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 county with the fewest smоkers in each state. Counties and county equivalents 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.
Though each county on this list has the lowest smоking rate in its state, the share of adults who are smоkers varies considerably, from 7.1% to 21.0%.
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 places with lower smоking rates. For example, in most counties 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 county on this list, average life expectancy at birth is above the comparable statewide average.
Click here for the county with the lowest smоking rate in every state
Alabama: Shelby County
> Smoking rate: 15.0% (Alabama: 20.0%)
> Adults reporting poor or fair health: 14.8% (Alabama: 21.4%)
> Premature deaths per 100,000: 294.3 (Alabama: 471.6)
> Life expectancy at birth (years): 80.74 (Alabama: 75.55)
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Alaska: Juneau City and Borough
> Smoking rate: 15.9% (Alaska: 18.5%)
> Adults reporting poor or fair health: 12.4% (Alaska: 15.6%)
> Premature deaths per 100,000: 307.2 (Alaska: 350.9)
> Life expectancy at birth (years): 81.05 (Alaska: 79.03)
Arizona: Maricopa County
> Smoking rate: 15.4% (Arizona: 14.5%)
> Adults reporting poor or fair health: 17.8% (Arizona: 18.6%)
> Premature deaths per 100,000: 304.8 (Arizona: 331.1)
> Life expectancy at birth (years): 80.48 (Arizona: 79.99)
Arkansas: Benton County
> Smoking rate: 18.6% (Arkansas: 23.7%)
> Adults reporting poor or fair health: 19.9% (Arkansas: 23.3%)
> Premature deaths per 100,000: 311.1 (Arkansas: 457.4)
> Life expectancy at birth (years): 79.91 (Arkansas: 76.05)
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California: Santa Clara County
> Smoking rate: 9.6% (California: 11.5%)
> Adults reporting poor or fair health: 14.3% (California: 17.6%)
> Premature deaths per 100,000: 185.7 (California: 268.4)
> Life expectancy at birth (years): 84.93 (California: 81.68)
Colorado: Douglas County
> Smoking rate: 10.7% (Colorado: 14.7%)
> Adults reporting poor or fair health: 8.6% (Colorado: 13.8%)
> Premature deaths per 100,000: 162.0 (Colorado: 281.6)
> Life expectancy at birth (years): 84.02 (Colorado: 80.61)
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Connecticut: Fairfield County
> 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 at birth (years): 82.98 (Connecticut: 80.87)
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Delaware: New Castle County
> Smoking rate: 18.4% (Delaware: 17.4%)
> Adults reporting poor or fair health: 16.6% (Delaware: 16.3%)
> Premature deaths per 100,000: 363.4 (Delaware: 360.1)
> Life expectancy at birth (years): 78.41 (Delaware: 78.47)
Florida: Orange County
> Smoking rate: 15.8% (Florida: 14.9%)
> Adults reporting poor or fair health: 20.2% (Florida: 19.5%)
> Premature deaths per 100,000: 299.3 (Florida: 336.7)
> Life expectancy at birth (years): 80.56 (Florida: 80.17)
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Georgia: Forsyth County
> Smoking rate: 12.2% (Georgia: 16.3%)
> Adults reporting poor or fair health: 12.0% (Georgia: 18.4%)
> Premature deaths per 100,000: 202.7 (Georgia: 378.1)
> Life expectancy at birth (years): 82.31 (Georgia: 77.94)
Hawaii: Honolulu County
> 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 at birth (years): 82.52 (Hawaii: 82.28)
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Idaho: Teton County
> Smoking rate: 14.2% (Idaho: 15.0%)
> Adults reporting poor or fair health: 14.0% (Idaho: 15.1%)
> Premature deaths per 100,000: 176.0 (Idaho: 303.7)
