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The transition to a more severe expression of smoking-associated disease is marked by the impaired ability of macrophages to kill bacteria or viruses, the loss of ability to remove dead cells, the degradation and chemical modification of the extracellular matrix, the increasing retention of oligoclonally expanded CD8+ T cells and the induction of interleukin-17-secreting effector T cells

States that have 40 to 44%: Arkansas, Arizona, Iowa, Kentucky, Michigan, Minnesota, Mississippi, North Carolina, South Carolina, and South Dakota States that have 45% or more: Alabama, Louisiana, Oklahoma, Tennessee, and West Virginia

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There is also great interest in developing a vaccine which can prevent infection, or its progression to chronic Hepatitis C