States most at risk of America's deadliest cancer... where does YOURS rank?
People living in Iowa may be at the greatest risk of lung cancer in the next decade, a new study suggests.
Researchers at the University of California San Diego surveyed 1.7million Americans in all 50 states to track rates of cigarette use from 1992 through 2022.
They also used that data to predict which states would have the most smokers in 2035.
The researchers found since the early 2000s, smoking rates have decreased by more than 60 percent nationwide, from 23 percent to 9.4 percent.
Statewide, Utah recorded the lowest rate of smokers in 2022 with 4.4 percent. Maine, however, had the highest smoking rate in the country at 16.4 percent.
And by 2035, even as nationwide smoking rates dip to just five percent on average, experts estimate Iowa's rate - which is about 16 percent - will remain unchanged, making it the highest in the country.
Smoking and tobacco use is the number one cause of lung cancer, responsible for 80 to 90 percent of cases. The disease is America's deadliest and third-most common cancer, with 226,000 cases per year and 130,000 deaths.
And while smoking is on the decline, lung cancer rates will take significantly longer to drop in areas with heavy smoking rates, researchers warned.
They also cautioned an increase in vaping among young people may further stall progress.
Matthew Stone, first study author and assistant professor at the UC San Diego Herbert Wertheim School of Public Health, said: 'The rapid decline in smoking among young adults is clear evidence that the smoking epidemic will come to an end in our lifetime.
'Indeed, we project that the national smoking prevalence will be under five percent by 2035. However, the much slower decline in smokers over the age of 50, particularly in previously high smoking states, will mean that the high rates of lung cancer, heart disease and chronic obstructive pulmonary disease that are caused by lifelong smoking will take longer to decrease.
The researchers analyzed US Census Bureau data on smoking and tobacco use from 1992 to 2022, which included responses from 1.7million Americans in 54,000 households.
The vast majority (78 percent) were white, and the largest age group (30 percent) was 35 to 49-year-olds.
Respondents were asked 18 times whether they had smoked at least 100 cigarettes in their lifetime.
Those who responded 'yes' were asked if they currently smoked every day, some days or none at all.
The researchers used the survey data to calculate a smoking rate for each state from 1992 to 2022 and a projected rate for 2035.
From 1992 to 2001, the national smoking rate was 23 percent. During that time, Utah had the lowest rate of 15 percent while Kentucky had the highest at 31 percent.
However, by 2022, smoking dropped significantly down to nine percent nationwide. Utah again had the fewest smokers that year with a rate of just 4.4 percent, while Maine had the highest at 16.4.
Among states with the highest smoking rates, following behind were Iowa and West Virginia both at 16 percent, Oklahoma at 15 percent and South Dakota at 14 percent.
States with low rates following Utah were California (5.6 percent), Colorado (six percent), Connecticut (6.5 percent) and Arizona (6.7 percent).
Based on the current trends, the researchers predicted Hawaii would have the lowest smoking rate in 2035, with a projected rate of 1.4 percent.
Following close behind in the predictions were Colorado at 1.5 percent, Utah at 2.5 percent, California at 3.3 percent and New Jersey at 3.5 percent.
Nationally, the researchers estimated the smoking rate will dip below five percent in 2035, nearly half that of 2022.
However, in 2035, Iowa is expected to have the highest smoking rate at 16 percent, followed by Oklahoma (15 percent), Wyoming and West Virginia (14 percent) and Maine (12.7 percent).
The findings are in line with rates of lung cancer, which are highest in Midwestern and some New England states.
The national average is 54 cases per 100,000 people.
Maine, which had the highest smoking rate in 2022, had the fourth-highest rate of lung cancer in 2021, at 63 cases per 100,000 people.
Kentucky (79.3 cases per 100,000 people), West Virginia (74 per 100,000) and Mississippi (65.6 per 100,000) were all in the top three states for worst lung cancer rates.
Iowa has a rate of 61 cases per 100,000 residents.
Utah, which had the fewest smokers, had a lung cancer rate of 24.4 cases per 100,000 people in 2021.
While the team found all 50 states experienced 'significant' declines in smoking, they warned the rise of vaping may stall this progress. The use of e-cigarettes among high schoolers has surged from 1.5 percent in 2011 to 27 percent in 2019.
John Pierce, corresponding author and distinguished professor at UC San Diego, said: 'While the ongoing decline in cigarette smoking is a major public health success story, recent evidence suggests that the tobacco industry has successfully recruited a new generation of teenagers into e-cigarette use and nicotine addiction.
'Further research is needed to assess the long-term impact of this shift.'
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