> Life expectancy at birth (years): 83.80 (Idaho: 79.44)
Illinois: DuPage County
> Smoking rate: 14.2% (Illinois: 15.9%)
> Adults reporting poor or fair health: 12.0% (Illinois: 15.9%)
> Premature deaths per 100,000: 214.5 (Illinois: 328.1)
> Life expectancy at birth (years): 82.53 (Illinois: 79.38)
Indiana: Hamilton County
> Smoking rate: 13.9% (Indiana: 21.7%)
> Adults reporting poor or fair health: 12.0% (Indiana: 18.2%)
> Premature deaths per 100,000: 210.4 (Indiana: 400.8)
> Life expectancy at birth (years): 81.98 (Indiana: 77.11)
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Iowa: Dallas County
> Smoking rate: 13.2% (Iowa: 17.4%)
> Adults reporting poor or fair health: 10.1% (Iowa: 13.5%)
> Premature deaths per 100,000: 241.0 (Iowa: 321.7)
> Life expectancy at birth (years): 82.33 (Iowa: 79.36)
Kansas: Johnson County
> Smoking rate: 12.5% (Kansas: 17.9%)
> Adults reporting poor or fair health: 10.6% (Kansas: 16.3%)
> Premature deaths per 100,000: 223.8 (Kansas: 354.3)
> Life expectancy at birth (years): 81.72 (Kansas: 78.45)
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Kentucky: Oldham County
> Smoking rate: 16.4% (Kentucky: 24.1%)
> Adults reporting poor or fair health: 14.8% (Kentucky: 21.8%)
> Premature deaths per 100,000: 287.5 (Kentucky: 469.6)
> Life expectancy at birth (years): 79.81 (Kentucky: 75.63)
Louisiana: St. Tammany Parish
> Smoking rate: 19.1% (Louisiana: 21.1%)
> Adults reporting poor or fair health: 16.2% (Louisiana: 21.4%)
> Premature deaths per 100,000: 341.7 (Louisiana: 452.9)
> Life expectancy at birth (years): 78.35 (Louisiana: 76.14)
Maine: Cumberland County
> Smoking rate: 14.3% (Maine: 19.4%)
> Adults reporting poor or fair health: 11.7% (Maine: 17.1%)
> Premature deaths per 100,000: 278.1 (Maine: 338.4)
> Life expectancy at birth (years): 80.23 (Maine: 78.69)
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Maryland: Howard County
> Smoking rate: 9.1% (Maryland: 12.6%)
> Adults reporting poor or fair health: 11.1% (Maryland: 15.2%)
> Premature deaths per 100,000: 197.0 (Maryland: 338.8)
> Life expectancy at birth (years): 83.15 (Maryland: 79.22)
Massachusetts: Middlesex County
> Smoking rate: 12.3% (Massachusetts: 13.7%)
> Adults reporting poor or fair health: 11.1% (Massachusetts: 13.5%)
> Premature deaths per 100,000: 222.6 (Massachusetts: 279.4)
> Life expectancy at birth (years): 82.37 (Massachusetts: 80.62)
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Michigan: Washtenaw County
> 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 at birth (years): 81.39 (Michigan: 78.14)
Minnesota: Carver County
> Smoking rate: 12.9% (Minnesota: 15.5%)
> Adults reporting poor or fair health: 9.9% (Minnesota: 12.9%)
> Premature deaths per 100,000: 180.2 (Minnesota: 266.7)
> Life expectancy at birth (years): 83.30 (Minnesota: 80.92)
Mississippi: Madison County
> Smoking rate: 14.3% (Mississippi: 21.0%)
> Adults reporting poor or fair health: 15.8% (Mississippi: 22.1%)
> Premature deaths per 100,000: 352.4 (Mississippi: 501.8)
> Life expectancy at birth (years): 76.46 (Mississippi: 74.88)
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Missouri: Platte County
> Smoking rate: 15.6% (Missouri: 20.1%)
> Adults reporting poor or fair health: 14.3% (Missouri: 19.5%)
> Premature deaths per 100,000: 283.5 (Missouri: 403.6)
> Life expectancy at birth (years): 80.25 (Missouri: 77.30)
Montana: Gallatin County
> Smoking rate: 15.2% (Montana: 18.9%)
> Adults reporting poor or fair health: 11.3% (Montana: 14.1%)
> Premature deaths per 100,000: 191.6 (Montana: 333.8)
> Life expectancy at birth (years): 82.64 (Montana: 78.91)
