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 — or 16.6% of the adult population — regularly smоke сigarettes. In some parts of the country, smоking rates are far higher.
Using data from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program, 24/7 Wall St. identified the 50 metro areas with the most smоkers. Metropolitan areas are ranked on the adult smоking rate — the share of the 18 and older population who smоke every day or most days and have smоked at least 100 сigarettes in their lifetime.
Smоking rates in the metro areas on this list range from over 22% to nearly 28%. The majority of metro areas on this list are located in Southern states. However, seven of the metro areas with the highest smоking rates are in Ohio, more than any other single state.
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 metros with higher smоking rates. For example, in all 50 metro areas with the highest smоking rates, the share of adults who report being in fair or poor health is greater than the 16.5% share nationwide. (This is what happens to your body when you stop smоking.)
The correlation between smоking rates and life expectancy is also strong. In every metro area on this list, average life expectancy at birth is below the 79.2 year national average.
Click here to see the metros with the most smоkers
Click here to read our detailed methodology
50. Hot Springs, AR
> Smoking rate: 22.7%
> Adults reporting poor or fair health: 22.7% — 45th highest of 384 metros
> Premature deaths per 100,000: 501.9 — 16th highest of 384 metros
> Life expectancy at birth (years): 75.05 — 19th lowest of 384 metros
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49. Elizabethtown-Fort Knox, KY
> Smoking rate: 22.7%
> Adults reporting poor or fair health: 21.7% — 74th highest of 384 metros
> Premature deaths per 100,000: 418.9 — 102nd highest of 384 metros
> Life expectancy at birth (years): 76.82 — 96th lowest of 384 metros
48. Elkhart-Goshen, IN
> Smoking rate: 22.8%
> Adults reporting poor or fair health: 20.7% — 101st highest of 384 metros
> Premature deaths per 100,000: 357.6 — 187th lowest of 384 metros
> Life expectancy at birth (years): 78.66 — 178th highest of 384 metros
47. Akron, OH
> Smoking rate: 22.8%
> Adults reporting poor or fair health: 17.1% — 137th lowest of 384 metros
> Premature deaths per 100,000: 385.7 — 153rd highest of 384 metros
> Life expectancy at birth (years): 77.36 — 130th lowest of 384 metros
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46. Evansville, IN-KY
> Smoking rate: 22.9%
> Adults reporting poor or fair health: 18.9% — 175th highest of 384 metros
> Premature deaths per 100,000: 414.5 — 109th highest of 384 metros
> Life expectancy at birth (years): 76.88 — 99th lowest of 384 metros
45. Toledo, OH
> Smoking rate: 22.9%
> Adults reporting poor or fair health: 19.4% — 154th highest of 384 metros
> Premature deaths per 100,000: 423.4 — 97th highest of 384 metros
> Life expectancy at birth (years): 76.46 — 83rd lowest of 384 metros
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44. Grants Pass, OR
> Smoking rate: 22.9%
> Adults reporting poor or fair health: 21.9% — 66th highest of 384 metros
> Premature deaths per 100,000: 430.8 — 88th highest of 384 metros
> Life expectancy at birth (years): 76.58 — 88th lowest of 384 metros
43. Clarksville, TN-KY
> Smoking rate: 22.9%
> Adults reporting poor or fair health: 22.3% — 53rd highest of 384 metros
> Premature deaths per 100,000: 467.9 — 49th highest of 384 metros
> Life expectancy at birth (years): 75.47 — 34th lowest of 384 metros
42. St. Joseph, MO-KS
> Smoking rate: 23.0%
> Adults reporting poor or fair health: 20.9% — 97th highest of 384 metros
> Premature deaths per 100,000: 410.8 — 111th highest of 384 metros
