Weakest Smoking Laws Linked to Highest Rates of Lung Cancer, Heart Disease, and COPD

The biggest cause of preventable disease, disability, and death in the United States is cigarette smoking.

In a new report, the Healthnews team has pinpointed a stark correlation. States grappling with the highest rates of lung cancer, heart disease, and COPD — key indicators of the lethal impact of smoking — are those with the most lenient smoking regulations.

This analysis focuses on the newest lung cancer, heart disease mortality, and the prevalence of Chronic Obstructive Pulmonary Disease (COPD) data obtained from the Centers for Disease Control and Prevention. This data is correlated with the particular smoking regulations — or lack thereof — implemented in each state.

The report findings show a troubling link between weak smoking laws and heightened health crises, underscoring the need for strict tobacco control policies.

Lung cancer rates

The following is what each type of restriction in the table means:

• "No law - designated areas - or separate ventilation law": In these places, there are no specific rules against smoking indoors. Some places may have designated smoking areas or separate ventilation systems, but no comprehensive smoke-free laws.
• "100% smokefree in three locations": This means smoking is completely banned indoors in three types of places, usually public spaces, workplaces, and restaurants.
• "100% smokefree in one location": Similar to the previous type, it signifies a complete indoor smoking ban, but in just one specific type of place, such as a workplace or a restaurant.

States without any smoking provisions (Kentucky and West Virginia) have the most cases of lung cancer, indicating a potential link between the lack of restrictions and higher lung cancer rates. Four out of five states with the highest lung cancer rates are part of the "Tobacco Nation" region, which has 50% more smokers than the rest of the country. It is Kentucky, West Virginia, Missouri, and Tennessee.

Nonetheless, Maine has the strictest smoking ban among the top 5 states, yet its lung cancer rate of 63.5 is still the third highest in the country. A closer look reveals a concerning trend: while tobacco use among U.S. high school students overall dropped from 16.5% to 12.6% in 2022–2023, in Maine, the rate is much higher at 33%. This stark contrast points to the need for more effective tobacco prevention programs targeting young people in Maine.

Even in states with a high prevalence of lung cancer, more stringent smoking restrictions may help mitigate the rates.

Heart disease mortality rates

Out of the top five, states with the least restrictive smoking policies (Oklahoma, Mississippi, and Alabama) have the highest heart disease mortality rates compared to the states with more comprehensive smoking bans, like Louisiana and Arkansas.

The data suggests a potential correlation between stricter smoking restrictions and lower heart disease mortality rates. Similar to the lung cancer rates, the relationship is not strictly linear, as states with partial restrictions (like Alabama) do not necessarily have intermediate heart disease rates.

In 2012, Alabama stood out as one of the states least impacted by health-promoting changes in tobacco policy. The recorded cigarette excise tax was exceptionally low at $0.42 per pack, ranking among the nation's lowest. The state's investment in tobacco prevention and control was meager, dedicating only 13% ($7.5 million) of the $56.7 million funding amount recommended by the CDC. Alabama had not yet established statewide smoke-free legislation for either restaurants or bars at that time.

It’s no surprise that all five states with the highest rates of heart disease mortality are part of the "Tobacco Nation."

Prevalence of COPD (%)

States with the most relaxed smoking policies, specifically West Virginia, Kentucky, and Mississippi, report the nation's higher COPD prevalence rates, marked at 12%, 10%, and 9%, respectively. This contrasts with other states that have implemented partial or full smoking bans, where there's a consistently lower average COPD prevalence of around 8%. "Tobacco Nation" includes all the first 10 states.

Tennessee stands out because it bans smoking in enclosed public places and workplaces. However, its high COPD rank might be related to the vaping situation. A 2024 Forbes study shows that Tennessee has the highest rate of vaping across all 50 states. Vaping, just like traditional smoking, plays a crucial role in the rates of COPD.

The Healthnews analysis shows that states with the highest lung cancer, heart disease, and COPD rates are attributed to weaker local policies on tobacco prevention and cessation. This highlights the critical role robust smoking laws play in reducing the prevalence of these diseases.