For me personally, the noxious habit of smoking does not seem to exist any more. At home and when traveling to large cities in the U.S., I rarely see anyone smoking. And yet, here's an article that indicates that smoking is linked to one-fourth of all U.S. cancer deaths (see: One-fourth of US cancer deaths linked with 1 thing: smoking). Below is an excerpt from it:
Cigarettes contribute to more than 1 in 4 cancer deaths in the U.S. The rate is highest among men in Southern states where smoking is more common and the rules against it are not as strict. The American Cancer Society study found the highest rate among men in Arkansas, where 40 percent of cancer deaths were linked to cigarette smoking. Kentucky had the highest rate among women - 29 percent.The lowest rates were in Utah, where 22 percent of cancer deaths in men and 11 percent in women were linked with smoking....Lung, throat, stomach, liver, colon, pancreas and kidney cancers were among those included, along with leukemia. The researchers estimated how many cancer deaths were likely attributable to smoking, and compared that with deaths from all cancers. While U.S. smoking rates have been falling, 40 million U.S. adults are cigarette smokers and smoking is the top cause of preventable deaths, according to the [CDC]. The study found that at least 167,000 cancer deaths in 2014 - about 29 percent of all U.S. cancer deaths - were attributable to smoking. A government estimate based on different methods says 1 in 3 U.S. cancer deaths are linked with smoking, and the study authors acknowledge they may have underestimated the true burden posed by cigarettes. Most of the 10 states with the highest rates of smoking-attributable cancer deaths were in the South, while most of the 10 states with the lowest rates were in the North or West....The average cigarette excise tax in major tobacco states, mostly in the South, is 49 cents, compared with $1.80 elsewhere. The tobacco industry heavily influences these policies and most of the U.S. tobacco crop is grown in the South....
Note that cigarette smoking is associated with many cancers in addition to the lungs: throat, stomach, liver, colon, pancreas and kidney. For example and on average, smokers have a 50% increase in risk of kidney cancer. Smokers also have up to three times the risk of developing cancer of the renal pelvis compared to non smokers (see: Risks and causes of kidney cancer). There are some 70 known carcinogens in tobacco smoke and some of them are undoubtedly concentrated in the urine as the cause of these cancers (see: Carcinogens in Tobacco ProductsTobacco smoke).
Clearly, smoking is an essential component of the economy of the southern U.S. states and also an important part of the culture. States, not just people, can become addicted to tobacco. "Tobacco production is an important industry in Kentucky, which along with North Carolina generates two-thirds of the nation's tobacco harvest....People aren't necessarily more likely to smoke if they live in a tobacco-growing state, but Kentuckians are certainly doing their part to help the local economy. The state has the nation's second-highest adult smoking rate, as well the highest rate of smoking-related deaths. Most alarming of all, Kentucky is encouraging more smokers: The smoking rate among high schoolers is the highest in the U.S." (see: The 10 States Most Addicted to Smoking). So unless and until the South is able to wean itself off tobacco production as well as increase the taxes it imposed on cigarettes, I suspect that the cancer rate and health costs associated with this addiction will continue at high levels compared to the rest of the country.