Smoking remains an important health issue in America, although we have fortunately seen some decline in cigarette smoking since 1990.

The prevalence of smoking in the population has an adverse impact on overall health by causing increased cases of respiratory diseases, heart disease, stroke, cancer, preterm birth, low birth weight and premature death (http://www.cdc.gov/tobacco/). Tobacco use is estimated to be responsible for about one in five deaths annually, or about 443,000 deaths per year. It is a lifestyle behavior that an individual can directly influence with support from the community and, as required, clinical intervention. It is an indication of known, addictive, health-adverse behavior within the population.

Smoking measures the percent of the population over age 18 who smoke tobacco products regularly. It is defined as the percentage of adults who self-report smoking at least 100 cigarettes and currently smoke regularly. The ranks are based on self-report data from Behavioral Risk Factor Surveillance System.