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Nebraska: Sarpy County
> Smoking rate: 14.0% (Nebraska: 16.6%)
> Adults reporting poor or fair health: 10.3% (Nebraska: 13.8%)
> Premature deaths per 100,000: 239.8 (Nebraska: 312.9)
> Life expectancy at birth (years): 81.32 (Nebraska: 79.57)
Nevada: Douglas County
> Smoking rate: 16.7% (Nevada: 15.7%)
> Adults reporting poor or fair health: 15.8% (Nevada: 19.1%)
> Premature deaths per 100,000: 292.6 (Nevada: 359.9)
> Life expectancy at birth (years): 80.71 (Nevada: 78.67)
New Hampshire: Rockingham County
> Smoking rate: 14.2% (New Hampshire: 16.6%)
> Adults reporting poor or fair health: 11.5% (New Hampshire: 12.8%)
> Premature deaths per 100,000: 263.4 (New Hampshire: 304.9)
> Life expectancy at birth (years): 80.89 (New Hampshire: 79.69)
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New Jersey: Somerset County
> Smoking rate: 11.9% (New Jersey: 13.2%)
> Adults reporting poor or fair health: 12.2% (New Jersey: 15.5%)
> Premature deaths per 100,000: 214.6 (New Jersey: 292.0)
> Life expectancy at birth (years): 82.55 (New Jersey: 80.49)
New Mexico: Los Alamos County
> Smoking rate: 9.6% (New Mexico: 15.9%)
> Adults reporting poor or fair health: 9.4% (New Mexico: 20.3%)
> Premature deaths per 100,000: 196.1 (New Mexico: 399.5)
> Life expectancy at birth (years): 83.80 (New Mexico: 77.98)
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New York: New York County
> Smoking rate: 11.9% (New York: 13.0%)
> Adults reporting poor or fair health: 15.6% (New York: 16.3%)
> Premature deaths per 100,000: 210.6 (New York: 276.3)
> Life expectancy at birth (years): 85.27 (New York: 81.44)
North Carolina: Wake County
> Smoking rate: 14.3% (North Carolina: 17.9%)
> Adults reporting poor or fair health: 13.6% (North Carolina: 18.0%)
> Premature deaths per 100,000: 233.0 (North Carolina: 369.6)
> Life expectancy at birth (years): 81.81 (North Carolina: 78.13)
North Dakota: Burleigh County
> Smoking rate: 16.3% (North Dakota: 19.7%)
> Adults reporting poor or fair health: 12.4% (North Dakota: 13.6%)
> Premature deaths per 100,000: 267.8 (North Dakota: 319.7)
> Life expectancy at birth (years): 81.62 (North Dakota: 79.72)
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Ohio: Delaware County
> Smoking rate: 15.3% (Ohio: 21.4%)
> Adults reporting poor or fair health: 11.8% (Ohio: 17.8%)
> Premature deaths per 100,000: 208.8 (Ohio: 406.8)
> Life expectancy at birth (years): 82.27 (Ohio: 76.98)
Oklahoma: Cleveland County
> Smoking rate: 17.8% (Oklahoma: 19.9%)
> Adults reporting poor or fair health: 17.3% (Oklahoma: 20.9%)
> Premature deaths per 100,000: 351.5 (Oklahoma: 456.6)
> Life expectancy at birth (years): 78.73 (Oklahoma: 76.05)
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Oregon: Washington County
> Smoking rate: 13.1% (Oregon: 15.7%)
> Adults reporting poor or fair health: 14.7% (Oregon: 18.2%)
> Premature deaths per 100,000: 215.6 (Oregon: 303.0)
> Life expectancy at birth (years): 82.73 (Oregon: 79.88)
Pennsylvania: Montgomery County
> Smoking rate: 14.2% (Pennsylvania: 17.9%)
> Adults reporting poor or fair health: 13.6% (Pennsylvania: 17.6%)
> Premature deaths per 100,000: 262.7 (Pennsylvania: 354.5)
> Life expectancy at birth (years): 80.90 (Pennsylvania: 78.45)
Rhode Island: Bristol County
> Smoking rate: 14.4% (Rhode Island: 15.2%)
> Adults reporting poor or fair health: 12.5% (Rhode Island: 16.5%)
> Premature deaths per 100,000: 230.6 (Rhode Island: 304.4)
> Life expectancy at birth (years): 81.48 (Rhode Island: 79.84)
