Cigarette smoking continues to decline in about half of American states, according to the latest estimates from the United States Centers for Disease Control and Prevention. However, despite this good news, rates have gone up in some states and a new trend has begun to emerge as people begin to use a combination of tobacco products, including cigarettes and smokeless tobacco.
"From 2011 to 2013 although we've seen some progress for cigarette smoking overall, there hasn't been a significant change in cigarette smoking or smokeless tobacco use across many states," said Brian King, acting deputy director for research translation in the Centers for Disease Control and Prevention's Office on Smoking and Health.
"What is most concerning is the preponderance of dual use -- people using multiple tobacco products," King said. "That's concerning because we know that dual users have a higher level of nicotine dependence and they are also less likely to quit."
Smoking declined across the US from 21 percent of adults in 2011 to 19 percent of adults in 2013. However, when you look at the statistics at a state level, vast differences exist. For example, rates varied from a low of 10 percent in Utah to a high of 27 percent in West Virginia.
Rates also varied widely for smokeless tobacco. In the District of Columbia and Massachusetts, only 1.5 percent of people used smokeless tobacco, however more than 9 percent of people in West Virginia used smokeless tobacco.
Between 2011 and 2013, cigarette smoking declined in 26 states. But smokeless tobacco rates only declined in the states of Ohio and Tennessee. During that same time, smokeless tobacco rose in four states - Louisiana, Montana, South Carolina and West Virginia.
The combined use of cigarettes and smokeless tobacco rose in five states - Delaware, Idaho, Nevada, New Mexico and West Virginia.
King said there are ways to get people to quit using tobacco including raising the price of tobacco, enacting smoke-free laws, and media campaigns that demonstrate the dangers of smoking.
"The states where we see the lowest tobacco use and the most marked declines are the ones that implemented these interventions," King says.
He did admit that increasing the price of cigarettes could be a driving factor in the increase of smokeless tobacco products that are far cheaper than smoking.
"We know that increasing the price of tobacco is the most effective method to reduce consumption," King says. "Since smokeless tobacco is taxed lower in most states along with other products like e-cigarettes, this could be contributing to the lack of decline in use."
Dr. Norman Edelman, senior consultant for specific scientific affairs at the American Lung Association, said that the association agrees that the states spend too little on helping people quit tobacco.
"Smokeless tobacco is cheap," Edelman says. "States have not raised taxes on it the way they have on cigarettes, and high prices are one of the best tools we have in combating the use of tobacco."
"We need the FDA (Food and Drug Administration) to bite the bullet and issue final regulations on e-cigarettes, and we need a more comprehensive approach to the regulation of all tobacco products."
