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 cigarettes, past month use of tobacco, and the perceptions of risk of heavy use of cigarettes using the 2002 and 2003 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.11 and B.12). Nationally among persons aged 12 or older, there were no significant changes between 2002 and 2003, either in past month or past year use of tobacco or cigarettes. However, both youths aged 12 to 17 and young adults aged 18 to 25 reported significant decreases in past year use of cigarettes: from 20.3 to 19.0 percent and from 49.0 to 47.6 percent, respectively. Although all three age groups (12 to 17, 18 to 25, and 26 or older) displayed small declines in past month use of tobacco and cigarettes, none of the decreases was statistically significant (Office of Applied Studies [OAS], 2004c, Tables 2.1B to 2.4B).

4.1. Tobacco

Nationally among persons aged 12 or older, the rate for past month use of tobacco in 2002–2003 was about 30 percent. The State with the highest prevalence rate for tobacco use among persons aged 12 or older was Kentucky (39.8 percent). As was the case with alcohol, Utah had the lowest rate in the Nation for tobacco use among all persons aged 12 or older (19.7 percent) (Table B.11).

Of the top 10 States with the highest rates of tobacco use among persons aged 12 or older, 6 were from the South. Arkansas, Kentucky, Missouri, and West Virginia ranked in the highest fifth for all three age groups (12 to 17, 18 to 25, and 26 or older). The lowest fifth included five Western States (California, Hawaii, Idaho, Utah, and Washington), three States in the Northeast (Connecticut, Massachusetts, and New Jersey), and two in the South (Florida and Maryland) (Figures 4.1 to 4.4).

4.2. Cigarettes

In 2002–2003, the national rate for past month use of cigarettes among persons aged 12 or older was 25.7 percent (Table B.12). Because cigarettes are the major tobacco product, States ranked highly for past month tobacco use tended also to be ranked highly for past month cigarette use. In fact, all 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. The same was true of States in the lowest fifth—all 10 were the same for both measures. Among youths aged 12 to 17, eight States in the top fifth were common to both tobacco and cigarette use, and eight States in the lowest fifth were common to both measures (Figures 4.1, 4.2, 4.5, and 4.6).

Four States were in the highest fifth for past month cigarette use in all three age groups (12 to 17, 18 to 25, and 26 or older): Arkansas, Kentucky, Missouri, and West Virginia. Kentucky had the highest rate of cigarette use in the Nation (34.8 percent), and Utah had the lowest rate (16.7 percent) for all persons aged 12 or older (Table B.12, Figures 4.5 to 4.8).

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). 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 among persons aged 12 or older. Exceptions to the rule were Arizona and Rhode Island, which ranked in the highest fifth for perception of risk of heavy cigarette use, but also ranked in the second highest quintile for actual use of cigarettes in the past month 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 (62.5 percent) for persons aged 12 or older. In fact, Kentucky had the lowest rate of perception of great risk for heavy cigarette use for all age groups (12 to 17, 18 to 25, and 26 or older) (Table B.13). Kentucky, Oklahoma, South Dakota, and West Virginia ranked in the lowest fifth for perception of great risk for heavy cigarette use for all age groups (12 to 17, 18 to 25, and 26 or older) (Figures 4.10 to 4.12).