The smoking rate in America continues to fall. From 2005 to 2010, the percentage of American adults who smoke dropped to 19.3% from 20.9%, according to a recent report published by the Centers for Disease Control and Prevention. While the trend is positive, tobacco use remains a significant health burden for the people of United States, said CDC Director Tom Frieden, MD, MPH, in a written statement. 

The problem is especially troubling in states with high poverty rates where tobacco use can be over 25%. 24/7 Wall St. examined the CDC data and found that states with the highest tobacco use also tend to have the highest rates of residents living below the poverty line. Mississippi, Arkansas and Kentucky have some of the highest poverty rates in the country. They are also among the seven states in the country with tobacco use exceeding 22%. West Virginia and Louisiana, which are also among the top ten states with the highest percentages of residents living below the poverty, similarly have some of the highest rates of smoking.

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States can take many actions to curb the popularity of tobacco use, such as smoking bans, increased taxes and media campaigns. States with the strongest tobacco control programs have the greatest success at reducing smoking, said Dr. Frieden. For example, Californias adult smoking rate has dropped nearly 50% and the number of cigarettes smoked per person has decreased by 67% since the state began the nations longest-running tobacco control program in 1988, according to the CDC.

However, preventative measures are not as successful in other states. Oklahoma, which is one of the few states to ban possession of cigarettes for residents under the age of 18, has one of the highest rates of cigarette use in the country. Louisiana has bans preventing smoking in private work sites, restaurants and daycare centers, and yet it also has one of the countrys highest smoking rates.

24/7 Wall St. used the CDCs Vital Signs report, Adult Smoking in the U.S., to identify the seven states with the highest rates of cigarette use among adults. We then compared that information with state data on poverty rates from the Census Bureau, high school graduation rates from the National Center for Education Statistics, and taxes on cigarettes sales from the Federation of Tax Administrators to identify.

These are the seven states where people cant quit smoking.

7. Louisiana
> Pct. of adults who smoke: 22.1%
> Poverty rate: 17.3% (7th highest)
> High school graduation rate: 67.3% (5th lowest)
> Tax rate on cigarettes: $0.36 (2nd lowest)

Smoking is banned in the majority of indoor areas in Louisiana, including government buildings, private work sites, restaurants and both commercial and home-based daycare centers. Despite this, the state has one of the highest rates of tobacco use in the country. According to the American Cancer Society, one of the reasons for the relatively high smoking rate in Louisiana is the states low tax on cigarettes, an amount that has not changed since 2002. Additionally, smoking continues to be allowed in bars and casinos.

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6. Ohio
> Pct. of adults who smoke: 22.5%
> Poverty rate: 15.2% (16th highest)
> High school graduation rate: 79.6% (18th highest)
> Tax rate on cigarettes: $1.25 (25th lowest)

In Ohio, the difference between graduating from high school and not graduating is profound, at least in terms of the implications on smoking. Just 16.5% of those with at least a 12th grade education were smokers in 2010. But among those who never finished high school, a whopping 44% regularly smoke cigarettes. While the Buckeye State has an average excise tax on tobacco, it has relatively strict laws against public tobacco use. In 2006, the state approved an indoor smoking ban, the first in the Midwest to do so. However, the percentage of households that reported having rules limiting smoking at home are lower than the national average.

4. Arkansas
> Pct. of adults who smoke: 22.9%
> Poverty rate: 18.8% (2nd highest)
> High school graduation rate: 74.0% (15th lowest)
> Tax rate on cigarettes: $1.15 (22nd lowest)

Arkansas ranks high in meeting the CDCs recommended minimum funding amount for comprehensive tobacco prevention and control programs. Despite this, the state has the fourth highest rate of smokers in the country. According to the Arkansas Tobacco Prevention and Cessation Program, 4,900 Arkansans die prematurely from illnesses caused by tobacco each year. Additionally, tobacco use costs Arkansas upwards of $812 million, including $242 million in state-funded Medicaid, in health care costs and $1.4 billion in lost productivity costs. Since the prevention program began, approximately $168 million has been directed away from tobacco purchases and back into the local economy, the program states.

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4. Mississippi
> Pct. of adults who smoke: 22.9%
> Poverty rate: 21.9% (highest)
> High school graduation rate: 62.0% (2nd lowest)
> Tax rate on cigarettes: $0.68 (14th lowest)

In Mississippi, 22.9% of adults smoke regularly, much higher than the national median rate of 17.4%. Nearly 40% of adults who did not graduate from high school were smokers. Three thousand and seven hundred Mississippi kids become new daily smokers each year, and 69,000 Mississippi kids currently under the age of 18 will die prematurely from smoking, according to Roy Hart, director of the Office of Tobacco Control at the Mississippi State Department of Health. The state has a very low cigarette excise tax of just $0.68 per pack. In addition, the state has very few antismoking regulations, and indoor smoking is only banned in government offices.

3. Oklahoma
> Pct. of adults who smoke: 23.7%
> Poverty rate: 16.2% (15th highest)
> High school graduation rate: 77.3% (25th highest)
> Tax rate on cigarettes: $1.03 (21st lowest)

Oklahoma has the third highest rate of tobacco use among adults in the country, despite the fact that it has more legislation to prevent smoking than much of the U.S. Smoking is restricted to designated areas in private workplaces, government work sites and restaurants, and is banned in daycare centers. In addition, it is one of the few states to ban possession of cigarettes for residents under the age of 18. Violators face a minimum fine of $100 on a first offense, $200 on a second offense, and they can even face jail time if they do not inform police where they obtained the cigarettes. This has not stopped the state from having a high school smoking rate above the national average.

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2. Kentucky
> Pct. of adults who smoke: 24.8%
> Poverty rate: 18.6% (3rd highest)
> High school graduation rate: 77.6% (23rd highest)
> Tax rate on cigarettes: $0.60 (11th lowest)

Nearly one in four adults in Kentucky smoke or use tobacco regularly. Part of the reason for this may be the particularly high smoking rate just in the states high schools: 26.6%. Kentucky has no indoor smoking bans of any kind, and the 11th lowest tax on cigarettes in the country, standing at $0.60 per pack. In Kentucky, 371 out of every 100,000 adults die each year from smoking-cased deaths, the highest rate in the country, according to an Associated Press article.

1. West Virginia
> Pct. of adults who smoke: 26.8%
> Poverty rate: 17.7% (5th highest)
> High school graduation rate: 77.0% (25th lowest)
> Tax rate on cigarettes: $0.55 (7th lowest)

West Virginia wins the dubious first place in this list with an alarming smoking rate among adults of 26.8%. The state has none of the bans on indoor smoking that other states impose. It is even legal to smoke in childcare centers. The state has the seventh-lowest cigarette tax in the country, at just $0.55 per person. Of the states current smokers, nearly 55% have tried and failed to quit in the past year. According to the CDC, the state has the second worst rate of tobacco-related deaths in the country.

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