Smoking Histories by State in the U.S

Area of Science:

• Public Health
• Epidemiology
• Tobacco Control Research

Background:

• Smoking rates vary significantly across U.S. states due to differing tobacco control policies.
• Each state possesses a unique history of smoking initiation, cessation, and prevalence.
• Understanding these state-specific smoking histories by birth cohort is crucial for effective public health strategies.

Purpose of the Study:

• To characterize detailed smoking histories for each U.S. state, broken down by birth cohort.
• To estimate state-specific trends in smoking initiation, cessation, intensity, prevalence, duration, and pack years.
• To provide a comprehensive analysis of how state-level tobacco control influences long-term smoking behaviors.

Main Methods:

• Utilized data from the National Health Interview Survey (1965-2018) and the Tobacco Use Supplement to the Current Population Survey (1992-2019).
• Applied an age-period-cohort modeling framework to reconstruct population-level smoking histories for all U.S. states.
• Estimated smoking initiation, cessation, and intensity by age, gender, and birth cohort to derive state-specific smoking metrics.

Main Results:

• Demonstrated significant variations in smoking initiation and cessation probabilities between states, using California and Kentucky as examples.
• Observed higher smoking prevalence and intensity in states with less aggressive tobacco control (e.g., Kentucky) compared to those with more progressive policies (e.g., California).
• Quantified substantial differences in estimated smoking duration and pack years across states, with some showing improvements for recent birth cohorts while others lagged.

Conclusions:

• Smoking initiation, cessation, and intensity trends exhibit considerable state-level variation, leading to major disparities in smoking prevalence, duration, and pack years.
• The effectiveness of tobacco control policies is evident in the differing smoking metrics observed across states and birth cohorts.
• Future tobacco control efforts must consider state-specific historical contexts and cohort experiences to effectively reduce smoking-related health burdens.