Special Report

States With the Most Smоkers

Claiming nearly half a million American lives annually, smоking is the leading cause of preventable death in the United States. Another 16 million Americans are living with a serious illness caused by smоking. Smоking also has an economic impact, including more than $225 billion each year spent on medical expenses to treat the smоking-related illness in the U.S. and over $156 billion in lost productivity.

Though the risks associated with smоking and tobacco use are well established and widely understood, 42.4 million American adults — of 16.6% of the adult population — regularly smоke cigarettes. Smоking rates vary considerably nationwide, however, and in some states, residents are far more likely to smоke than in others. 

Using data from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program, 24/7 Tempo identified the states with the most smоkers. States are ranked on the adult smоking rate — or the share of adults who smоke every day or most days and have smоked at least 100 cigarettes in their lifetime.

Smоking rates vary from less than 10% to over 25%, depending on the state. States with the lowest smоking rates are disproportionately concentrated in the West, while Southern states account for the largest share of states with higher than average smоking rates. 

Given the proven detrimental effects of smоking, it is perhaps not surprising that some important health outcome measures tend to be worse than average in states with higher smоking rates. For example, in most of the 25 states with higher than average smоking rates, the share of adults who report being in fair or poor health is greater than the 16.5% share nationwide.

The correlation between smоking rates and life expectancy is even stronger. In all but three of the 25 states with the highest smоking rates, average life expectancy at birth is below the 79.2 year national average. (This is what happens to your body after you quit smоking.)

Click here to see the states with the most smоkers
Click here to read our detailed methodology