During 2000-2004, overall average annual SAM rates per 100,000 population were lowest in Utah (138.3), Hawaii (167.6), and Minnesota (215.1), and highest in Kentucky (370.6), West Virginia (344.3), and Nevada (343.7). Median SAM rates per 100,000 population overall were 288.1 for 1996-1999 and 263.3 for 2000-2004. Changes in smoking-attributable deaths per 100,000 population during these two periods varied among states; SAM rates among adults declined the most in Nevada (-44.4 deaths per 100,000 population), California (-37.8), and Virginia (-33.4). Average annual overall SAM rates decreased from 1996-1999 to 2000-2004 in all states except Oklahoma, which experienced an increase of 26.9 deaths per 100,000. Compared with 1996-1999, average annual SAM rates declined in 2000-2004 among men in all states except Oklahoma, but increased among women in several states (Alabama, Arizona, Arkansas, Georgia, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Michigan, North Carolina, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas) and DC.