About 18.2% of the U.S. adult population smokes, down from over 40% half a century ago.

Despite the dramatic decline, smoking is the leading cause of preventable death in the United States. Each year, tobacco consumption kills nearly half a million Americans, and another 16 million are currently living with a disease caused by smoking.

Though no major U.S. metro area tops the nationwide smoking rate of 50 years ago, there are several cities where more than one in five adult residents report a smoking habit. 24/7 Wall St. reviewed Gallup poll data to identify the U.S. metro areas with the highest smoking rates. In a handful of cities, the smoking rate tops 25%.

Click here to see the cities where the most people smoke.
Click here to see the detailed findings and methodology.

30. Springfield, MO
> Smoking rate: 23.0%
> Avg. price per pack in Missouri: $4.83 (5th lowest)
> Adults living with cancer diagnosis: 8.7%
> Adults who have had a heart attack: 4.6%

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29. Lexington-Fayette, KY
> Smoking rate: 23.1%
> Avg. price per pack in Kentucky: $4.77 (4th lowest)
> Adults living with cancer diagnosis: 7.8%
> Adults who have had a heart attack: 2.8%

28. Columbia, SC
> Smoking rate: 23.1%
> Avg. price per pack in South Carolina: $4.97 (6th lowest)
> Adults living with cancer diagnosis: 7.1%
> Adults who have had a heart attack: 4.2%

27. Chattanooga, TN-GA
> Smoking rate: 23.2%
> Avg. price per pack in Georgia: $4.67 (3rd lowest)
> Adults living with cancer diagnosis: 9.2%
> Adults who have had a heart attack: 5.5%

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26. Youngstown-Warren-Boardman, OH-PA
> Smoking rate: 23.2%
> Avg. price per pack in Ohio: $6.12 (24th highest)
> Adults living with cancer diagnosis: 7.3%
> Adults who have had a heart attack: 6.0%

25. Palm Bay-Melbourne-Titusville, FL
> Smoking rate: 23.2%
> Avg. price per pack in Florida: $5.90 (24th lowest)
> Adults living with cancer diagnosis: 9.2%
> Adults who have had a heart attack: 5.3%

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24. Cincinnati, OH-KY-IN
> Smoking rate: 23.5%
> Avg. price per pack in Indiana: $5.40 (15th lowest)
> Adults living with cancer diagnosis: 7.3%
> Adults who have had a heart attack: 5.1%

23. Flint, MI
> Smoking rate: 23.5%
> Avg. price per pack in Michigan: $6.9 (16th highest)
> Adults living with cancer diagnosis: 6.7%
> Adults who have had a heart attack: 6.9%

22. Louisville/Jefferson County, KY-IN
> Smoking rate: 23.5%
> Avg. price per pack in Indiana: $5.40 (15th lowest)
> Adults living with cancer diagnosis: 7.2%
> Adults who have had a heart attack: 3.9%

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21. Davenport-Moline-Rock Island, IA-IL
> Smoking rate: 23.9%
> Avg. price per pack in Illinois: $7.61 (11th highest)
> Adults living with cancer diagnosis: 8.2%
> Adults who have had a heart attack: 4.9%

20. Salisbury, MD-DE
> Smoking rate: 24.0%
> Avg. price per pack in Delaware: $5.53 (17th lowest)
> Adults living with cancer diagnosis: 10.7%
> Adults who have had a heart attack: 3.2%

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19. Toledo, OH
> Smoking rate: 24.2%
> Avg. price per pack in Ohio: $6.12 (24th highest)
> Adults living with cancer diagnosis: 7.1%
> Adults who have had a heart attack: 4.8%

18. Rockford, IL
> Smoking rate: 24.2%
> Avg. price per pack in Illinois: $7.61 (11th highest)
> Adults living with cancer diagnosis: 9.0%
> Adults who have had a heart attack: 3.7%

17. Clarksville, TN-KY
> Smoking rate: 24.3%
> Avg. price per pack in Kentucky: $4.77 (4th lowest)
> Adults living with cancer diagnosis: 5.8%
> Adults who have had a heart attack: 2.7%

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16. Scranton–Wilkes-Barre–Hazleton, PA
> Smoking rate: 24.4%
> Avg. price per pack in Pennsylvania: $7.61 (11th highest)
> Adults living with cancer diagnosis: 6.6%
> Adults who have had a heart attack: 3.6%

15. Topeka, KS
> Smoking rate: 24.6%
> Avg. price per pack in Kansas: $5.82 (23rd lowest)
> Adults living with cancer diagnosis: 5.3%
> Adults who have had a heart attack: 4.8%

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14. Gulfport-Biloxi-Pascagoula, MS
> Smoking rate: 24.8%
> Avg. price per pack in Mississippi: $5.05 (12th lowest)
> Adults living with cancer diagnosis: 4.5%
> Adults who have had a heart attack: 4.8%

13. Evansville, IN-KY
> Smoking rate: 24.8%
> Avg. price per pack in Indiana: $5.40 (15th lowest)
> Adults living with cancer diagnosis: 11.6%
> Adults who have had a heart attack: 5.5%

