increases (at the 5 percent level of significance) in the rates of perception of great risk of smoking one or more packs of cigarettes a day (Table C.15). At the State level, across the three age groups and the combined age group of those 12 or older, there were 46 significant increases in the perceived risk of heavy smoking—and no decreases. Of the 46 State-by-age group increases in perceived risk between 2003-2004 and 2004-2005, only 7 were accompanied by similar decreases in past month use of cigarettes (Table s C.14 and C.15).