Cigarette Smoking and Geographic Divergences in Adult Mortality in the United States

Andrew Fenelon, Brown University

Between 1965 and 2004, there was a substantial divergence in adult mortality between states in the American South and states in other regions. This paper investigates the contribution of cigarette smoking epidemic to these diverging trends. Cigarette smoking is an important factor responsible for widening regional mortality gaps among both men and women. States that have maintained a high burden of smoking have suffered relative to states with more successful anti-tobacco campaigns. Among men, smoking is responsible for 50%-75% of the divergence between the Central South and other regions. Among women, smoking explains half of the divergence between the Central South and the Upper Midwest and Pacific, Smoking explains nearly all of the under-performance of the state of Kentucky. At a time when health policy goals explicitly involve narrowing health disparities, the observation of widening geographic differentials in mortality should be particularly alarming for policymakers.