Small number of counties leads way in reducing smoking rates in U.S.Nationally smoking rates have decreased since 1996 but the declines have been driven by a relatively small share of counties across the US according to new research from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.The study Cigarette smoking prevalence in US counties: 1996-2012 was published March 24 in the open-access peer-reviewed journal Population Health Metrics.Total cigarette smoking prevalence -- the percentage of the population that smokes -- has not decreased significantly in all counties but because a small group of counties accounts for a large percentage of the population three-quarters of men and two-thirds of women live in counties that did see significant declines.Most of the decline in smoking rates has occurred within the past decade. Nationally smoking rates have declined for men from 27.3% to 22.2% and for women from 22.2% to 17.9% between 1996 and 2012. In individual counties there were much bigger gains.Annualized rate of change captures the pace of change in smoking rates between 1996 and 2012. The greatest decline in smoking rates for men was 4.5% per year in Falls Church City Virginia and the largest increase for men was 1.1% per year in Issaquena County Mississippi. The greatest decline in smoking rates for women was 4.1% per year in Maverick County Texas and the greatest increase for women was 1.7% per year in McMullen County Texas.We know what works in tobacco control. It's taxation. It's smoking bans. It's advertising bans among other measures said IHME Director Dr. Christopher Murray. We now need to understand what is happening on the ground in these counties that is leading to such great success in parts of New York Iowa and Texas and near total stagnation in parts of Montana Oklahoma and Mississippi.IHME's study found striking differences in smoking rates by geography gender and income.Overall counties in the South particularly in Kentucky Tennessee and West Virginia as well as those with large Native American populations have the highest rates of total cigarette smoking while counties in Utah and other Western states have the lowest.Smoking rates for men were high in the South and parts of the Midwest Alaska South Dakota Nevada and Arizona. In Utah Colorado Wyoming California Washington and parts of New England smoking rates for men were low.High smoking rates for women were found in southern states including Kentucky West Virginia Tennessee Missouri Oklahoma Arkansas and Louisiana. Female smoking rates also were high in parts of Alaska Nevada Arizona North Dakota and South Dakota. Counties with the lowest rates of smoking for women were found in Utah Colorado Wyoming California and the area along the Mexico-Texas border.Out of all counties in the US men in Falls Church City Virginia had the lowest total cigarette smoking prevalence in 2012 at 9.9% and men in Northwest Arctic Borough Alaska had the highest at 41.5%. For women smoking rates were lowest in Utah County Utah at 5.8% and highest in Northwest Arctic Borough Alaska at 40.8%.Smoking rates vary dramatically between counties and even within states.For men Virginia had the largest gap in the highest and lowest smoking rates among counties: a 23.6 percentage point difference between men in Falls Church City (9.9%) and their counterparts in Sussex County (33.5%). Alaska was the state with the largest gap for women a 25.4 percentage point difference between Haines Borough (15.4%) and Northwest Arctic Borough (40.8%).What we are seeing with gaps in smoking rates is very similar to what we have seen with gaps in life expectancy between counties said Dr. Ali Mokdad Professor of Global Health at IHME and one of the study authors. It should not be the case that in one county in Virginia less than 10 percent of people smoke while nearby a full third do. And it shouldn't be the case that people are living more than a decade longer in some counties than in others.Evaluating smoking rates at the county level provides a more detailed picture of which communities have made progress on tobacco control and which ones are falling behind. While state-level policies may not be implemented or enforced evenly across all jurisdictions local jurisdictions have the ability to implement their own tobacco control policies and programs.According to the most recent figures from the Global Burden of Disease (GBD) study coordinated by IHME tobacco smoking was linked to 465000 deaths and 12% of total health loss in the US. Globally tobacco led to 5.7 million deaths and 5.5% of total health