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 (chewing tobacco and snuff), cigars, and pipe tobacco. Using 2006 and 2007 NSDUH data, 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. The latter 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 (around 4.5 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) (Tables B.13 and B.14). Nationally, both the percentage of tobacco use and the percentage of cigarette use in the past month were unchanged between 2005-2006 and 2006-2007 for the total population aged 12 or older (Tables C.13 and C.14). However, there were significant declines nationally for both measures among other age groups (from 44.1 to 42.9 percent for past month tobacco use among young adults aged 18 to 25; from 10.6 to 10.1 percent for past month cigarette use among youths aged 12 to 17; and from 38.7 to 37.3 percent for past month cigarette use among persons aged 18 to 25).

4.1 Tobacco

Nationally among persons aged 12 or older, the rate for past month use of tobacco in 2006-2007 was 29.1 percent (Table B.13). The State with the highest prevalence rate for tobacco use among persons aged 12 or older was West Virginia (37.8 percent). Utah had the lowest rate in the Nation for tobacco use among all persons aged 12 or older (20.0 percent). Seven of the top 10 States for past month tobacco use among persons 12 or older were Southern States. Arkansas, Kentucky, Ohio, West Virginia, and Wyoming 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).

Eight States showed changes in past month tobacco use among persons 12 or older between 2005-2006 and 2006-2007: Colorado had an increase from 26.5 to 29.8 percent, while Idaho, Massachusetts, Michigan, Montana, New York, Utah, and West Virginia had declines (Table C.13). The Northeast region had a decrease in tobacco use as well (28.1 to 27.1 percent). Across the three age groups (12 to 17, 18 to 25, and 26 or older) and across all States, there were 15 significant changes in past month tobacco use between 2005-2006 and 2006-2007. Most of these changes were declines.

4.2 Cigarettes

In 2006-2007, the national rate for past month use of cigarettes among persons aged 12 or older was 24.6 percent, which was similar to the national rate in 2005-2006 (25.0 percent) (Table C.14). Because cigarettes are the main tobacco product, States that ranked high for past month tobacco use also ranked high for past month cigarette use. In fact, all 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, all of the 10 States ranked in the lowest fifth among persons 12 or older were the same for both measures. As was the case for past month tobacco use, West Virginia had the highest rate of past month cigarette use in the Nation (31.1 percent), and Utah had the lowest rate (17.5 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 the same between 2005-2006 and 2006-2007, the rate of cigarette use in the 12 to 17 age group had a significant decline, from 10.6 to 10.1 percent, and the rate of cigarette use in the 18 to 25 age group declined from 38.7 to 37.3 percent (Table C.14). Among all persons 12 or older, Colorado was the only State to show an increase in cigarette use (from 22.2 to 24.4 percent), while Idaho, Massachusetts, Michigan, Montana, and New York all showed declines. Across the three age groups (12 to 17, 18 to 25, and 26 or older) and across all States, there were 16 significant changes in cigarette use between 2005-2006 and 2006-2007. With the exception of Colorado, where cigarette use increased among persons aged 26 or older, these changes were all declines.

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 States (Alabama, Kentucky, Missouri, Ohio, Oklahoma, 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). West Virginia had the lowest rate of perception of great risk for heavy cigarette use (67.9 percent), and the District of Columbia had the highest rate (78.6 percent) among 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 remained almost the same from 74.1 percent in 2005-2006 to 73.9 percent in 2006-2007 among persons 12 or older (Table C.15). Among young adults aged 18 to 25, there was a significant increase in the perception of risk of smoking one or more packs of cigarettes a day in the Northeast (from 70.9 to 73.1 percent). Among persons aged 12 or older, Montana had a significant increase from 71.3 to 74.5 percent; whereas Ohio had a decrease from 70.6 to 69.0 percent.