California has long been a trendsetter. But when it comes to reducing smoking and lung cancer, the Golden State's success hasn't taken the entire nation by storm.
Just take a look at the chart, which shows lung cancer death rates among white women by the year they were born.
For those women born since 1933, lung cancer death rates in California have dropped by more than half. In Alabama, they've more than doubled.
Why such a big discrepancy between the best state and the worst? "Lung cancer follows the smoking pattern," Ahmedin Jemal, an epidemiologist at the American Cancer Society, tells Shots.
California led the way with excise taxes on cigarettes and ordinances banning smoking at the workplace and in bars. The state also did a lot to encourage smokers to quit.
Alabama and other states in the South and Midwest weren't nearly as aggressive.
When Jemal and colleagues from the American Cancer Society and the National Cancer Institute crunched the lung cancer numbers, the differences were stark.
To make the comparisons easier to see, they expressed the rates as a ratio pegged to the death rate for women born in 1933. The national death rate from lung cancer was highest for women born then, Jemal says.
The findings appear in the latest Journal of Clinical Oncology.