State officials estimate Hawaii has saved more than $1 billion in total heath care costs due to the reduction in smoking since 2000.

That represents reduced costs in the treatment of heart disease, cancer, diabetes and other chronic conditions known to be caused by the habit, which kills an estimated 1,400 Hawaii adults each year.

“Tobacco use is still the No. 1 cause of morbidity and mortality in Hawaii as well as in the rest of the United States,” said Virginia Pressler, director of the Department of Health, at a news conference Thursday. “There’s so many devastating impacts of tobacco use as well as the impact on those around a smoker with the secondhand smoke.”

Smokers in general cost the health system an average $11,000 more than nonsmokers because they are at greater risk for chronic diseases, DOH officials said.

In 2000 about 1 in 5 Hawaii adults — or 19.9 percent of the population — were smokers. By 2016 that number decreased to 13.1 percent — roughly 1 in 10 adults — or 141,200.

“We have about 73,300 fewer smokers in the state of Hawaii today,” said Ranjani Starr, Health Department epidemiologist. “We have achieved huge reductions in smoking over the past two decades, and these reductions have resulted in substantial savings.”

Still, research shows there are subgroups that continue smoking at much higher rates than the general population, particularly heavy drinkers and people with mental health disorders, low-income residents and Native Hawaiians.

And while the number of tobacco users has declined, the use of e-cigarettes — known as vaping — is rising at alarming rates, particularly among children.

In 2017 about 10,700 — or 1 in 4 high school teens — and 4,400, or 1 in 5 middle schoolers, reported using electronic vaping products. In 2016 about 46,200 adults also said they used the electronic devices. That equates to about 25.5 percent of high school students, 15.7 percent of middle schoolers and 4.3 percent of adults.

“We have to keep fighting even though we’ve had some major progress,” Pressler said. “It’s tragic to see that a quarter of our high school students are vaping today.”

The state has spent $151.4 million on tobacco prevention and cessation programs since 2000 through money from a settlement agreement with tobacco companies. That equates to a savings of $6.64 in health care costs for every dollar spent, DOH officials said.

The next part of that campaign is deterring vaping among youth.

To this end, health officials are pushing legislation to impose tobacco taxes on e-cigarettes, require retailers and wholesalers to obtain tobacco licenses and permits, restrict online sales to those with licenses and prohibit the sale of tobacco, including e-cigs, within 500 feet of schools.

“These policies are critical to change social norms around e-cigs and to begin to reduce our youth use rate,” said Jessica Yamauchi, executive director of the Hawaii Public Health Institute’s Coalition for a Tobacco-Free Hawaii.

Lawmakers over the past few years have passed tobacco tax increases, measures requiring smoke-free beaches and parks, and raising the age for the sale of tobacco to 21. However, the tobacco industry continues to spend $25.5 million in Hawaii to market the products to keep people addicted, she said.

Donita Garcia, a nearly 50-year smoker, collected 128 cans a day while homeless for six months in Nanakuli just to buy a pack of cigarettes.

“I even would reach into maggot-infested trash cans just to get recyclables to get my cigarettes. I went through extreme measures,” the 62-year-old said. “It controls every second of your life. It’s just like you’re a slave to the cigarette.

Garcia finally quit when her health started to deteriorate. Her mother died from esophageal cancer and her father from a bad heart. Her younger sister had to have an oxygen tank. All were smokers.

“It started to get to the point that I was on two inhalers. I was constantly having leg problems because of low potassium because of smoking,” she said. “I didn’t want to die like my mother did or my father did. I have four grandchildren and they’re young, and I wanted to be an example to them. I didn’t want them to smoke.”

Garcia said she has been smoke-free for 668 days.