Cigаrette sales climbed in the U.S. in 2020 for the first time in two decades. Americans bought a total of 203.7 billion cigаrettes last year, up from 202.9 billion the year before, according to a Federal Trade Commission report. The uptick coincided with increased cigаrette promotional and ad spending by tobacco companies.
Smоking is the leading cause of preventable death in the United States, claiming nearly half a million American lives annually, according to the Centers for Disease Control and Prevention. Another 16 million Americans are living with a serious illness caused by smоking.
Though the risks associated with smоking and tobacco use are well established, 42.4 million American adults — or 16.6% of the adult population — regularly smоke cigаrettes. In some parts of the country, however, residents are far more likely to take the dangers associated with smоking seriously.
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 metro area with the fewest smоkers in each state. 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 cigаrettes in their lifetime.
It is important to note that in four states — Delaware, New Hampshire, Rhode Island, and Vermont — there is only one metro area. As a result, the metro area listed ranks as having the lowest smоking rate in the state by default alone.
Though each metro area on this list has the lowest smоking rate in its state, the share of adults who are smоkers varies considerably, from 7.2% to 22.0%.
Given the proven detrimental effects of smоking, it is perhaps not surprising that some important health outcome measures tend to be better than average in metros with lower smоking rates. For example, in most metro areas on this list, the share of adults who report being in fair or poor health is below the share of adults statewide who do.
The correlation between smоking rates and life expectancy is also strong. In nearly every metro area on this list, average life expectancy at birth is above the comparable statewide average.
Click here to see the metro with the fewest smоkers in every state
Click here to see our detailed methodology
Alabama: Huntsville
> Smoking rate: 17.8% (Alabama: 20.0%)
> Adults reporting poor or fair health: 18.3% (Alabama: 21.4%)
> Premature deaths per 100,000: 381.8 (Alabama: 471.6)
> Life expectancy: 77.69 (Alabama: 75.55)
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Alaska: Fairbanks
> Smoking rate: 17.4% (Alaska: 18.5%)
> Adults reporting poor or fair health: 14.0% (Alaska: 15.6%)
> Premature deaths per 100,000: 311.6 (Alaska: 350.9)
> Life expectancy: 80.47 (Alaska: 79.03)
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Arizona: Phoenix-Mesa-Chandler
> Smoking rate: 15.7% (Arizona: 14.5%)
> Adults reporting poor or fair health: 18.2% (Arizona: 18.6%)
> Premature deaths per 100,000: 305.5 (Arizona: 331.1)
> Life expectancy: 80.67 (Arizona: 79.99)
Arkansas: Little Rock-North Little Rock-Conway
> Smoking rate: 19.9% (Arkansas: 23.7%)
> Adults reporting poor or fair health: 21.5% (Arkansas: 23.3%)
> Premature deaths per 100,000: 430.0 (Arkansas: 457.4)
> Life expectancy: 76.44 (Arkansas: 76.05)
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California: San Jose-Sunnyvale-Santa Clara
> Smoking rate: 9.7% (California: 11.5%)
> Adults reporting poor or fair health: 14.5% (California: 17.6%)
> Premature deaths per 100,000: 188.0 (California: 268.4)
> Life expectancy: 84.84 (California: 81.68)
Colorado: Boulder
> Smoking rate: 12.8% (Colorado: 14.7%)
> Adults reporting poor or fair health: 11.2% (Colorado: 13.8%)
> Premature deaths per 100,000: 207.0 (Colorado: 281.6)
> Life expectancy: 82.85 (Colorado: 80.61)
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Connecticut: Bridgeport-Stamford-Norwalk
> Smoking rate: 11.7% (Connecticut: 12.5%)
> Adults reporting poor or fair health: 11.9% (Connecticut: 13.0%)
> Premature deaths per 100,000: 216.2 (Connecticut: 278.1)
> Life expectancy: 82.98 (Connecticut: 80.87)
Delaware: Dover*
> Smoking rate: 19.7% (Delaware: 17.4%)
> Adults reporting poor or fair health: 21.0% (Delaware: 16.3%)
> Premature deaths per 100,000: 389.3 (Delaware: 360.1)
> Life expectancy: 77.82 (Delaware: 78.47)
*Because Dover is the only eligible metro in Delaware, it is the metro with the fewest smokers by default.
