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%.
50. Hickory-Lenoir-Morganton, North Carolina
> Adults who smoke regularly: 22.06%
> Adults reporting poor or fair health: 21.19% — #110 highest out of 384
> Life expectancy at birth: 76.39 years — #278 highest out of 384
> Premature deaths: 433 per 100,000 people — #115 highest out of 384
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49. Panama City, Florida
> Adults who smoke regularly: 22.10%
> Adults reporting poor or fair health: 20.10% — #145 highest out of 384
> Life expectancy at birth: 76.07 years — #291 highest out of 384
> Premature deaths: 479 per 100,000 people — #63 highest out of 384
48. Fort Smith, Arkansas-Oklahoma
> Adults who smoke regularly: 22.15%
> Adults reporting poor or fair health: 25.34% — #20 highest out of 384
> Life expectancy at birth: 75.35 years — #327 highest out of 384
> Premature deaths: 494 per 100,000 people — #49 highest out of 384
47. Macon-Bibb County, Georgia
> Adults who smoke regularly: 22.26%
> Adults reporting poor or fair health: 23.17% — #54 highest out of 384
> Life expectancy at birth: 74.09 years — #368 highest out of 384
> Premature deaths: 550 per 100,000 people — #11 highest out of 384
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46. Jonesboro, Alabama
> Adults who smoke regularly: 22.30%
> Adults reporting poor or fair health: 23.38% — #49 highest out of 384
> Life expectancy at birth: 75.16 years — #335 highest out of 384
> Premature deaths: 490 per 100,000 people — #52 highest out of 384
45. Williamsport, Pennsylvania
> Adults who smoke regularly: 22.30%
> Adults reporting poor or fair health: 18.50% — #223 highest out of 384
> Life expectancy at birth: 77.43 years — #219 highest out of 384
> Premature deaths: 379 per 100,000 people — #198 highest out of 384
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44. Farmington, New Mexico
> Adults who smoke regularly: 22.30%
> Adults reporting poor or fair health: 23.40% — #46 highest out of 384
> Life expectancy at birth: 74.04 years — #370 highest out of 384
> Premature deaths: 547 per 100,000 people — #12 highest out of 384
43. Rocky Mount, North Carolina
> Adults who smoke regularly: 22.31%
> Adults reporting poor or fair health: 24.11% — #31 highest out of 384
> Life expectancy at birth: 73.99 years — #371 highest out of 384
> Premature deaths: 531 per 100,000 people — #22 highest out of 384
42. Cleveland, Tennessee
> Adults who smoke regularly: 22.33%
> Adults reporting poor or fair health: 23.81% — #35 highest out of 384
> Life expectancy at birth: 75.67 years — #309 highest out of 384
> Premature deaths: 467 per 100,000 people — #75 highest out of 384
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41. Lake Charles, Louisiana
> Adults who smoke regularly: 22.33%
> Adults reporting poor or fair health: 21.99% — #84 highest out of 384
> Life expectancy at birth: 74.59 years — #354 highest out of 384
> Premature deaths: 512 per 100,000 people — #32 highest out of 384
40. Toledo, Ohio
> Adults who smoke regularly: 22.38%
> Adults reporting poor or fair health: 20.33% — #134 highest out of 384
> Life expectancy at birth: 75.73 years — #307 highest out of 384
> Premature deaths: 451 per 100,000 people — #94 highest out of 384
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39. Dothan, Alabama
> Adults who smoke regularly: 22.41%
> Adults reporting poor or fair health: 23.60% — #43 highest out of 384
> Life expectancy at birth: 75.11 years — #338 highest out of 384
> Premature deaths: 480 per 100,000 people — #60 highest out of 384
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38. Shreveport-Bossier City, Louisiana
> Adults who smoke regularly: 22.49%
> Adults reporting poor or fair health: 23.18% — #53 highest out of 384
> Life expectancy at birth: 74.83 years — #346 highest out of 384
> Premature deaths: 506 per 100,000 people — #37 highest out of 384
37. Muncie, Indiana
> Adults who smoke regularly: 22.50%
> Adults reporting poor or fair health: 22.10% — #77 highest out of 384
> Life expectancy at birth: 74.18 years — #366 highest out of 384
> Premature deaths: 528 per 100,000 people — #24 highest out of 384
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36. Lafayette, Louisiana
> Adults who smoke regularly: 22.53%
> Adults reporting poor or fair health: 22.60% — #67 highest out of 384
> Life expectancy at birth: 76.20 years — #287 highest out of 384
> Premature deaths: 446 per 100,000 people — #98 highest out of 384
35. Alexandria, Louisiana
> Adults who smoke regularly: 22.55%
> Adults reporting poor or fair health: 23.72% — #37 highest out of 384
> Life expectancy at birth: 73.47 years — #376 highest out of 384
> Premature deaths: 574 per 100,000 people — #8 highest out of 384
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34. Albany, Georgia
> Adults who smoke regularly: 22.58%
> Adults reporting poor or fair health: 25.14% — #23 highest out of 384
