Not the least bit surprising, but something to think about when it comes to tobacco control.

This is why people in tobacco control care about the issue; ultimately it comes down to people dying from tobacco.

When most people think of Kentucky, they think of horse country, the Kentucky Derby, and idyllic bluegrass hills. But, there’s a terrible dark side to that bucolic landscape. According to this USA Today story, Kentucky has the dubious distinction of being No. 1 in the nation for having the worst cancer rate. The biggest reason why? Lung cancer. Lung cancer is the third-most common form of cancer in the U.S. (behind breast cancer for women and prostate cancer for men). However, while lung cancer represents about 13 percent of all cancers, it also represents 27 percent of all cancer deaths. That’s the most … by a LOT. Lung cancer kills more people than colon, breast, pancreatic and prostate cancer combined. It continues to be one of the most, if not the most, difficult form of cancer to treat.

According to USA Today, the rate for lung cancer deaths in Kentucky is 50 percent higher than the national average. From the article:

Lung cancer incidence per 100,000 people: 92.4, compared with 60.4 nationally. Mortality per 100,000: 68.8 — around 120 in the hardest-hit Appalachian counties — compared with 45 nationally.

Kentucky has a notoriously high smoking rate. It was the highest in the nation until recently, but now it is second highest in the U.S. at 26.5 percent, (only West Virginia is higher) considerably higher than the national average. Kentucky’s smoking rate was over 30 percent as recently as 10 years ago. The national average, according to this article, has dropped all the down to 15.2 percent (I haven’t seen that figure widely reported; I saw 16.8 percent a few weeks ago.). Kentucky also has a higher than normal death rate from breast, colon and cervical cancers. That might be partly attributable to smoking. Kentucky also has a ridiculously low cigarette tax at 60 cents a pack, one of the lowest in the nation.  The national average is over $1.50 a pack. There is also no statewide indoor smoking ban, though several large cities in Kentucky do ban smoking indoors. These factors help to encourage smoking. They really do. Every state that imposes a smoking ban and/or raises its cigarette tax sees its smoking rate go down. Of course, Kentucky just elected a conservative Republican as its governor, so don’t expect a cigarette tax increase any time soon.

From the article

For many years, Kentucky has had a quarter of adults smoking,” said oncologist Dr. Goetz Kloecker, a lung cancer specialist with University of Louisville Physicians. “I have patients who started puffing at 8, 9 and 10 years old…It’s part of the culture.”

Because of that culture, “cigarettes are still cheaper than in other places,” Kloecker added. “If you go to Chicago or New York, there are fewer teenagers starting to smoke. The higher the costs, the lower the smoking rate.”

One of the reasons smoking is so ingrained in the culture is Kentucky is one of the leading tobacco-growing states. Kentucky has a lot fewer tobacco farmers than it once did (wow, there were 56,000 tobacco farms in Kentucky in 1992), but it is still second in the U.S. behind North Carolina in the level of tobacco produced. And in fact, North Carolina and Kentucky absolutely dominate the market with over 70 percent of the tobacco grown in the U.S. coming from those two states. (Interestingly, North Carolina actually has a statewide smoking ban and a relatively low smoking rate for a Southern state at 20.2 percent in 2013 — likely lower than that today.)

Other environmental factors are playing a role. Kentucky has a high level of radon in homes and especially in the Appalachian region, residents have high levels of chromium and arsenic in their systems. (Probably from mining operations and groundwater contamination.).

Other factors are mentioned by USA Today, such as poor health screenings in the state and obesity, but the high smoking rate is the biggest factor, no doubt.