Florida: Naples-Marco Island
> Smoking rate: 16.0% (Florida: 14.9%)
> Adults reporting poor or fair health: 18.3% (Florida: 19.5%)
> Premature deaths per 100,000: 230.2 (Florida: 336.7)
> Life expectancy: 86.12 (Florida: 80.17)
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Georgia: Atlanta-Sandy Springs-Alpharetta
> Smoking rate: 15.5% (Georgia: 16.3%)
> Adults reporting poor or fair health: 16.8% (Georgia: 18.4%)
> Premature deaths per 100,000: 321.7 (Georgia: 378.1)
> Life expectancy: 79.45 (Georgia: 77.94)
Hawaii: Urban Honolulu
> Smoking rate: 14.9% (Hawaii: 14.4%)
> Adults reporting poor or fair health: 17.0% (Hawaii: 15.4%)
> Premature deaths per 100,000: 277.9 (Hawaii: 283.2)
> Life expectancy: 82.52 (Hawaii: 82.28)
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Idaho: Idaho Falls
> Smoking rate: 16.3% (Idaho: 15.0%)
> Adults reporting poor or fair health: 17.1% (Idaho: 15.1%)
> Premature deaths per 100,000: 333.8 (Idaho: 303.7)
> Life expectancy: 78.21 (Idaho: 79.44)
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Illinois: Chicago-Naperville-Elgin
> Smoking rate: 16.2% (Illinois: 15.9%)
> Adults reporting poor or fair health: 17.0% (Illinois: 15.9%)
> Premature deaths per 100,000: 310.4 (Illinois: 328.1)
> Life expectancy: 80.04 (Illinois: 79.38)
Indiana: Indianapolis-Carmel-Anderson
> Smoking rate: 20.3% (Indiana: 21.7%)
> Adults reporting poor or fair health: 18.2% (Indiana: 18.2%)
> Premature deaths per 100,000: 378.4 (Indiana: 400.8)
> Life expectancy: 77.66 (Indiana: 77.11)
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Iowa: Iowa City
> Smoking rate: 15.1% (Iowa: 17.4%)
> Adults reporting poor or fair health: 12.9% (Iowa: 13.5%)
> Premature deaths per 100,000: 239.1 (Iowa: 321.7)
> Life expectancy: 82.57 (Iowa: 79.36)
Kansas: Lawrence
> Smoking rate: 16.0% (Kansas: 17.9%)
> Adults reporting poor or fair health: 14.8% (Kansas: 16.3%)
> Premature deaths per 100,000: 276.6 (Kansas: 354.3)
> Life expectancy: 80.44 (Kansas: 78.45)
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Kentucky: Lexington-Fayette
> Smoking rate: 19.2% (Kentucky: 24.1%)
> Adults reporting poor or fair health: 19.7% (Kentucky: 21.8%)
> Premature deaths per 100,000: 380.3 (Kentucky: 469.6)
> Life expectancy: 77.93 (Kentucky: 75.63)
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Louisiana: New Orleans-Metairie
> Smoking rate: 20.1% (Louisiana: 21.1%)
> Adults reporting poor or fair health: 20.6% (Louisiana: 21.4%)
> Premature deaths per 100,000: 409.6 (Louisiana: 452.9)
> Life expectancy: 77.31 (Louisiana: 76.14)
Maine: Portland-South Portland
> Smoking rate: 15.6% (Maine: 19.4%)
> Adults reporting poor or fair health: 13.2% (Maine: 17.1%)
> Premature deaths per 100,000: 298.0 (Maine: 338.4)
> Life expectancy: 79.80 (Maine: 78.69)
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Maryland: Baltimore-Columbia-Towson
> Smoking rate: 15.7% (Maryland: 12.6%)
> Adults reporting poor or fair health: 16.1% (Maryland: 15.2%)
> Premature deaths per 100,000: 390.8 (Maryland: 338.8)
> Life expectancy: 77.92 (Maryland: 79.22)
Massachusetts: Boston-Cambridge-Newton
> Smoking rate: 14.2% (Massachusetts: 13.7%)
> Adults reporting poor or fair health: 13.3% (Massachusetts: 13.5%)
> Premature deaths per 100,000: 258.4 (Massachusetts: 279.4)
> Life expectancy: 81.36 (Massachusetts: 80.62)
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Michigan: Ann Arbor
> Smoking rate: 14.8% (Michigan: 20.1%)
> Adults reporting poor or fair health: 14.4% (Michigan: 18.3%)
> Premature deaths per 100,000: 250.8 (Michigan: 364.5)
> Life expectancy: 81.39 (Michigan: 78.14)
Minnesota: Minneapolis-St. Paul-Bloomington
> Smoking rate: 15.0% (Minnesota: 15.5%)
> Adults reporting poor or fair health: 12.0% (Minnesota: 12.9%)
> Premature deaths per 100,000: 250.8 (Minnesota: 266.7)
> Life expectancy: 81.30 (Minnesota: 80.92)
Mississippi: Jackson
> Smoking rate: 18.9% (Mississippi: 21.0%)
> Adults reporting poor or fair health: 21.4% (Mississippi: 22.1%)
> Premature deaths per 100,000: 439.2 (Mississippi: 501.8)
> Life expectancy: 76.46 (Mississippi: 74.88)
