Attempts to Quit Smoking, State by State, 2011–2017

From 1965 to 2017, cigarette smoking among U.S. adults fell from 42.4% to 14.0%, partly because more people quit. More quitting means less smoking-related disease, death and health spending, and it depends heavily on more quit attempts. Healthy People 2020 aimed for at least 80% of adult smokers to make a quit attempt each year. CDC used the Behavioral Risk Factor Surveillance System (BRFSS) for 2011–2017 to track quit attempts in all 50 states, the District of Columbia, Guam and Puerto Rico.

The survey

BRFSS is a yearly telephone survey (landline and cell) of a random, representative sample of adults living in the community. Samples ranged from 441,456 people (2014) to 506,467 (2011). A quit attempt meant answering yes to whether, in the past 12 months, the person had stopped smoking for a day or longer while trying to quit; it was counted among current smokers and among former smokers who had quit within the past year.

Results

In 2017, the share of smokers who had tried to quit in the past year ranged from 58.6% in Wisconsin to 72.3% in Guam, with a median of 65.4% (North Carolina). The lowest quarter (58.6%–62.5%) included six Midwestern states, four in the South, three in the West and one in the Northeast. In 2011 the range had been 57.4% (West Virginia) to 71.6% (New York), with a median of 64.9% (Mississippi).

Adult smokers reporting a past-year quit attempt, by state and territory, 2017. CDC figure.

Comparing 2017 with 2011, quit attempts were significantly higher in Alabama, Hawaii, Kansas, Louisiana and Guam, and lower in New York and Wisconsin.

Across 2011–2017 as a trend, quit attempts rose in four states — Kansas, Louisiana, Virginia and West Virginia — and fell in two, New York and Tennessee. The other 44 states, DC and two territories showed no significant change.

By age in 2017, younger smokers were more likely to try to quit. Median rates were 76.4% at ages 18–24, 68.6% at 25–44, 60.8% at 45–64 and 55.8% at 65 and older.

What it means

About 60% to 70% of adult smokers tried to quit in 2017, but no state or territory reached the 80% target, and most showed no progress since 2011. An earlier study had found quit attempts rising in 29 states and one territory in 2001–2010 but changing little in 2011–2013, and another found smokers on Medicaid more likely than privately insured or uninsured smokers to try to quit.

The population quit rate depends on how many smokers try and how many of those succeed. Most smokers try many times — as many as 30 on average — before succeeding, so tobacco dependence is treated as a chronic, relapsing condition that needs repeated help. Smokers should keep trying and providers should keep supporting them; three of every five U.S. adults who ever smoked have quit, and it is never too late to quit.

Proven measures work together to prompt quit attempts and improve success: higher tobacco prices, comprehensive smoke-free laws, hard-hitting media campaigns that promote free help such as state quitlines, and barrier-free access to proven treatments. So do state efforts to build tobacco treatment into routine care, improve insurance coverage and use of covered treatments, and extend quitlines' reach. Differences among states may partly reflect how far they have put these measures in place.

Limitations: people in institutions and those without phones were not surveyed; answers were self-reported; and response rates varied by state, which could introduce bias.

Sources

• Walton K, Wang TW, Schauer GL, et al. "State-Specific Prevalence of Quit Attempts Among Adult Cigarette Smokers — United States, 2011–2017." MMWR 2019;68(28).