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 cigаrettes. 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 cigаrettes 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
Source: Adventure_Photo / Getty Images
50. Utah
> Smoking rate: 9.1%
> Adults reporting poor or fair health: 14.8% (13th lowest)
> Premature deaths per 100,000: 282.4 (7th lowest)
> Life expectancy at birth (years): 80.07 (11th highest)
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49. California
> Smoking rate: 11.5%
> Adults reporting poor or fair health: 17.6% (22nd highest)
> Premature deaths per 100,000: 268.4 (2nd lowest)
> Life expectancy at birth (years): 81.68 (2nd highest)
Source: PhilAugustavo / E+ via Getty Images
48. Washington
> Smoking rate: 12.1%
> Adults reporting poor or fair health: 15.0% (14th lowest)
> Premature deaths per 100,000: 288.1 (9th lowest)
> Life expectancy at birth (years): 80.42 (9th highest)
Source: SeanPavonePhoto / Getty Images
47. Connecticut
> Smoking rate: 12.5%
> Adults reporting poor or fair health: 13.0% (4th lowest)
> Premature deaths per 100,000: 278.1 (4th lowest)
> Life expectancy at birth (years): 80.87 (5th highest)
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46. Maryland
> Smoking rate: 12.6%
> Adults reporting poor or fair health: 15.2% (16th lowest)
> Premature deaths per 100,000: 338.8 (23rd highest)
> Life expectancy at birth (years): 79.22 (24th highest)
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45. New York
> Smoking rate: 13.0%
> Adults reporting poor or fair health: 16.3% (22nd lowest)
> Premature deaths per 100,000: 276.3 (3rd lowest)
> Life expectancy at birth (years): 81.44 (3rd highest)
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44. New Jersey
> Smoking rate: 13.2%
> Adults reporting poor or fair health: 15.5% (19th lowest)
> Premature deaths per 100,000: 292.0 (10th lowest)
> Life expectancy at birth (years): 80.49 (8th highest)
Source: Sean Pavone / Getty Images
43. Massachusetts
> Smoking rate: 13.7%
> Adults reporting poor or fair health: 13.5% (7th lowest)
> Premature deaths per 100,000: 279.4 (5th lowest)
> Life expectancy at birth (years): 80.62 (6th highest)
Source: Sean Pavone / Getty Images
42. Texas
> Smoking rate: 14.2%
> Adults reporting poor or fair health: 18.7% (13th highest)
> Premature deaths per 100,000: 338.6 (24th highest)
> Life expectancy at birth (years): 79.17 (25th highest)
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41. Hawaii
> Smoking rate: 14.4%
> Adults reporting poor or fair health: 15.4% (18th lowest)
> Premature deaths per 100,000: 283.2 (8th lowest)
> Life expectancy at birth (years): 82.28 (the highest)
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40. Arizona
> Smoking rate: 14.5%
> Adults reporting poor or fair health: 18.6% (14th highest)
> Premature deaths per 100,000: 331.1 (22nd lowest)
> Life expectancy at birth (years): 79.99 (12th highest)
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39. Colorado
> Smoking rate: 14.7%
> Adults reporting poor or fair health: 13.8% (9th lowest)
> Premature deaths per 100,000: 281.6 (6th lowest)
> Life expectancy at birth (years): 80.61 (7th highest)
Source: Sean Pavone / Getty Images
38. Vermont
> Smoking rate: 14.7%
> Adults reporting poor or fair health: 12.8% (the lowest)
> Premature deaths per 100,000: 302.2 (11th lowest)
> Life expectancy at birth (years): 79.83 (15th highest)
Source: Sean Pavone / Getty Images
37. Florida
> Smoking rate: 14.9%
> Adults reporting poor or fair health: 19.5% (10th highest)
> Premature deaths per 100,000: 336.7 (25th lowest)
> Life expectancy at birth (years): 80.17 (10th highest)
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36. Idaho
> Smoking rate: 15.0%
> Adults reporting poor or fair health: 15.1% (15th lowest)
> Premature deaths per 100,000: 303.7 (13th lowest)
> Life expectancy at birth (years): 79.44 (21st highest)
Source: Sean Pavone / Getty Images
35. Virginia
> Smoking rate: 15.1%
> Adults reporting poor or fair health: 16.6% (25th highest)
> Premature deaths per 100,000: 320.0 (19th lowest)
> Life expectancy at birth (years): 79.55 (19th highest)
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34. Rhode Island
> Smoking rate: 15.2%
> Adults reporting poor or fair health: 16.5% (25th lowest)
> Premature deaths per 100,000: 304.4 (14th lowest)
> Life expectancy at birth (years): 79.84 (14th highest)
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33. Minnesota
> Smoking rate: 15.5%
> Adults reporting poor or fair health: 12.9% (3rd lowest)