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Missouri: Kansas City
> Smoking rate: 18.2% (Missouri: 20.1%)
> Adults reporting poor or fair health: 16.8% (Missouri: 19.5%)
> Premature deaths per 100,000: 340.9 (Missouri: 403.6)
> Life expectancy: 78.93 (Missouri: 77.30)
Montana: Missoula
> Smoking rate: 17.2% (Montana: 18.9%)
> Adults reporting poor or fair health: 13.2% (Montana: 14.1%)
> Premature deaths per 100,000: 293.6 (Montana: 333.8)
> Life expectancy: 79.84 (Montana: 78.91)
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Nebraska: Grand Island
> Smoking rate: 16.4% (Nebraska: 16.6%)
> Adults reporting poor or fair health: 16.0% (Nebraska: 13.8%)
> Premature deaths per 100,000: 336.0 (Nebraska: 312.9)
> Life expectancy: 78.86 (Nebraska: 79.57)
Nevada: Reno
> Smoking rate: 16.9% (Nevada: 15.7%)
> Adults reporting poor or fair health: 18.1% (Nevada: 19.1%)
> Premature deaths per 100,000: 337.8 (Nevada: 359.9)
> Life expectancy: 78.73 (Nevada: 78.67)
New Hampshire: Manchester-Nashua*
> Smoking rate: 16.0% (New Hampshire: 16.6%)
> Adults reporting poor or fair health: 12.2% (New Hampshire: 12.8%)
> Premature deaths per 100,000: 309.3 (New Hampshire: 304.9)
> Life expectancy: 79.63 (New Hampshire: 79.69)
*Because Manchester-Nashua is the only eligible metro in New Hampshire, it is the metro with the fewest smokers by default.
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New Jersey: Trenton-Princeton
> Smoking rate: 15.0% (New Jersey: 13.2%)
> Adults reporting poor or fair health: 16.8% (New Jersey: 15.5%)
> Premature deaths per 100,000: 302.9 (New Jersey: 292.0)
> Life expectancy: 80.58 (New Jersey: 80.49)
New Mexico: Santa Fe
> Smoking rate: 14.2% (New Mexico: 15.9%)
> Adults reporting poor or fair health: 17.8% (New Mexico: 20.3%)
> Premature deaths per 100,000: 295.2 (New Mexico: 399.5)
> Life expectancy: 81.53 (New Mexico: 77.98)
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New York: New York-Newark-Jersey City
> Smoking rate: 14.5% (New York: 13.0%)
> Adults reporting poor or fair health: 17.2% (New York: 16.3%)
> Premature deaths per 100,000: 257.8 (New York: 276.3)
> Life expectancy: 82.38 (New York: 81.44)
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North Carolina: Raleigh-Cary
> Smoking rate: 15.6% (North Carolina: 17.9%)
> Adults reporting poor or fair health: 14.9% (North Carolina: 18.0%)
> Premature deaths per 100,000: 257.4 (North Carolina: 369.6)
> Life expectancy: 81.06 (North Carolina: 78.13)
North Dakota: Bismarck
> Smoking rate: 17.5% (North Dakota: 19.7%)
> Adults reporting poor or fair health: 13.5% (North Dakota: 13.6%)
> Premature deaths per 100,000: 302.9 (North Dakota: 319.7)
> Life expectancy: 80.58 (North Dakota: 79.72)
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Ohio: Columbus
> Smoking rate: 19.6% (Ohio: 21.4%)
> Adults reporting poor or fair health: 16.2% (Ohio: 17.8%)
> Premature deaths per 100,000: 370.6 (Ohio: 406.8)
> Life expectancy: 77.77 (Ohio: 76.98)
Oklahoma: Oklahoma City
> Smoking rate: 18.6% (Oklahoma: 19.9%)
> Adults reporting poor or fair health: 19.5% (Oklahoma: 20.9%)
> Premature deaths per 100,000: 410.8 (Oklahoma: 456.6)
> Life expectancy: 77.00 (Oklahoma: 76.05)
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Oregon: Corvallis
> Smoking rate: 14.7% (Oregon: 15.7%)
> Adults reporting poor or fair health: 16.1% (Oregon: 18.2%)
> Premature deaths per 100,000: 198.3 (Oregon: 303.0)
> Life expectancy: 82.99 (Oregon: 79.88)
Pennsylvania: Philadelphia-Camden-Wilmington
> Smoking rate: 17.7% (Pennsylvania: 17.9%)
> Adults reporting poor or fair health: 17.2% (Pennsylvania: 17.6%)
> Premature deaths per 100,000: 361.1 (Pennsylvania: 354.5)
> Life expectancy: 78.51 (Pennsylvania: 78.45)
Rhode Island: Providence-Warwick*
> Smoking rate: 18.0% (Rhode Island: 15.2%)
> Adults reporting poor or fair health: 16.8% (Rhode Island: 16.5%)
> Premature deaths per 100,000: 321.8 (Rhode Island: 304.4)
> Life expectancy: 79.44 (Rhode Island: 79.84)
*Because Providence-Warwick is the only eligible metro in Rhode Island, it is the metro with the fewest smokers by default.
