While the United States trails most other industrialized countries in adult mortality, adults in central southern states, which are notoriously tobacco-friendly, die more frequently than those in other states. A new study from Brown University suggests the shift in higher mortality rates to Alabama, Kentucky, Mississippi, and Tennessee may be attributed to smoking cigarettes.

"In the U.S., more than 90 percent of lung cancer deaths among men, and more than 80 percent among women result from smoking," wrote Population Council, referencing the study. "Although the prevalence of smoking declined in all states in that time period, southern states, particularly Kentucky, have maintained overall high levels of smoking."

According to Population Council, laws in the Central South don’t discourage smoking the way laws in other regions do. Nearly all 10 states that do not enforce bans on smoking in public places are in the South. State taxes on tobacco products remain low in the South. In states like New York, on the other hand, smoking is banned in bars, places of employment, food service establishments — and basically any other public place. Most recently, the New York City Council took its ban on smoking in public places a step further, banning the use of electronic cigarettes, too. If you make it difficult for people to find a place to smoke, the thinking goes, you’re also making it more difficult for people to keep up with the habit. And so far, based on this new study, that approach seems to be working.

The researchers responsible for the study suggest tailoring anti-smoking campaigns to address geographic inequalities in the number of smokers in a given region. They believe that smoking may be a major contributing factor to the higher mortality rates in central southern states but also say that smoking may only be “one piece of a more complex health-related puzzle.”

Source: Felelon A. Geographic Divergence in Mortality in the United States. Population and Development Review. 2013.