> Life expectancy at birth: 73.55 years — #375 highest out of 384
> Premature deaths: 560 per 100,000 people — #10 highest out of 384
33. Vineland-Bridgeton, New Jersey
> Adults who smoke regularly: 22.60%
> Adults reporting poor or fair health: 25.17% — #21 highest out of 384
> Life expectancy at birth: 74.60 years — #353 highest out of 384
> Premature deaths: 509 per 100,000 people — #35 highest out of 384
32. Anniston-Oxford, Alabama
> Adults who smoke regularly: 22.60%
> Adults reporting poor or fair health: 23.70% — #38 highest out of 384
> Life expectancy at birth: 72.83 years — #380 highest out of 384
> Premature deaths: 587 per 100,000 people — #6 highest out of 384
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31. Jackson, Tennessee
> Adults who smoke regularly: 22.61%
> Adults reporting poor or fair health: 23.99% — #33 highest out of 384
> Life expectancy at birth: 74.28 years — #364 highest out of 384
> Premature deaths: 536 per 100,000 people — #20 highest out of 384
30. Lima, Ohio
> Adults who smoke regularly: 22.80%
> Adults reporting poor or fair health: 20.10% — #146 highest out of 384
> Life expectancy at birth: 76.25 years — #283 highest out of 384
> Premature deaths: 433 per 100,000 people — #114 highest out of 384
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29. Jackson, Michigan
> Adults who smoke regularly: 22.80%
> Adults reporting poor or fair health: 18.70% — #210 highest out of 384
> Life expectancy at birth: 76.53 years — #271 highest out of 384
> Premature deaths: 421 per 100,000 people — #129 highest out of 384
28. Hammond, Louisiana
> Adults who smoke regularly: 22.90%
> Adults reporting poor or fair health: 24.30% — #28 highest out of 384
> Life expectancy at birth: 74.64 years — #352 highest out of 384
> Premature deaths: 506 per 100,000 people — #38 highest out of 384
27. Flint, Michigan
> Adults who smoke regularly: 22.90%
> Adults reporting poor or fair health: 20.20% — #139 highest out of 384
> Life expectancy at birth: 74.82 years — #347 highest out of 384
> Premature deaths: 495 per 100,000 people — #48 highest out of 384
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26. Canton-Massillon, Ohio
> Adults who smoke regularly: 22.99%
> Adults reporting poor or fair health: 19.61% — #172 highest out of 384
> Life expectancy at birth: 76.54 years — #269 highest out of 384
> Premature deaths: 417 per 100,000 people — #133 highest out of 384
25. Johnson City, Tennessee
> Adults who smoke regularly: 23.07%
> Adults reporting poor or fair health: 22.55% — #69 highest out of 384
> Life expectancy at birth: 74.65 years — #351 highest out of 384
> Premature deaths: 510 per 100,000 people — #33 highest out of 384
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24. Muskegon, Michigan
> Adults who smoke regularly: 23.10%
> Adults reporting poor or fair health: 20.30% — #135 highest out of 384
> Life expectancy at birth: 76.23 years — #285 highest out of 384
> Premature deaths: 430 per 100,000 people — #119 highest out of 384
23. Kingsport-Bristol, Tennessee-Virginia
> Adults who smoke regularly: 23.10%
> Adults reporting poor or fair health: 22.44% — #70 highest out of 384
> Life expectancy at birth: 74.87 years — #344 highest out of 384
> Premature deaths: 510 per 100,000 people — #34 highest out of 384
22. St. Joseph, Missouri-Kansas
> Adults who smoke regularly: 23.23%
> Adults reporting poor or fair health: 20.89% — #119 highest out of 384
> Life expectancy at birth: 76.39 years — #279 highest out of 384
> Premature deaths: 437 per 100,000 people — #105 highest out of 384
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21. Altoona, Pennsylvania
> Adults who smoke regularly: 23.30%
> Adults reporting poor or fair health: 19.80% — #161 highest out of 384
> Life expectancy at birth: 76.55 years — #268 highest out of 384
> Premature deaths: 410 per 100,000 people — #146 highest out of 384
20. Homosassa Springs, Florida
> Adults who smoke regularly: 23.30%
> Adults reporting poor or fair health: 21.60% — #98 highest out of 384
> Life expectancy at birth: 74.52 years — #356 highest out of 384
> Premature deaths: 543 per 100,000 people — #13 highest out of 384
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19. Parkersburg-Vienna, West Virginia
> Adults who smoke regularly: 23.31%
> Adults reporting poor or fair health: 23.68% — #40 highest out of 384
> Life expectancy at birth: 74.85 years — #345 highest out of 384
> Premature deaths: 496 per 100,000 people — #46 highest out of 384
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18. Bowling Green, Kentucky
> Adults who smoke regularly: 23.34%
> Adults reporting poor or fair health: 21.84% — #87 highest out of 384
> Life expectancy at birth: 76.18 years — #289 highest out of 384
> Premature deaths: 453 per 100,000 people — #92 highest out of 384
17. Terre Haute, Indiana
> Adults who smoke regularly: 23.35%
> Adults reporting poor or fair health: 21.11% — #111 highest out of 384
