Tobacco Use Among Individuals With Medical Conditions: Findings From a Multi-State Rapid-Response Survey in the U.S., 2023–2024

INTRODUCTION: Smoking cessation can improve outcomes in individuals with smoking-related medical conditions. This study examined cigarette smoking and quitting behavior among those with a history of cardiovascular conditions, pulmonary conditions, and cancer within 13 high-tobacco-burden states with high smoking prevalence in the American South and Midwest versus 4 low-tobacco-burden comparison states with lower prevalence. METHODS: Respondents in high- (n=9,099) and low- (n=3,200) tobacco-burden states were from 2 waves of an American Cancer Society online probability-based rapid-response survey of U.S. adults (aged 18-65 years) conducted in April-May 2023 and 2024. Associations of place of residence (high- versus low-tobacco-burden states) with tobacco use and quitting behavior in a self-reported medical condition-stratified sample was examined. RESULTS: There was a significantly higher prevalence of ever-diagnosed cardiovascular conditions (26.9% [95% CI=25.5%, 28.3%] vs 21.4% [95% CI=19.3%, 23.6%], p=0.0001) and elevated prevalence of pulmonary conditions (16.8% [95% CI=15.6%, 18.0%] vs 14.5% [95% CI=12.7%, 16.5%], p=0.0505) but not cancer (4.2% [95% CI=3.7%, 4.9%] vs 4.1% [95% CI=3.2%, 5.3%], p=0.8653) in high- than in low-tobacco-burden states. Individuals in high-tobacco-burden states with pulmonary conditions were more likely to be currently smoking than their counterparts in low-tobacco-burden states (AOR=1.68, 95% CI=1.19, 2.40, p=0.003) despite no differences in quitting behavior. CONCLUSIONS: Elevated medical condition prevalence and higher odds of current smoking were found among respondents with a history of pulmonary conditions in high-tobacco-burden states. Increased cessation resources targeted at individuals with pulmonary conditions is warranted.