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A relatively small number of counties, most of them with big populations or near larger cities, account for much of the declining smoking rates in the United States, according to new research.

The survey of 5 million smokers found smoking rates for people who smoked at least 100 cigarettes in their lifetime have dropped in the past decade. Among men, the rate declined from 27.3 percent to 22.2 percent. Among women, the rate dropped from 22.2 percent to 17.9 percent, USA Today reports.

Only 39.8 percent of counties for males and 16.2 percent of counties for females experienced statistically significant declines in cigarette smoking prevalence between 1996 and 2012.  The study appears in Population Health Metrics.

Counties with significant declines in smoking rates are usually near cities, where laws banning smoking in public places could be contributing to the decrease, the researchers say. They note that social stigma may also drive drops in smoking rates in cities. The city with the lowest rate of daily smoking in 2012 was Falls Church, Virginia, a suburb of Washington, D.C. The daily smoking rate for men and women was 5.4 percent, down from 14 percent in 1996. Covington County, Virginia, on the western side of the state, had a smoking rate almost five times higher.

Bill Blatt, Director of Tobacco Programs at the American Lung Association, told the newspaper there are several reasons smoking rates are higher in rural areas. “One problem in rural areas is access,” he said. “Broad campaigns around tobacco use and cessation tend to be concentrated in major media markets. On top of that the small areas don’t have the same societal pressures as larger areas.”

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