The rate of cancer deaths caused by cigarette smoking varies across the United States but is highest among states in the South, where up to 40% of cancer deaths in men are caused by smoking, according to data published in JAMA Internal Medicine.

Cancer mortality rates are currently available on a national scale, but state-specific data could help improve state-level initiatives with tobacco control. Therefore, Joannie Lortet-Tieulent, MSc, from Surveillance and Health Services Research, American Cancer Society in Atlanta, and colleagues sought to calculate the proportion of cancer deaths attributable to cigarette smoking in each state and the District of Columbia among adults older than 35 years of age.

The investigators calculated the population-attributable fraction (PAF) of cancer deaths caused by cigarette smoking using data from prospective studies conducted throughout the United States and from state-specific prevalence data. The data included relative risks for 12 smoking-related cancers, including acute myeloid leukemia, cancers of the oral cavity and pharynx, and cancers of the esophagus, stomach, colorectum, liver, pancreas, larynx, trachea and lung, cervix uteri, kidney and renal pelvis, and urinary bladder.

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In 2014, 167,133 cancer deaths in the United States were attributable to cigarette smoking (28.6%). The proportion of cancer deaths due to cigarette smoking in men ranged from 21.8% in Utah to 39.5% in Arkansas. The rates were at least 30% in every state, with the exception of Utah. In women, the rates ranged from 11.1% in Utah to 29.0% in Kentucky, and they were at least 20% in every state except for Utah.

Cigarette smoking accounted for almost 40% of cancer deaths in men in the top 5 ranked states— Arkansas, Louisiana, Tennessee, West Virginia, and Kentucky. Among women, smoking accounted for more than 26% of cancer deaths in the top 5 ranked states, 3 of which were Southern states (Kentucky, Arkansas, and Tennessee) and 2 of which were Western states (Alaska and Nevada).

“The human costs of cigarette smoking are high in all states, regardless of ranking,” the study authors noted. “Increasing tobacco control funding, implementing innovative new strategies, and strengthening tobacco control policies and programs, federally and in all states and localities, might further increase smoking cessation, decrease initiation, and reduce the future burden of smoking-related cancers.”


  1. Lortet-Tieulent J, Sauer AG, Siegel RL, et al. State-level cancer mortality attributable to cigarette smoking in the United States. JAMA Intern Med. 2016; doi: 10.1001/jamainternmed.2016.6530.