The rate of cigarette smoking declined significantly in about half of states between 2011 and 2013, according to a new report by the Centers for Disease Control and Prevention (CDC).
There was relatively little change in the rate of smokeless tobacco use, the report found.
There was also little change overall in the rate of people who used both cigarettes and smokeless tobacco.
In some states the rate of concurrent use of cigarettes and smokeless tobacco increased.
This trend concerns the CDC researchers, who note that adults who use more than one tobacco product have higher levels of nicotine dependence and are less likely to want to quit than those who only smoke cigarettes.
"From 2011 to 2013 although we've seen some progress for cigarette smoking overall, there hasn't been a significant change in cigarette smoking or smokeless tobacco use across many states," the CDC's Brian King told HealthDay. "What is most concerning is the preponderance of dual use—people using multiple tobacco products," he said.
Smoking decreased across the country from 21 percent of adults in 2011 to 19 percent in 2013, according to the report.
West Virginia had the highest smoking rate, at 27 percent, while Utah had the lowest rate, at 10 percent. West Virginia also had the highest rate of smokeless tobacco use, at 9 percent. In contrast, only 1.5 percent of people in Massachusetts used smokeless tobacco.
While cigarette smoking rates decreased in 26 states during the study period, only two states—Ohio and Tennessee—saw a decline in smokeless tobacco rates during that period. The use of smokeless tobacco rose in four states—Louisiana, Montana, South Carolina and West Virginia between 2011 and 2013. The combined use of cigarettes and smokeless tobacco increased in five states—Delaware, Idaho, Nevada, New Mexico and West Virginia.