Cigarette smoking in the United States results in an estimated 443,000 premature deaths and $193 billion in direct health-care expenditures and productivity losses each year. During 2007, an estimated 19.8% of adults in the United States were current smokers. To update 2006 state-specific estimates of cigarette smoking, CDC analyzed data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey and examined trends in cigarette smoking from 1998-2007. Results of these analyses indicated substantial variation in current cigarette smoking during 2007 (range: 8.7%-31.1%) among the 50 states, the District of Columbia (DC), Guam, Puerto Rico (PR), and the U.S. Virgin Islands (USVI). Trend analyses of 1998-2007 data indicated that smoking prevalence decreased in 44 states, DC, and PR, and six states had no substantial changes in prevalence after controlling for age, sex, and race/ethnicity. However, only Utah and USVI met the Healthy People 2010 target for reducing adult smoking prevalence to 12% (objective 27-1a). The Institute of Medicine (IOM) calls for full implementation of comprehensive, evidence-based tobacco control programs at CDC-recommended funding levels to achieve substantial reductions in tobacco use in all states and areas.