UCLA’s latest California Health Interview Survey shows high smoking rates in several large pockets across the state, despite an overall decrease in smoking.

Aside from a brief uptick in smoking from 2009 to 2011, the number of smokers in California declined steadily from 15.3 percent in 2003 to 10.8 percent in 2014 — a figure that translates to about 3.4 million smokers currently.

However, smoking remains rampant in many portions of the state. Areas with the highest percent of teen and adult smokers included Lake County (26 percent), Yuba County (21 percent), Shasta County (19 percent) and several other rural and inland regions, mainly in northern and central California, according to the survey.

It is widely recognized that increasing the cost of tobacco is the most effective way to reduce smoking across California, which is one reason why the California Medical Association — in partnership with the Save Lives California coalition — has filed a 2016 ballot initiative to raise the state’s tobacco tax by $2 per pack.

The initiative will save the lives of Californians who are suffering from deadly and preventable diseases caused by tobacco use, as well as prevent more youth from using tobacco products in the first place. It will accomplish this by using the revenue generated from the law to improve access to health care services, support existing statewide education and outreach efforts, stop illegal sales of tobacco to minors, and increase funding for medical research.

Without it, smoking will continue to have detrimental impacts on California’s economy. Tobacco-related diseases already cost the state about $13.29 billion in medical expenses annually and another $10.35 billion in lost productivity.

Tobacco use is the single most preventable cause of death and disease in California, claiming the lives of nearly 40,000 people each year. Despite this, California’s tobacco tax has not been increased since 1998, making its current 87-cents-per-pack tax one of the lower in the nation.