12. Roanoke, VA
> Smoking rate: 24.9%
> Avg. price per pack in Virginia: $5.04 (9th lowest)
> Adults living with cancer diagnosis: 8.0%
> Adults who have had a heart attack: 5.4%

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11. Columbus, GA-AL
> Smoking rate: 24.9%
> Avg. price per pack in Alabama: $5.05 (12th lowest)
> Adults living with cancer diagnosis: 6.2%
> Adults who have had a heart attack: 3.6%

10. Winston-Salem, NC
> Smoking rate: 25.0%
> Avg. price per pack in North Carolina: $4.64 (2nd lowest)
> Adults living with cancer diagnosis: 7.9%
> Adults who have had a heart attack: 4.8%

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9. Hickory-Lenoir-Morganton, NC
> Smoking rate: 25.4%
> Avg. price per pack in North Carolina: $4.64 (2nd lowest)
> Adults living with cancer diagnosis: 8.1%
> Adults who have had a heart attack: 6.0%

8. Huntington-Ashland, WV-KY-OH
> Smoking rate: 27.2%
> Avg. price per pack in Kentucky: $4.77 (4th lowest)
> Adults living with cancer diagnosis: 9.6%
> Adults who have had a heart attack: 6.8%

7. Canton-Massillon, OH
> Smoking rate: 27.5%
> Avg. price per pack in Ohio: $6.12 (24th highest)
> Adults living with cancer diagnosis: 9.2%
> Adults who have had a heart attack: 2.7%

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6. Spartanburg, SC
> Smoking rate: 27.6%
> Avg. price per pack in South Carolina: $4.97 (6th lowest)
> Adults living with cancer diagnosis: 11.5%
> Adults who have had a heart attack: 3.8%

5. Fayetteville, NC
> Smoking rate: 27.8%
> Avg. price per pack in North Carolina: $4.64 (2nd lowest)
> Adults living with cancer diagnosis: 6.3%
> Adults who have had a heart attack: 7.1%

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4. Kingsport-Bristol-Bristol, TN-VA
> Smoking rate: 28.0%
> Avg. price per pack in Tennessee: $5.00 (7th lowest)
> Adults living with cancer diagnosis: 7.0%
> Adults who have had a heart attack: 6.6%

3. Erie, PA
> Smoking rate: 28.2%
> Avg. price per pack in Pennsylvania: $7.61 (11th highest)
> Adults living with cancer diagnosis: 6.8%
> Adults who have had a heart attack: 4.4%

2. Lafayette, LA
> Smoking rate: 28.3%
> Avg. price per pack in Louisiana: $5.81 (22nd lowest)
> Adults living with cancer diagnosis: 5.8%
> Adults who have had a heart attack: 4.8%

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1. Fort Smith, AR-OK
> Smoking rate: 28.3%
> Avg. price per pack in Arkansas: $5.78 (21st lowest)
> Adults living with cancer diagnosis: 9.1%
> Adults who have had a heart attack: 7.4%

Detailed Findings and Methodology

Cigarettes are by far the preferred method of smoking among Americans. Of adults nationwide who identify as smokers, about 16.6% smoke cigarettes, 2.3% choose cigars, and less than 1% favor pipes.

Multiple studies have shown that governments can reduce smoking rates by increasing excise taxes on cigarettes. Indeed, smoking rates tend to be higher in parts of the country where they are less expensive. In 25 of the 30 metro areas with the highest smoking rates, the average price of a pack of cigarettes is lower than $6.16 — the average price per pack nationwide. In North Carolina, a state with three cities on this list, the average pack of cigarettes costs only $4.64, the second lowest of any state.

Speaking with 24/7 Wall St., Dan Witters, research director for the Gallup-Sharecare Well-Being Index, noted that smoking rates are affected by more than quantifiable factors like price. Some cities, he explained, have a culture of smoking, and this will drive up rates, regardless of how much cigarettes cost. “You can think of culture as ‘how we do things around here’… The more people who smoke around you, the greater probability that you yourself will be a smoker” Witters said.

While smokers in states with low cigarette prices may be getting a good deal financially, they are likely paying a heavy price with their health. According to the Centers for Disease Control and Prevention, smoking can cause a number of diseases and conditions, including cancer and heart disease, the two leading causes of death in the United States.

In 22 of the 30 metro areas on this list, the share of adults who have had a heart attack is higher than the 3.9% national share. In 19, the share of adult residents who have been diagnosed with cancer is greater than the 7.1% share nationwide.

In addition to a higher incidence of certain deadly diseases and conditions, metro areas with high smoking rates tend to be less healthy in general. Lafayette, Louisiana is the only metro area on this list with a larger share of adults who perceive their own physical health to be near perfect than the 57.4% of American adults who do.

To determine the cities with the highest smoking rates, 24/7 Wall St. used the Gallup-Sharecare Well-Being Index. Gallup’s results are based on roughly 354,500 telephone interviews conducted nationwide between January 2015 and December 2016. Gallup only reports the results for metropolitan areas in which at least 300 interviews were completed. The smoking rate represents the share of residents who identify themselves as current smokers. All other data related to health outcomes also came from the Gallup survey. The average price of a pack of cigarettes by state came from the Campaign for Tobacco Free Kids, and cigarette tax data came from policy think tank, Tax Foundation.

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