> Life expectancy at birth: 75.84 years — #299 highest out of 384
> Premature deaths: 463 per 100,000 people — #80 highest out of 384
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16. Elizabethtown-Fort Knox, Kentucky
> Adults who smoke regularly: 23.47%
> Adults reporting poor or fair health: 21.58% — #99 highest out of 384
> Life expectancy at birth: 75.80 years — #302 highest out of 384
> Premature deaths: 458 per 100,000 people — #87 highest out of 384
15. Gadsden, Alabama
> Adults who smoke regularly: 23.50%
> Adults reporting poor or fair health: 23.00% — #60 highest out of 384
> Life expectancy at birth: 72.54 years — #383 highest out of 384
> Premature deaths: 596 per 100,000 people — #2 highest out of 384
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14. Owensboro, Kentucky
> Adults who smoke regularly: 23.62%
> Adults reporting poor or fair health: 21.54% — #100 highest out of 384
> Life expectancy at birth: 76.36 years — #281 highest out of 384
> Premature deaths: 442 per 100,000 people — #101 highest out of 384
13. Monroe, Louisiana
> Adults who smoke regularly: 23.84%
> Adults reporting poor or fair health: 25.16% — #22 highest out of 384
> Life expectancy at birth: 73.32 years — #377 highest out of 384
> Premature deaths: 562 per 100,000 people — #9 highest out of 384
12. Houma-Thibodaux, Louisiana
> Adults who smoke regularly: 23.88%
> Adults reporting poor or fair health: 24.20% — #29 highest out of 384
> Life expectancy at birth: 75.89 years — #297 highest out of 384
> Premature deaths: 457 per 100,000 people — #89 highest out of 384
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11. Wheeling, West Virginia-Ohio
> Adults who smoke regularly: 24.10%
> Adults reporting poor or fair health: 21.20% — #108 highest out of 384
> Life expectancy at birth: 75.51 years — #317 highest out of 384
> Premature deaths: 465 per 100,000 people — #76 highest out of 384
10. Pine Bluff, Arkansas
> Adults who smoke regularly: 24.12%
> Adults reporting poor or fair health: 26.92% — #10 highest out of 384
> Life expectancy at birth: 72.88 years — #379 highest out of 384
> Premature deaths: 596 per 100,000 people — #3 highest out of 384
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9. Morristown, Tennessee
> Adults who smoke regularly: 24.24%
> Adults reporting poor or fair health: 24.96% — #24 highest out of 384
> Life expectancy at birth: 74.43 years — #359 highest out of 384
> Premature deaths: 522 per 100,000 people — #27 highest out of 384
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8. Youngstown-Warren-Boardman, Ohio-Pennsylvania
> Adults who smoke regularly: 24.41%
> Adults reporting poor or fair health: 21.33% — #103 highest out of 384
> Life expectancy at birth: 75.44 years — #322 highest out of 384
> Premature deaths: 469 per 100,000 people — #73 highest out of 384
7. Michigan City-La Porte, Indiana
> Adults who smoke regularly: 24.80%
> Adults reporting poor or fair health: 22.00% — #82 highest out of 384
> Life expectancy at birth: 75.36 years — #326 highest out of 384
> Premature deaths: 475 per 100,000 people — #68 highest out of 384
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6. Huntington-Ashland, West Virginia-Kentucky-Ohio
> Adults who smoke regularly: 24.87%
> Adults reporting poor or fair health: 23.56% — #44 highest out of 384
> Life expectancy at birth: 73.28 years — #378 highest out of 384
> Premature deaths: 576 per 100,000 people — #7 highest out of 384
5. Springfield, Ohio
> Adults who smoke regularly: 24.90%
> Adults reporting poor or fair health: 21.80% — #91 highest out of 384
> Life expectancy at birth: 73.90 years — #373 highest out of 384
> Premature deaths: 543 per 100,000 people — #15 highest out of 384
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4. Charleston, West Virginia
> Adults who smoke regularly: 24.93%
> Adults reporting poor or fair health: 24.33% — #27 highest out of 384
> Life expectancy at birth: 72.64 years — #381 highest out of 384
> Premature deaths: 595 per 100,000 people — #5 highest out of 384
3. Mansfield, Ohio
> Adults who smoke regularly: 25.30%
> Adults reporting poor or fair health: 20.90% — #117 highest out of 384
> Life expectancy at birth: 75.62 years — #314 highest out of 384
> Premature deaths: 473 per 100,000 people — #69 highest out of 384
2. Weirton-Steubenville, West Virginia-Ohio
> Adults who smoke regularly: 25.49%
> Adults reporting poor or fair health: 22.17% — #74 highest out of 384
> Life expectancy at birth: 74.71 years — #348 highest out of 384
> Premature deaths: 499 per 100,000 people — #43 highest out of 384
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1. Beckley, West Virginia
> Adults who smoke regularly: 26.10%
> Adults reporting poor or fair health: 26.95% — #9 highest out of 384
> Life expectancy at birth: 71.94 years — #384 highest out of 384
> Premature deaths: 644 per 100,000 people — #1 highest out of 384
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