> Premature deaths per 100,000: 266.7 (the lowest)
> Life expectancy at birth (years): 80.92 (4th highest)
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32. Nevada
> Smoking rate: 15.7%
> Adults reporting poor or fair health: 19.1% (12th highest)
> Premature deaths per 100,000: 359.9 (18th highest)
> Life expectancy at birth (years): 78.67 (20th lowest)
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31. Oregon
> Smoking rate: 15.7%
> Adults reporting poor or fair health: 18.2% (18th highest)
> Premature deaths per 100,000: 303.0 (12th lowest)
> Life expectancy at birth (years): 79.88 (13th highest)
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30. New Mexico
> Smoking rate: 15.9%
> Adults reporting poor or fair health: 20.3% (9th highest)
> Premature deaths per 100,000: 399.5 (13th highest)
> Life expectancy at birth (years): 77.98 (14th lowest)
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29. Illinois
> Smoking rate: 15.9%
> Adults reporting poor or fair health: 15.9% (21st lowest)
> Premature deaths per 100,000: 328.1 (21st lowest)
> Life expectancy at birth (years): 79.38 (22nd highest)
Source: Sean Pavone / Getty Images
28. Georgia
> Smoking rate: 16.3%
> Adults reporting poor or fair health: 18.4% (15th highest)
> Premature deaths per 100,000: 378.1 (14th highest)
> Life expectancy at birth (years): 77.94 (13th lowest)
Source: DenisTangneyJr / Getty Images
27. Nebraska
> Smoking rate: 16.6%
> Adults reporting poor or fair health: 13.8% (10th lowest)
> Premature deaths per 100,000: 312.9 (17th lowest)
> Life expectancy at birth (years): 79.57 (18th highest)
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26. New Hampshire
> Smoking rate: 16.6%
> Adults reporting poor or fair health: 12.8% (2nd lowest)
> Premature deaths per 100,000: 304.9 (15th lowest)
> Life expectancy at birth (years): 79.69 (17th highest)
Source: Sean Pavone / Getty Images
25. Wisconsin
> Smoking rate: 17.2%
> Adults reporting poor or fair health: 14.8% (12th lowest)
> Premature deaths per 100,000: 308.2 (16th lowest)
> Life expectancy at birth (years): 79.46 (20th highest)
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24. Iowa
> Smoking rate: 17.4%
> Adults reporting poor or fair health: 13.5% (6th lowest)
> Premature deaths per 100,000: 321.7 (20th lowest)
> Life expectancy at birth (years): 79.36 (23rd highest)
Source: DenisTangneyJr / Getty Images
23. Delaware
> Smoking rate: 17.4%
> Adults reporting poor or fair health: 16.3% (23rd lowest)
> Premature deaths per 100,000: 360.1 (17th highest)
> Life expectancy at birth (years): 78.47 (19th lowest)
Source: f11photo / Getty Images
22. Pennsylvania
> Smoking rate: 17.9%
> Adults reporting poor or fair health: 17.6% (23rd highest)
> Premature deaths per 100,000: 354.5 (19th highest)
> Life expectancy at birth (years): 78.45 (17th lowest)
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Source: Sean Pavone / Getty Images
21. North Carolina
> Smoking rate: 17.9%
> Adults reporting poor or fair health: 18.0% (19th highest)
> Premature deaths per 100,000: 369.6 (15th highest)
> Life expectancy at birth (years): 78.13 (15th lowest)
Source: Davel5957 / Getty Images
20. Kansas
> Smoking rate: 17.9%
> Adults reporting poor or fair health: 16.3% (24th lowest)
> Premature deaths per 100,000: 354.3 (20th highest)
> Life expectancy at birth (years): 78.45 (18th lowest)
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19. Alaska
> Smoking rate: 18.5%
> Adults reporting poor or fair health: 15.6% (20th lowest)
> Premature deaths per 100,000: 350.9 (21st highest)
> Life expectancy at birth (years): 79.03 (25th lowest)
Source: Sean Pavone / Getty Images
18. South Carolina
> Smoking rate: 18.7%
> Adults reporting poor or fair health: 17.8% (20th highest)
> Premature deaths per 100,000: 410.6 (9th highest)
> Life expectancy at birth (years): 77.12 (11th lowest)
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17. Montana
> Smoking rate: 18.9%
> Adults reporting poor or fair health: 14.1% (11th lowest)
> Premature deaths per 100,000: 333.8 (23rd lowest)
> Life expectancy at birth (years): 78.91 (24th lowest)
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16. Wyoming
> Smoking rate: 19.2%
> Adults reporting poor or fair health: 15.3% (17th lowest)
> Premature deaths per 100,000: 344.2 (22nd highest)
> Life expectancy at birth (years): 78.91 (23rd lowest)
> Smoking rate: 19.2%
> Adults reporting poor or fair health: 15.3% (17th lowest)
> Premature deaths per 100,000: 344.2 (22nd highest)
