2004 State Estimates of Substance Use

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 the 2003 and 2004 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) (Tables B.13 and B.14). Nationally, among persons aged 12 or older, both the percentage using tobacco and the percentage using cigarettes in the past month decreased between 2002-2003 and 2003-2004 (Tables C.13 and C.14).

4.1 Tobacco

Nationally among persons aged 12 or older, the rate for past month use of tobacco in 2003-2004 was 29.5 percent (Table B.13). The State with the highest prevalence rate for tobacco use among persons aged 12 or older was West Virginia (39.5 percent). Utah had the lowest rate in the Nation for tobacco use among all persons aged 12 or older (20.1 percent). Kentucky, Missouri, Oklahoma, South Dakota, 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).

Past month tobacco use declined in the United States between 2002-2003 and 2003-2004 for persons 12 or older, from 30.1 to 29.5 percent (Table C.13). Given 11 statistically significant State-level changes occurring across the four age categories (12 or older, 12 to 17, 18 to 25, and 26 or older), only 2 of them were increases: in California, the percentage of youths using tobacco in the past month increased from 9.2 to 10.9 percent, and in Kansas, the percentage of persons aged 18 to 25 reporting past month use of tobacco went from 45.7 to 49.9 percent. Even though California had an increase among youths, California had an overall decrease among persons aged 12 or older from 22.5 to 20.7 percent that was driven by a decrease among persons aged 26 or older (Tables B.13 and C.13).

4.2 Cigarettes

In 2003-2004, the national rate for past month use of cigarettes among persons aged 12 or older was 25.2 percent (Table B.14). 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, 7 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, 9 of the 10 States ranked in the lowest fifth were the same for both measures. 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 cigarettes: Kentucky, Missouri, Oklahoma, South Dakota, and West Virginia (Figures 4.2 to 4.4 and 4.6 to 4.8). Kentucky had the highest rate of past month cigarette use in the Nation (33.3 percent), and Utah had the lowest rate (17.6 percent) for all persons aged 12 or older (Table B.14).

The national rate for past month use of cigarettes declined among persons aged 12 or older from 25.7 percent in 2002-2003 to 25.2 percent in 2003-2004 (Table C.14). Declines in past month cigarette use were observed in the 12 to 17 and the 18 to 25 age groups (Tables C.13 and C.14). Of a total of 14 statistically significant State changes in past month use of cigarettes, across the four age groups, 13 of them were decreases. Four States showed decreases in past month cigarette use among the 12 or older population: Arizona (from 27.5 to 24.8 percent), Arkansas (from 32.8 to 30.0 percent), California (from 19.4 to 17.8 percent), and Nevada (from 30.5 to 26.6 percent). In the 12 to 17 age group, California was the only State showing an increase, from 7.5 to 8.7 percent.

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 (Kentucky, Missouri, Ohio, Oklahoma, South Dakota, and West Virginia) 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 (64.2 percent), and California had the highest rate (77.1 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 71.3 percent in 2002-2003 to 72.8 percent in 2003-2004 among persons 12 or older. Nationally among all age groups, the rates of perception of great risk of smoking one or more packs of cigarettes a day showed significant increases from 2002-2003 to 2003-2004 (Table C.15). Among the 12 or older population, this trend was observed in each of the four geographic regions as well. Several States showed increases in the perception of great risk of smoking one or more packs of cigarettes a day among all age groups, and no State showed a decline between 2002-2003 and 2003-2004.

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