Key findings:

  • New Jersey, Delaware and Indiana top states with largest difference in smokers quitting and people picking up vaping.
  • South Dakota, Indiana and West Virginia saw largest increase in vaping.
  • New York, Nevada and Oklahoma saw the largest decrease in smoking.
  • Nationwide 10% decrease in smoking and 8% increase in vaping.
  • 2.2% decline in cancer deaths propelled by gains against lung cancer in 2017.
  • Smoking reaches all-time low of 13.7% in 2018.

Across the nation we’re seeing sweeping trends in how people are consuming their nicotine vices. For years cigarettes were the choice among users. And while cigarettes remain the most common tobacco product among Americans. The prevailing trends are showing more and more people are ditching cigarettes.

The CDC reported that cigarette smoking reached an all-time low of 13.7% of users in 2018. That’s down two thirds in the nearly 50 years since the first Surgeon General’s warning. The effects of people quitting cigarettes in recent years has had significant impact on the health of Americans. The American Cancer Society reported a 2.2% drop in the cancer death rate in 2017. The drop was the single biggest decrease ever reported. The 2.2% drop was overall cancer deaths but given lung cancer is the single largest cause of cancer deaths that kind of movement was due to a decline in lung cancer. The decline in smoking has led to a decrease in lung cancer deaths.

With lung cancer deaths on the decline, we’re starting to see new lung related health issues due to vaping. Thousands have been hospitalized with vaping related injuries and 55 deaths have been confirmed from vaping. These telling health trends are reflective of the usage trends. As more people give up smoking for vaping, there becomes new consequences for vapers. Given the rising rates in vaping over the past few years, we can expect those trends to continue at even higher rates. The youth vaping epidemic, as some experts are calling it, is introducing a whole generation of the population that prefers vaping over smoking. Data from the University of Michigan estimates e-cigarette usage among high school students has increased 10% to 20%. As the current youth age into adults the vaping trends are expected to increase, and smoking continue to decline.

What does that mean for health insurance?

Under the Affordable Care Act there’s the Tobacco Use Surcharge that allows insurers to increase health insurance premiums up to 50% for enrollees who indicate they are tobacco users. The gray area here is e-cigarettes are not technically a tobacco product. However, given the recent health problems vaping has cause and the youth trends, regulators could very well change the classification of the Surcharge rules to include e-cigarette use. If e-cigarettes are reclassified, we could begin to see vapers and smokers subject to the same steep insurance rate increases.

Methodology

QuoteWizard analyzed CDC data on the prevalence of smokers in each state from a period of 2009 to 2018 to find which states saw the largest increase or decrease in smoking rates. We then paired smoker rates with e-cigarette prevalence from a period of 2016 to 2017 to find which states saw the largest increase or decrease in vaping rates. Final rankings are the calculated difference between smoking and vaping rates to show which states saw the largest decrease in smoking with the largest increase in vaping. Rankings show which states are seeing people quit smoking and pick up vaping at the highest rate.

Rank State % Smokers % Vapers Difference
1 New Jersey -17.09% 35.14% -52.22%
2 Delaware -9.84% 37.50% -47.34%
3 Indiana -8.66% 38.30% -46.96%
4 South Dakota 8.57% 51.72% -43.15%
5 Pennsylvania -15.84% 23.81% -39.65%
6 West Virginia -1.17% 38.30% -39.47%
7 Oklahoma -22.75% 11.94% -34.69%
8 Hawaii -12.99% 18.60% -31.59%
9 Maryland -17.11% 12.50% -29.61%
10 Virginia -21.05% 8.16% -29.22%
11 New York -28.89% 0.00% -28.89%
12 Vermont -19.88% 8.82% -28.71%
13 Missouri -16.02% 12.00% -28.02%
14 North Carolina -14.29% 13.64% -27.92%
15 Maine 2.89% 28.95% -26.06%
16 Illinois -16.67% 9.30% -25.97%
17 Nevada -28.64% -3.33% -25.30%
18 New Mexico -15.08% 10.20% -25.29%
19 Kentucky -8.59% 16.07% -24.67%
20 Rhode Island -3.31% 20.00% -23.31%
21 Colorado -15.20% 7.69% -22.90%
22 Mississippi -12.02% 10.64% -22.66%
23 North Dakota 2.69% 25.00% -22.31%
24 Oregon -12.85% 9.09% -21.94%
25 Texas -19.55% 2.13% -21.68%
26 Arizona -13.04% 7.55% -20.59%
27 Alabama -14.67% 3.92% -18.59%
28 Wyoming -5.53% 12.73% -18.25%
29 Florida -15.20% 2.13% -17.33%
30 Tennessee -5.91% 10.53% -16.44%
31 Idaho -9.82% 6.52% -16.34%
32 Michigan -3.57% 12.24% -15.82%
33 California -13.18% 0.00% -13.18%
34 Minnesota -10.12% 2.63% -12.75%
35 Connecticut -20.78% -12.20% -8.58%
36 New Hampshire -1.27% 5.88% -7.15%
37 Iowa -3.49% 2.33% -5.81%
38 South Carolina -11.76% -6.25% -5.51%
39 Georgia -9.04% -4.17% -4.87%
40 Washington -19.46% -15.09% -4.37%
41 Utah -8.16% -3.92% -4.24%
42 Wisconsin -12.77% -9.43% -3.33%
43 Kansas -2.81% 0.00% -2.81%
44 Montana 7.14% 9.76% -2.61%
45 Ohio 0.99% 3.51% -2.52%
46 Arkansas 5.58% 6.90% -1.32%
47 Alaska -7.28% -14.63% 7.35%
48 Massachusetts -10.67% -18.18% 7.52%
49 Nebraska -4.19% -16.33% 12.13%
50 Louisiana -7.24% -20.00% 12.76%