> Life expectancy at birth (years): 78.91 (23rd lowest)
Source: SeanPavonePhoto / Getty Images
15. Maine
> Smoking rate: 19.4%
> Adults reporting poor or fair health: 17.1% (24th highest)
> Premature deaths per 100,000: 338.4 (25th highest)
> Life expectancy at birth (years): 78.69 (21st lowest)
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14. North Dakota
> Smoking rate: 19.7%
> Adults reporting poor or fair health: 13.6% (8th lowest)
> Premature deaths per 100,000: 319.7 (18th lowest)
> Life expectancy at birth (years): 79.72 (16th highest)
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13. Oklahoma
> Smoking rate: 19.9%
> Adults reporting poor or fair health: 20.9% (8th highest)
> Premature deaths per 100,000: 456.6 (6th highest)
> Life expectancy at birth (years): 76.05 (7th lowest)
Source: Sean Pavone / Getty Images
12. Alabama
> Smoking rate: 20.0%
> Adults reporting poor or fair health: 21.4% (6th highest)
> Premature deaths per 100,000: 471.6 (3rd highest)
> Life expectancy at birth (years): 75.55 (3rd lowest)
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11. Missouri
> Smoking rate: 20.1%
> Adults reporting poor or fair health: 19.5% (11th highest)
> Premature deaths per 100,000: 403.6 (11th highest)
> Life expectancy at birth (years): 77.30 (12th lowest)
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10. Michigan
> Smoking rate: 20.1%
> Adults reporting poor or fair health: 18.3% (16th highest)
> Premature deaths per 100,000: 364.5 (16th highest)
> Life expectancy at birth (years): 78.14 (16th lowest)
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9. South Dakota
> Smoking rate: 20.2%
> Adults reporting poor or fair health: 13.4% (5th lowest)
> Premature deaths per 100,000: 335.4 (24th lowest)
> Life expectancy at birth (years): 78.91 (22nd lowest)
Source: Sean Pavone / Getty Images
8. Tennessee
> Smoking rate: 20.8%
> Adults reporting poor or fair health: 21.2% (7th highest)
> Premature deaths per 100,000: 453.1 (7th highest)
> Life expectancy at birth (years): 75.98 (5th lowest)
Source: SeanPavonePhoto / Getty Images
7. Mississippi
> Smoking rate: 21.0%
> Adults reporting poor or fair health: 22.1% (3rd highest)
> Premature deaths per 100,000: 501.8 (2nd highest)
> Life expectancy at birth (years): 74.88 (2nd lowest)
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Source: f11photo / Getty Images
6. Louisiana
> Smoking rate: 21.1%
> Adults reporting poor or fair health: 21.4% (5th highest)
> Premature deaths per 100,000: 452.9 (8th highest)
> Life expectancy at birth (years): 76.14 (8th lowest)
Source: Davel5957 / Getty Images
5. Ohio
> Smoking rate: 21.4%
> Adults reporting poor or fair health: 17.8% (21st highest)
> Premature deaths per 100,000: 406.8 (10th highest)
> Life expectancy at birth (years): 76.98 (9th lowest)
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4. Indiana
> Smoking rate: 21.7%
> Adults reporting poor or fair health: 18.2% (17th highest)
> Premature deaths per 100,000: 400.8 (12th highest)
> Life expectancy at birth (years): 77.11 (10th lowest)
Source: Sean Pavone / Getty Images
3. Arkansas
> Smoking rate: 23.7%
> Adults reporting poor or fair health: 23.3% (2nd highest)
> Premature deaths per 100,000: 457.4 (5th highest)
> Life expectancy at birth (years): 76.05 (6th lowest)
Source: Sean Pavone / Getty Images
2. Kentucky
> Smoking rate: 24.1%
> Adults reporting poor or fair health: 21.8% (4th highest)
> Premature deaths per 100,000: 469.6 (4th highest)
> Life expectancy at birth (years): 75.63 (4th lowest)
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Source: Sean Pavone / Getty Images
1. West Virginia
> Smoking rate: 26.9%
> Adults reporting poor or fair health: 23.6% (the highest)
> Premature deaths per 100,000: 504.8 (the highest)
> Life expectancy at birth (years): 74.79 (the lowest)
Methodology
To determine the states with the most smokers, 24/7 Tempo reviewed the share of adults that are current smokers from the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute joint program’s 2021 County Health Rankings & Roadmaps report. While the CHR report is from 2021, adult smоking rates are from 2018.
States were ranked based on the adult smоking rate. Additional information on the share of adults reporting poor or fair health, the number of deaths among residents under age 75 per 100,000, and average life expectancy at birth are also from the 2021 CHR and also for periods before the pandemic.
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