> Life expectancy at birth (years): 77.23 — 121st lowest of 384 metros
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41. Dothan, AL
> Smoking rate: 23.0%
> Adults reporting poor or fair health: 23.9% — 24th highest of 384 metros
> Premature deaths per 100,000: 458.2 — 61st highest of 384 metros
> Life expectancy at birth (years): 75.68 — 40th lowest of 384 metros
40. Johnstown, PA
> Smoking rate: 23.0%
> Adults reporting poor or fair health: 18.7% — 184th highest of 384 metros
> Premature deaths per 100,000: 437.3 — 79th highest of 384 metros
> Life expectancy at birth (years): 76.12 — 61st lowest of 384 metros
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39. Homosassa Springs, FL
> Smoking rate: 23.1%
> Adults reporting poor or fair health: 19.8% — 136th highest of 384 metros
> Premature deaths per 100,000: 501.5 — 17th highest of 384 metros
> Life expectancy at birth (years): 75.73 — 42nd lowest of 384 metros
38. Gadsden, AL
> Smoking rate: 23.1%
> Adults reporting poor or fair health: 22.0% — 64th highest of 384 metros
> Premature deaths per 100,000: 559.2 — 5th highest of 384 metros
> Life expectancy at birth (years): 73.33 — 3rd lowest of 384 metros
37. Jonesboro, AR
> Smoking rate: 23.3%
> Adults reporting poor or fair health: 24.1% — 21st highest of 384 metros
> Premature deaths per 100,000: 463.6 — 55th highest of 384 metros
> Life expectancy at birth (years): 75.97 — 54th lowest of 384 metros
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36. Joplin, MO
> Smoking rate: 23.3%
> Adults reporting poor or fair health: 21.4% — 80th highest of 384 metros
> Premature deaths per 100,000: 460.3 — 58th highest of 384 metros
> Life expectancy at birth (years): 76.08 — 59th lowest of 384 metros
35. Lafayette, LA
> Smoking rate: 23.3%
> Adults reporting poor or fair health: 21.6% — 76th highest of 384 metros
> Premature deaths per 100,000: 415.8 — 108th highest of 384 metros
> Life expectancy at birth (years): 77.12 — 114th lowest of 384 metros
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34. Farmington, NM
> Smoking rate: 23.5%
> Adults reporting poor or fair health: 23.5% — 32nd highest of 384 metros
> Premature deaths per 100,000: 475.7 — 37th highest of 384 metros
> Life expectancy at birth (years): 75.96 — 53rd lowest of 384 metros
33. Altoona, PA
> Smoking rate: 23.6%
> Adults reporting poor or fair health: 18.4% — 183rd lowest of 384 metros
> Premature deaths per 100,000: 395.3 — 140th highest of 384 metros
> Life expectancy at birth (years): 77.10 — 111th lowest of 384 metros
32. Elmira, NY
> Smoking rate: 23.6%
> Adults reporting poor or fair health: 17.6% — 153rd lowest of 384 metros
> Premature deaths per 100,000: 421.8 — 99th highest of 384 metros
> Life expectancy at birth (years): 76.49 — 86th lowest of 384 metros
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31. Flint, MI
> Smoking rate: 23.7%
> Adults reporting poor or fair health: 20.2% — 118th highest of 384 metros
> Premature deaths per 100,000: 473.0 — 44th highest of 384 metros
> Life expectancy at birth (years): 75.45 — 33rd lowest of 384 metros
30. Bowling Green, KY
> Smoking rate: 23.7%
> Adults reporting poor or fair health: 22.9% — 42nd highest of 384 metros
> Premature deaths per 100,000: 429.4 — 93rd highest of 384 metros
> Life expectancy at birth (years): 76.69 — 92nd lowest of 384 metros
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29. Wheeling, WV-OH
> Smoking rate: 23.9%
> Adults reporting poor or fair health: 19.9% — 130th highest of 384 metros
> Premature deaths per 100,000: 435.9 — 81st highest of 384 metros
> Life expectancy at birth (years): 76.38 — 78th lowest of 384 metros
28. Jackson, TN
> Smoking rate: 24.0%
> Adults reporting poor or fair health: 23.7% — 26th highest of 384 metros
> Premature deaths per 100,000: 478.6 — 34th highest of 384 metros