loss. These estimates exclude the effects of secondhand smoke.Although it's been 50 years since the first US Surgeon General's report on the negative health impact of smoking some counties in the US have higher smoking rates than certain countries around the world.For women nearly half of all the countries in the world including Indonesia and Saudi Arabia have lower daily smoking prevalence than any county in the US. At the same time only 1.6% of countries have higher female daily smoking prevalence than any county in the US.Many of the counties with the lowest smoking rates for women are in Utah ranging from 9.1% to 5.8%. And yet daily smoking prevalence for women in 2012 was even lower in countries such as India and Thailand.It continues to be true that men smoke at higher rates than women nearly everywhere you go in the U.S. In the vast majority of counties men smoked cigarettes at higher rates than women.That was true in 99% of counties in 1996 and 96.4% of counties in 2012.The researchers also broke down the findings by income group. They found that those who live in counties with higher incomes tended to smoke a lot less over time than those living in counties with lower incomes. In the top income group 75% of counties saw a statistically significant decline in male smoking from 1996 to 2012 compared to 14% of counties in the bottom income group. For women 45% of the counties in the top income group saw significant smoking declines while only 4% of counties in the bottom income group had significant declines.We know that there is a very strong relationship between poverty and people's health said the study's lead author Laura Dwyer-Lindgren. We need to better understand how to break that connection between poverty and health outcomes not only with smoking but with a range of risk factors.Which counties had the highest and lowest total cigarette smoking prevalence for men in 2012?Lowest:Falls Church City VA 9.9% Utah County UT 9.9% Davis County UT 11.7% Wasatch County UT 11.8% Arlington County VA 11.8% Summit County UT 12.5% Howard County MD 12.7% Whitman County WA 12.8% Cache County UT 12.8% Loudoun County VA 13.1%Highest:Northwest Arctic Borough AK 41.5% Wade Hampton AK 41.2% Nome Census Area AK 38.1% Shannon County SD 37.9% Sioux County ND 37.7% Bethel Census Area AK 37.5% Lee County KY 37.4% Clay County KY 37.2% East Carroll Parish LA 37% Issaquena County MS 36.8%Which counties had the highest and lowest total cigarette smoking prevalence for women in 2012?Lowest:Utah County UT 5.8% Wasatch County UT 7.1% Davis County UT 8.3% Hidalgo County TX 8.6% San Mateo County CA 8.7% Cameron County TX 8.8% Summit County UT 8.9% Santa Clara County CA 9% Cache County UT 9.1% Los Angeles County CA 9.6%Highest:Northwest Arctic Borough AK 40.8% North Slope Borough AK 37.5% Menominee County WI 36.5% Clay County KY 36.2% Wade Hampton AK 36.2% Nome Census Area AK 35.8%Buffalo County SD 35.4% Knox County KY 34.7% Shannon County SD 34.1% Elliott County KY 34%For men which counties had the fastest declines and the biggest annual increases in total cigarette smoking prevalence between 1996 and 2012?Decreases:Falls Church City VA -4.5% Arlington County VA -3.2% San Francisco County CA -3.1% Loudoun County VA -2.9% New York County NY -2.8% Orange County CA -2.8% Dallas County IA -2.8% Rockingham County NH -2.8% San Mateo County CA -2.8% Utah County UT -2.8%Increases:Issaquena County MS 1.1% Meagher County MT 0.9% Bent County CO 0.8% Hardy County WV 0.7% East Carroll Parish LA 0.7% Wheeler County GA 0.6% Benson County ND 0.5% Claiborne County MS 0.5% Lee County AR 0.5% Lincoln County AR 0.4%For women which counties had the fastest declines and the biggest annual increases in total cigarette smoking prevalence between 1996 and 2012?Decreases:Maverick County TX -4.1% Hidalgo County TX -3.7% San Luis Obispo County CA -3.7% Falls Church City VA -3.7% Webb County TX -3.6% Santa Barbara County CA -3.5% San Francisco County CA -3.5% San Mateo County CA -3.4% Wasatch County UT -3.4% Chittenden County VT -3.3%Increases:McMullen County TX 1.7% Mineral County WV 1.6% Muskogee County OK 1.4% Allen Parish LA 1.4% Bristol City VA 1.4% Benson County ND 1.3% Grant County WV 1.2% Hampshire County WV 1.2% Adair County OK 1.2% Sullivan County TN 1.2%An online visualization tool showing data for each county is available at: http://www.healthmetricsandevaluation.org/tools/data-visualization/us-health-mapStory Source:The above story is based on materials provided by Institute for Health Metrics and Evaluation. 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