skip to main content

Public Health - Seattle & King County

Public Health Data Watch: Tobacco Use in King County

Volume 11, Issue 2 / May 2012 / Short version of this report (PDF)

Adult smoking rates are highest among Black/African-American, LGBT and low-income adults
Progress to reduce smoking among adults has stalled
More than 15,000 students (including 1 in 4 12th graders) used cigarettes or other tobacco products in the past month
Tobacco remains the leading preventable cause of death nationally, and in King County it accounts for 1 in 5 deaths and costs $343 million annually

King County has extreme smoking inequities

King County has the most extreme smoking inequities of the 15 largest metropolitan counties in the U.S., despite having an overall smoking rate that is among the lowest in the country.

  • The smoking rate among Black/African-American or Multiple Race adults (more than 1 in 5) is double the rate among whites (about 1 in 10) and four times that of Asians (1 in 20).
  • 19% of lesbian, gay, bisexual, or transgender adults were smokers, almost double the county average.
  • King County adults in low-income households are 3 times more likely to be smokers than high-income household adults.

King County has extreme smoking inequities

Smoking decline among adults has stalled

After a nearly 50% decline from 1996 to 2007, smoking rates among adults flattened in the most recent 5 year period (2007-2011).

In 2011, an estimated 155,000 King County adults (10% of adults 18 and older) were cigarette smokers. An additional 2% of adults, or 26,000 people, reported use of smokeless tobacco products such as chewing tobacco, snuff, or snus but not cigarettes.

Adults ages 18+ who are current smokers in King County

Cigarette smoking among King County youth is common

In 2010, students who reported smoking cigarettes in the past 30 days included:

  • 1% of 6th graders
  • 4% of 8th graders
  • 9% of 10th graders, and
  • 15% of 12th graders

This translates to at least 10,000 middle and high school cigarette smokers.

Youth with the highest cigarette smoking rates are:

  • American Indian/Alaska Native;
  • Native Hawaiian/ Pacific Islander; and
  • Hispanic/Latino youth.

Male youth are more likely to smoke than females.

Many youth use "alternative" tobacco products

In addition to cigarettes, youth also use alternative tobacco products such as: chewing tobacco, snuff, dip, cigars, cigarillos, and little cigars - many of which are flavored to taste like fruit, candy, or alcohol.

The rate of middle and high school students using any tobacco product is 15% (15,000 students). Tobacco use increases with age, with 1 of every 4 12th grade students using tobacco products. (These numbers do not include hookah users. In 2008, 21% of all King County 12th graders reported using hookah. 2010 figures for hookah are not available.)

Use of multiple tobacco types is also common: 50% of female and 67% of male tobacco users reported using multiple tobacco types.

Cigarette smoking among King County youth

Tobacco use is leading preventable cause of death among youth

Tobacco use is leading preventable cause of death

Every year, tobacco use in King County, Washington, costs $343 million in health care expenses and lost wages1. Use of tobacco is linked with cancer, heart disease, respiratory disease, poor birth outcomes, infertility, sudden infant death syndrome (SIDS), and many other poor health outcomes2. Smoking accounts for 1 out of every 5 deaths3, or about 1,800 deaths each year in King County. According to the most recent data, King County has an estimated 196,000 tobacco users. An additional 200,000 adults and youth are exposed to second-hand smoke1, to which there is no safe level of exposure4.

Effective strategies to reduce tobacco use and exposure to tobacco smoke

To reduce the harmful effects of tobacco we must prevent youth from starting to use tobacco, reduce non-smokers’ exposure to tobacco smoke, and help smokers quit. Though state tobacco funding has been almost completely eliminated, the burden of tobacco can be best reduced through comprehensive tobacco programs, including youth initiation prevention, to:

  • Increase the price of tobacco products;
  • Promote tobacco-free places, including parks, hospitals, multi-unit housing, and college and university campuses;
  • Educate the public about the risks of tobacco use;
  • Restrict tobacco advertising and promotions; and
  • Increase access to affordable, evidence-based cessation programs.

King County smoking inequities

Compared to other large United States metropolitan counties, in King County, Washington, adult smoking disparities by income and race are the most extreme. In King County, adults from households that earn less than $25,000 annually are 2.9 times more likely to be smokers than adults from households that earn at least $75,0000 annually. King County African American non-Hispanics are 1.9 times more likely to be smokers than white non-Hispanic adults. A ratio of 1.0 denotes that the percent of adults 18 and older reporting smoking is the same in the two groups being compared.

Ratio of smoking prevalence, annual household income, 15 largest counties in the US

Ratio of smoking prevalence, Black/African American NH to white NH, 15 largest counties in US

Additional charts

The following graphs present adult cigarette smoking by age group, gender, sexual preference, income, education, employment, children in household, relationship status, disability status, and veteran status. For more information please visit our Community Health Indicators website at

Adults who are current smokers by age, gender and sexual preference

Adults who are current smokers by household income, education and employment status

Adults who are smokers by children, disability and veteran status

Data sources and definitions:

Local data on youth tobacco use are from the Washington State Healthy Youth Survey, a self-administered school-based survey conducted every two years to measure adolescent health risk behaviors. Washington public schools, except institutional/correctional schools, serving grades 6, 8, 10 or 12 are eligible to participate.

Local data on adult tobacco use are from the Behavioral Risk Factor Surveillance System, a telephone survey of adults 18 and older. The survey is offered in English and Spanish.

To learn more, visit:


1 Washington State Department of Health, Tobacco Prevention and Control Evaluation Unit. Tobacco and Health in Washington State—County Profiles of Tobacco Use. April 2010. Accessed 12/28/2011.

2 Centers for Disease Control and Prevention. Health Effects of Cigarette Smoking. Last updated 3/21/2011. Accessed 12/28/2011.

3 Mokdad et al. Actual Causes of Death in the United States, 2000. JAMA. 2004; 291(10):1238-1245.

4 U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. The Health Consequences of Involuntary Exposure to Tobacco Smoke, report of the Surgeon General, 2006. Accessed 5/10/2012.

This issue of Public Health Data Watch was produced by Eva Wong of the Assessment, Policy Development & Evaluation Unit of Public Health - Seattle & King County. Scott Neal, Jim Krieger, Anne Pearson, Matías Valenzuela, Laura Hitchcock and David Solet provided review and comments. For more information, contact and visit