> Life expectancy at birth (years): 75.60 — 39th lowest of 384 metros
27. Monroe, LA
> Smoking rate: 24.0%
> Adults reporting poor or fair health: 23.8% — 25th highest of 384 metros
> Premature deaths per 100,000: 490.7 — 26th highest of 384 metros
> Life expectancy at birth (years): 75.15 — 22nd lowest of 384 metros
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26. Hammond, LA
> Smoking rate: 24.0%
> Adults reporting poor or fair health: 23.1% — 38th highest of 384 metros
> Premature deaths per 100,000: 481.3 — 32nd highest of 384 metros
> Life expectancy at birth (years): 75.20 — 25th lowest of 384 metros
25. Danville, IL
> Smoking rate: 24.1%
> Adults reporting poor or fair health: 21.1% — 90th highest of 384 metros
> Premature deaths per 100,000: 493.3 — 23rd highest of 384 metros
> Life expectancy at birth (years): 74.89 — 14th lowest of 384 metros
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24. Canton-Massillon, OH
> Smoking rate: 24.1%
> Adults reporting poor or fair health: 19.0% — 174th highest of 384 metros
> Premature deaths per 100,000: 404.1 — 127th highest of 384 metros
> Life expectancy at birth (years): 76.95 — 103rd lowest of 384 metros
23. Johnson City, TN
> Smoking rate: 24.3%
> Adults reporting poor or fair health: 21.8% — 68th highest of 384 metros
> Premature deaths per 100,000: 486.3 — 29th highest of 384 metros
> Life expectancy at birth (years): 75.19 — 24th lowest of 384 metros
22. Lima, OH
> Smoking rate: 24.5%
> Adults reporting poor or fair health: 19.5% — 151st highest of 384 metros
> Premature deaths per 100,000: 406.7 — 120th highest of 384 metros
> Life expectancy at birth (years): 76.92 — 102nd lowest of 384 metros
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21. Youngstown-Warren-Boardman, OH-PA
> Smoking rate: 24.5%
> Adults reporting poor or fair health: 20.0% — 126th highest of 384 metros
> Premature deaths per 100,000: 442.8 — 73rd highest of 384 metros
> Life expectancy at birth (years): 76.16 — 66th lowest of 384 metros
20. Muskegon, MI
> Smoking rate: 24.6%
> Adults reporting poor or fair health: 20.1% — 124th highest of 384 metros
> Premature deaths per 100,000: 408.1 — 118th highest of 384 metros
> Life expectancy at birth (years): 77.03 — 106th lowest of 384 metros
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19. Lake Havasu City-Kingman, AZ
> Smoking rate: 24.6%
> Adults reporting poor or fair health: 22.5% — 48th highest of 384 metros
> Premature deaths per 100,000: 494.8 — 21st highest of 384 metros
> Life expectancy at birth (years): 76.01 — 55th lowest of 384 metros
18. Cleveland, TN
> Smoking rate: 24.9%
> Adults reporting poor or fair health: 22.5% — 47th highest of 384 metros
> Premature deaths per 100,000: 452.5 — 63rd highest of 384 metros
> Life expectancy at birth (years): 76.11 — 60th lowest of 384 metros
17. Kingsport-Bristol, TN-VA
> Smoking rate: 24.9%
> Adults reporting poor or fair health: 21.8% — 70th highest of 384 metros
> Premature deaths per 100,000: 473.1 — 42nd highest of 384 metros
> Life expectancy at birth (years): 75.69 — 41st lowest of 384 metros
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16. Alexandria, LA
> Smoking rate: 24.9%
> Adults reporting poor or fair health: 23.1% — 40th highest of 384 metros
> Premature deaths per 100,000: 517.2 — 10th highest of 384 metros
> Life expectancy at birth (years): 74.60 — 11th lowest of 384 metros
15. Muncie, IN
> Smoking rate: 25.0%
> Adults reporting poor or fair health: 21.3% — 83rd highest of 384 metros
> Premature deaths per 100,000: 501.3 — 18th highest of 384 metros
> Life expectancy at birth (years): 74.77 — 12th lowest of 384 metros
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14. Terre Haute, IN
> Smoking rate: 25.0%
> Adults reporting poor or fair health: 20.0% — 128th highest of 384 metros
