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Research shows that people with these conditions account for nearly 40% of all cigarettes consumed in the U.S., despite representing a much smaller share of the population. Population-based studies, including a major Norwegian survey, have found that individuals with symptoms of anxiety and depression are significantly more likely to be current smokers compared to those without these symptoms. This association is particularly concerning because individuals with depression or anxiety often smoke more heavily and are more likely to become nicotine dependent. Additionally, the co-occurrence of both conditions has been found to strengthen the association with tobacco use, suggesting a compounding effect. The relationship between tobacco use and emotional distress is commonly explained by the self-medication hypothesis

Smoking costs Montanas Medicaid program $81.1m each year, or $779 per household in federal and state taxes in the sparsely populated state, according to the Campaign for Tobacco-Free Kids