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South Carolina: Charleston-North Charleston
> Smoking rate: 15.6% (South Carolina: 18.7%)
> Adults reporting poor or fair health: 15.8% (South Carolina: 17.8%)
> Premature deaths per 100,000: 345.5 (South Carolina: 410.6)
> Life expectancy: 78.82 (South Carolina: 77.12)
South Dakota: Sioux Falls
> Smoking rate: 16.8% (South Dakota: 20.2%)
> Adults reporting poor or fair health: 12.3% (South Dakota: 13.4%)
> Premature deaths per 100,000: 298.3 (South Dakota: 335.4)
> Life expectancy: 79.72 (South Dakota: 78.91)
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Tennessee: Nashville-Davidson–Murfreesboro–Franklin
> Smoking rate: 20.4% (Tennessee: 20.8%)
> Adults reporting poor or fair health: 18.7% (Tennessee: 21.2%)
> Premature deaths per 100,000: 383.0 (Tennessee: 453.1)
> Life expectancy: 77.56 (Tennessee: 75.98)
Texas: Austin-Round Rock-Georgetown
> Smoking rate: 13.0% (Texas: 14.2%)
> Adults reporting poor or fair health: 16.3% (Texas: 18.7%)
> Premature deaths per 100,000: 248.1 (Texas: 338.6)
> Life expectancy: 81.61 (Texas: 79.17)
Utah: Provo-Orem
> Smoking rate: 7.2% (Utah: 9.1%)
> Adults reporting poor or fair health: 13.3% (Utah: 14.8%)
> Premature deaths per 100,000: 254.6 (Utah: 282.4)
> Life expectancy: 80.57 (Utah: 80.07)
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Vermont: Burlington-South Burlington*
> Smoking rate: 13.6% (Vermont: 14.7%)
> Adults reporting poor or fair health: 11.8% (Vermont: 12.8%)
> Premature deaths per 100,000: 269.2 (Vermont: 302.2)
> Life expectancy: 81.00 (Vermont: 79.83)
*Because Burlington-South Burlington is the only eligible metro in Vermont, it is the metro with the fewest smokers by default.
Virginia: Charlottesville
> Smoking rate: 16.8% (Virginia: 15.1%)
> Adults reporting poor or fair health: 16.4% (Virginia: 16.6%)
> Premature deaths per 100,000: 276.6 (Virginia: 320.0)
> Life expectancy: 80.98 (Virginia: 79.55)
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Washington: Seattle-Tacoma-Bellevue
> Smoking rate: 11.9% (Washington: 12.1%)
> Adults reporting poor or fair health: 14.0% (Washington: 15.0%)
> Premature deaths per 100,000: 265.6 (Washington: 288.1)
> Life expectancy: 81.25 (Washington: 80.42)
West Virginia: Morgantown
> Smoking rate: 22.0% (West Virginia: 26.9%)
> Adults reporting poor or fair health: 20.8% (West Virginia: 23.6%)
> Premature deaths per 100,000: 330.8 (West Virginia: 504.8)
> Life expectancy: 78.97 (West Virginia: 74.79)
Wisconsin: Madison
> Smoking rate: 15.1% (Wisconsin: 17.2%)
> Adults reporting poor or fair health: 12.5% (Wisconsin: 14.8%)
> Premature deaths per 100,000: 241.3 (Wisconsin: 308.2)
> Life expectancy: 81.51 (Wisconsin: 79.46)
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Wyoming: Cheyenne
> Smoking rate: 19.2% (Wyoming: 19.2%)
> Adults reporting poor or fair health: 15.4% (Wyoming: 15.3%)
> Premature deaths per 100,000: 353.1 (Wyoming: 344.2)
> Life expectancy: 78.44 (Wyoming: 78.91)
Methodology
To determine the metro with the fewest smоkers in every state, 24/7 Tempo reviewed the share of adults that are current smоkers 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 smoking rates are from 2018.
We used the 384 metropolitan statistical areas as delineated by the United States Office of Management and Budget and used by the Census Bureau as our definition of metros.
Metros were ranked within their state based on the adult smоking rate. Since many metros cross state lines, the metro was assigned to the state of its first-listed principal city. Thus, the Washington-Arlington-Alexandria, DC-VA-MD-WV metro area was excluded as it is principally in the District of Columbia.
Additional information on the share of adults reporting poor or fair health, the number of deaths among residents under age 75 per 100,000 (the premature death rate), and life expectancy are also from the 2021 CHR.
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