Residents of 12 states in the South and Midwest are more likely to smoke – and to smoke more – than people living in the rest of the United States, according to a new report.

Truth Initiative, a nonprofit focused on ending tobacco use, has dubbed that group of states “Tobacco Nation,” a region that spans Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Tennessee and West Virginia.

This group of states is home to about 21% of the US population but 28% of smokers in the country.

Overall, smoking prevalence is about 50% higher there than in the rest of the US. About 19% of adults smoke in this group of states, compared with about 13% of adults in other states.

A similar pattern holds among young adults. About 11% of adults under 25 in these states smoke, compared with less than 8% in other states. Teenagers in these states are also more likely to smoke.

Smoking prevalence has been consistently higher than average among these 12 states since Truth Initiative’s first report on the topic five years ago.

According to Truth Initiative, much of the disparity can be attributed to weaker local policy on tobacco prevention and cessation, particularly due to industry influence and lack of political will from decision-makers.

For example, federal data shows that the share of adults who smoke fell to a historic low in 2022, but e-cigarettes grew in popularity. To battle this trend, hundreds of local governments have enacted laws that restrict the sale of flavored tobacco – but only three of them have been within the 12 states with higher smoking prevalence.

The latest report from Truth Initiative, published last week, also shows that people in these 12 states who smoke tend to do so significantly more than smokers in other states.

An average smoker in “Tobacco Nation” goes through about 53 packs in one year, compared with an average of 29 packs in the rest of the US, a difference of about 500 cigarettes per person each year.

According to the US Centers for Disease Control and Prevention, tobacco use is the leading cause of preventable disease, disability and death in the US. Smoking or exposure to secondhand smoke causes premature death for nearly half a million people each year, and millions more live with a serious illness caused by smoking.

In 2020, the US surgeon general issued a report on smoking cessation – the first in 20 years – highlighting the health benefits of quitting that make it one of the most important actions a person could take to improve their health.

The new report from Truth Initiative found that adults in nine of the 12 states in “Tobacco Nation” also have among the highest rates of e-cigarette use.

“Due in part to policies that favor the tobacco industry over public health, residents of ‘Tobacco Nation’ are too often suffering from shorter life expectancy, worse indicators of health, and high prevalence of tobacco use,” Barbara Schillo, chief research officer at Truth Initiative, said in a statement.

Life expectancy is about three years lower in the 12 states where smoking is more common than it is in the rest of the country, according to the new report – about 76 years compared with 79 years.

“We owe it to all those who live in these states to take strong actions to close these geographic disparities and give them a fighting chance for a healthy, smoke-free life,” Schillo said.