Special Report

US Cities With the Most Smokers

There’s no doubt the U.S. has made significant progress in reducing the smоking rate and changing the general attitude toward tobacco use. Still, smоking remains the nation’s leading cause of preventable disease, disability, and death, accounting for more than 480,000 fatalities each year, according to the Centers for Disease Control and Prevention. (Here are health conditions with soaring medical costs in America.)

The CDC also notes that “over 16 million people live with at least one disease caused by smоking.” In addition to the human toll, there is an economic toll: Сigarette smоking cost more than $600 billion in 2018, through direct healthcare costs, loss of productivity, and other factors.  

To find the cities with the highest smоking rate, 24/7 Tempo reviewed data from County Health Rankings & Roadmaps, a joint program of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The study ranks metro areas by the adult smоking rate – i.e., the share of the population aged 18 and older who smоke every day or most days and have smоked at least 100 сigarettes in their lifetime. While the CHR report is from 2022, the smоking rates are from 2019, the latest year for which data is available. 

Information on the share of adults reporting poor or fair health is from 2019; average life expectancy at birth and premature death rate (the number of deaths among those under age 75 per 100,000) are from the years 2018 to 2020. This data is also from the 2022 CHR. 

The metro areas on this list have some of the lowest average life expectancies at birth and highest premature death rates in the country. Four of the 10 cities with the highest smоking rates are also among the 10 cities with the highest premature death rate. (These are 28 states with the shortest life expectancies.)

Click here to see the U.S. cities with the most smоkers

All the metro areas on the list are in Midwest and South – six of them in Louisiana, five entirely within Ohio, and another four spanning Ohio and a neighboring state. The two metro areas with the smоking rates, however, are in West Virginia – including No. 1 Beckley, where 26.1% of adults smоke regularly, nearly 10 percentage points higher than the national smоking rate of 16.5%.

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