Many smokers also use smokeless tobacco, according to new data compiled by the Centers for Disease Control and Prevention that covers use of smokeless tobacco in all 50 states, the District of Columbia, the U.S. Virgin Islands, Puerto Rico, and Guam. The data show that the rates of smokers who also use smokeless tobacco, including chew tobacco and snuff, range from 0.9 percent in Puerto Rico to 13.7 percent in Wyoming, a CDC press release states.

Smoking causes cancer, heart disease, emphysema and more, all of which lead to premature death. Use of smokeless tobacco while continuing to smoke may add to one's risk for tobacco-related diseases. Smokeless tobacco use has been marketed by tobacco companies as a substitute for tobacco users when they are in a place that does not allow smoking. "Tobacco use is the leading preventable cause of death in this country," said CDC Director Tom Frieden, M.D., M.P.H., "and unfortunately smokers are also using smokeless tobacco. If you smoke, quitting is the single most important thing you can do to improve your health. Use of smokeless tobacco may keep some people from quitting tobacco altogether. We need to intensify our anti-tobacco efforts to help people quit using all forms of tobacco."

The research found that smokeless tobacco is predominantly a problem among men, young adults, those with a high school education or less, and in some states with higher smoking rates. Among the states in 2009 smoking prevalence was highest in Kentucky (25.6 percent), West Virginia (25.6 percent), and Oklahoma (25.5 percent), and lowest in Utah (9.8 percent), California (12.9 percent), and Washington (14.9 percent).

Smokeless tobacco use was highest in Wyoming (9.1 percent) and West Virginia (8.5 percent) and lowest in the U.S. Virgin Islands (0.8 percent) and California (1.3 percent). Among adult male smokers, 23.4 percent in Wyoming and 20.8 percent in Arkansas reported smokeless tobacco use.

"These new numbers are concerning." said Tim McAfee, M.D., M.P.H., Director of CDC's Office on Smoking and Health. "But progress is possible. We need to fully put into practice effective strategies such as strong state laws that protect nonsmokers from secondhand smoke, higher tobacco prices, aggressive ad campaigns that show the human impact of tobacco use, and well-funded tobacco control programs, while stepping up our work to help people quit using all forms of tobacco."

For the full report, visit www.cdc.gov/mmwr. For state-specific tobacco data, visit CDC's State Tobacco Activities Tracking and Evaluation System at http://www.cdc.gov/tobacco/statesystem. Call 1-800-QUIT-NOW (1-800-784-8669) or visit www.smokefree.gov for quitting assistance.