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South Carolina: Charleston County
> Smoking rate: 14.3% (South Carolina: 18.7%)
> Adults reporting poor or fair health: 14.4% (South Carolina: 17.8%)
> Premature deaths per 100,000: 339.5 (South Carolina: 410.6)
> Life expectancy at birth (years): 79.05 (South Carolina: 77.12)
South Dakota: Lincoln County
> Smoking rate: 14.9% (South Dakota: 20.2%)
> Adults reporting poor or fair health: 10.9% (South Dakota: 13.4%)
> Premature deaths per 100,000: 204.3 (South Dakota: 335.4)
> Life expectancy at birth (years): 84.29 (South Dakota: 78.91)
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Tennessee: Williamson County
> Smoking rate: 13.9% (Tennessee: 20.8%)
> Adults reporting poor or fair health: 12.2% (Tennessee: 21.2%)
> Premature deaths per 100,000: 216.5 (Tennessee: 453.1)
> Life expectancy at birth (years): 81.73 (Tennessee: 75.98)
Texas: Collin County
> Smoking rate: 11.5% (Texas: 14.2%)
> Adults reporting poor or fair health: 13.5% (Texas: 18.7%)
> Premature deaths per 100,000: 208.5 (Texas: 338.6)
> Life expectancy at birth (years): 82.68 (Texas: 79.17)
Utah: Utah County
> Smoking rate: 7.1% (Utah: 9.1%)
> Adults reporting poor or fair health: 13.2% (Utah: 14.8%)
> Premature deaths per 100,000: 252.5 (Utah: 282.4)
> Life expectancy at birth (years): 80.63 (Utah: 80.07)
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Vermont: Chittenden County
> Smoking rate: 12.5% (Vermont: 14.7%)
> Adults reporting poor or fair health: 11.2% (Vermont: 12.8%)
> Premature deaths per 100,000: 249.6 (Vermont: 302.2)
> Life expectancy at birth (years): 81.76 (Vermont: 79.83)
Virginia: Falls Church city
> Smoking rate: 9.3% (Virginia: 15.1%)
> Adults reporting poor or fair health: 9.0% (Virginia: 16.6%)
> Premature deaths per 100,000: 224.9 (Virginia: 320.0)
> Life expectancy at birth (years): 80.70 (Virginia: 79.55)
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Washington: King County
> Smoking rate: 10.7% (Washington: 12.1%)
> Adults reporting poor or fair health: 12.4% (Washington: 15.0%)
> Premature deaths per 100,000: 233.6 (Washington: 288.1)
> Life expectancy at birth (years): 82.44 (Washington: 80.42)
West Virginia: Monongalia County
> Smoking rate: 21.0% (West Virginia: 26.9%)
> Adults reporting poor or fair health: 19.9% (West Virginia: 23.6%)
> Premature deaths per 100,000: 310.9 (West Virginia: 504.8)
> Life expectancy at birth (years): 79.55 (West Virginia: 74.79)
Wisconsin: Ozaukee County
> Smoking rate: 14.1% (Wisconsin: 17.2%)
> Adults reporting poor or fair health: 10.9% (Wisconsin: 14.8%)
> Premature deaths per 100,000: 213.4 (Wisconsin: 308.2)
> Life expectancy at birth (years): 82.14 (Wisconsin: 79.46)
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Wyoming: Teton County
> Smoking rate: 12.9% (Wyoming: 19.2%)
> Adults reporting poor or fair health: 11.4% (Wyoming: 15.3%)
> Premature deaths per 100,000: 128.7 (Wyoming: 344.2)
> Life expectancy at birth (years): 87.47 (Wyoming: 78.91)
Methodology
To determine the county 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 smоking rates are from 2018.
Of the 3,220 counties or county equivalents, 3,141 had boundaries that fell within one of the 50 states, while the rest were in the District of Columbia or Puerto Rico. Counties with a 2019 five-year population estimate from the U.S. Census Bureau of less than 1,000 were excluded.
The remaining 3,105 places were ranked within their state 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 (premature death rate), and life expectancy are also from the 2021 CHR.
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