Smoking is down significantly across the country, and the rate is even lower in Connecticut. But the overall picture masks significant disparities in who the remaining smokers are. The group is heavily weighted toward those with the least education, lowest incomes, gays and lesbians, people who are covered by Medicaid or uninsured, and those with a disability.

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And despite the overall drop in tobacco smoking, it remains the leading cause of preventable disease and death in the country, according to the Centers for Disease Control and Prevention.

Here’s a more detailed look at who smokes in Connecticut and the U.S.

The information here is based on data published this month in the CDC’s Morbidity and Mortality Weekly Report – it comes from the 2014 National Health Information Survey – and Connecticut’s 2013 Behavioral Risk Factor Surveillance Survey.

Overall, 16.8 percent of U.S. adults smoked in 2014, according to the national survey. In Connecticut, the smoking rate was 15.5 percent in 2013, the state’s survey found.

Lower education levels, higher smoking rates

People with no high school degree are more than four times more likely to smoke than people with graduate degrees, according to the national survey.

Similarly, Connecticut’s survey found that those with a high school education or less were twice as likely to smoke as those with at least some post-high school education – 22.4 percent to 11 percent.

Lower income, more tobacco use

Nationally, more than one in four people with incomes below the poverty level smoked in 2014, compared to slightly less than one in six of those at or above the poverty level.

In Connecticut, people earning less than $35,000 were nearly three times as likely to smoke as those earning $75,000 or more.

More uninsured, Medicaid clients smoke

People with Medicaid or who had no health insurance were far more likely to smoke than those covered by Medicare or private insurance.

Connecticut’s data come from 2013, the year before the major coverage expansion provisions of the federal health law took effect. The survey found that 26.1 percent of those without health insurance smoked, compared to 14.3 percent of those with coverage.

The authors of the CDC report suggested that the differences in smoking rates based on health coverage could be partly explained by differences in coverage for smoking cessation treatment. The federal health law requires private insurance companies to cover tobacco cessation, but the authors said insurers and Medicaid programs don’t consistently provide comprehensive coverage of proven treatments.

Connecticut’s Medicaid program is one of only nine in the country that covered both individual and group counseling and all seven FDA-approved smoking cessation medications for all members, according to a recent federal report.

Race and ethnicity: CT vs. national data

This is one measure on which Connecticut and national data don’t align.

Nationally, the prevalence of smoking varied widely by race and ethnic group. Rates of smoking for blacks and Hispanics were lower than for whites.

In the past decade, smoking rates fell for all racial and ethnic groups included in the national survey, with the exception of people of mixed race.

In Connecticut, unlike the country overall, blacks and Hispanics smoked at higher rates than whites.

Fewer young people smoking, but are they using more e-cigarettes?

The cigarette smoking rate fell most among young people from 2005 to 2014, but the authors of the CDC report questioned whether some of that decrease was the result of electronic cigarettes or other tobacco products, such as hookahs.

E-cigarettes most common among the young

In Connecticut, young people are the most likely to have tried electronic cigarettes, as well as the most likely to smoke cigarettes.

Overall, 12 percent of Connecticut residents surveyed said they had tried e-cigarettes. As with cigarettes, use was more common among those with lower incomes, lower education levels, no health care coverage and disabilities.

Disabilities and smoking

People with disabilities are significantly more likely to smoke than those who don’t have disabilities.

Smoking and sexual orientation

Smoking rates were also higher among people who said they are gay, lesbian or bisexual, according to the national survey.

Tobacco control dollars

The authors of the CDC report noted that states’ spending on comprehensive tobacco-control programs for 2015 is expected to represent just 1.9 percent of the $25.6 billion they will receive in tobacco taxes and revenues from a settlement with tobacco companies.

Connecticut has received nearly $2 billion in the past 15 years from a legal settlement with tobacco companies, but has spent only a small fraction of it on anti-tobacco efforts. This fiscal year, the money that would have gone into a trust fund for anti-tobacco efforts and other health programs was instead used to help the state balance its budget.

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

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