> Premature deaths per 100,000: 465.3 — 52nd highest of 384 metros
> Life expectancy at birth (years): 75.89 — 50th lowest of 384 metros
13. Kokomo, IN
> Smoking rate: 25.2%
> Adults reporting poor or fair health: 20.2% — 120th highest of 384 metros
> Premature deaths per 100,000: 519.4 — 9th highest of 384 metros
> Life expectancy at birth (years): 74.49 — 9th lowest of 384 metros
12. Fort Smith, AR-OK
> Smoking rate: 25.2%
> Adults reporting poor or fair health: 26.2% — 10th highest of 384 metros
> Premature deaths per 100,000: 487.5 — 28th highest of 384 metros
> Life expectancy at birth (years): 75.58 — 38th lowest of 384 metros
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11. Pine Bluff, AR
> Smoking rate: 25.2%
> Adults reporting poor or fair health: 28.0% — 7th highest of 384 metros
> Premature deaths per 100,000: 563.7 — 4th highest of 384 metros
> Life expectancy at birth (years): 73.82 — 7th lowest of 384 metros
10. Parkersburg-Vienna, WV
> Smoking rate: 25.2%
> Adults reporting poor or fair health: 23.1% — 39th highest of 384 metros
> Premature deaths per 100,000: 477.0 — 35th highest of 384 metros
> Life expectancy at birth (years): 75.30 — 29th lowest of 384 metros
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9. Huntington-Ashland, WV-KY-OH
> Smoking rate: 25.6%
> Adults reporting poor or fair health: 23.2% — 36th highest of 384 metros
> Premature deaths per 100,000: 565.0 — 3rd highest of 384 metros
> Life expectancy at birth (years): 73.51 — 5th lowest of 384 metros
8. Michigan City-La Porte, IN
> Smoking rate: 25.8%
> Adults reporting poor or fair health: 21.5% — 77th highest of 384 metros
> Premature deaths per 100,000: 438.7 — 77th highest of 384 metros
> Life expectancy at birth (years): 76.26 — 71st lowest of 384 metros
7. Mansfield, OH
> Smoking rate: 25.8%
> Adults reporting poor or fair health: 20.6% — 105th highest of 384 metros
> Premature deaths per 100,000: 469.0 — 47th highest of 384 metros
> Life expectancy at birth (years): 75.95 — 52nd lowest of 384 metros
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6. Houma-Thibodaux, LA
> Smoking rate: 25.8%
> Adults reporting poor or fair health: 23.7% — 28th highest of 384 metros
> Premature deaths per 100,000: 451.9 — 65th highest of 384 metros
> Life expectancy at birth (years): 76.18 — 67th lowest of 384 metros
5. Weirton-Steubenville, WV-OH
> Smoking rate: 25.8%
> Adults reporting poor or fair health: 20.9% — 96th highest of 384 metros
> Premature deaths per 100,000: 473.3 — 41st highest of 384 metros
> Life expectancy at birth (years): 75.24 — 27th lowest of 384 metros
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4. Charleston, WV
> Smoking rate: 26.0%
> Adults reporting poor or fair health: 22.9% — 43rd highest of 384 metros
> Premature deaths per 100,000: 571.6 — 2nd highest of 384 metros
> Life expectancy at birth (years): 73.05 — 2nd lowest of 384 metros
3. Morristown, TN
> Smoking rate: 26.2%
> Adults reporting poor or fair health: 24.1% — 20th highest of 384 metros
> Premature deaths per 100,000: 488.0 — 27th highest of 384 metros
> Life expectancy at birth (years): 75.42 — 32nd lowest of 384 metros
2. Springfield, OH
> Smoking rate: 26.2%
> Adults reporting poor or fair health: 20.9% — 98th highest of 384 metros
> Premature deaths per 100,000: 535.2 — 8th highest of 384 metros
> Life expectancy at birth (years): 74.25 — 8th lowest of 384 metros
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1. Beckley, WV
> Smoking rate: 27.9%
> Adults reporting poor or fair health: 25.6% — 15th highest of 384 metros
> Premature deaths per 100,000: 611.4 — the highest of 384 metros
> Life expectancy at birth (years): 72.69 — the lowest of 384 metros
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