Well-Being Prevention & Cures

These states have the highest rates of smoking

Rates of smoking nationwide continue to fall, but smoking is still prevalent in several states.
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Story at a glance


  • Smoking remains popular in many Southern and Midwestern states.

  • West Virginia has the highest rate of smoking in the country.

  • Cigarette smoking among U.S. adults dropped from more than 33 percent in 1980 to about 12 percent in 2020, an all-time low.

While the number of Americans who smoke has fallen dramatically over the past several decades and continues to trend downward, smoking continues to take a huge toll on the lives of Americans. 

Cigarette smoking among U.S. adults dropped from more than 33 percent in 1980 to about 12 percent in 2020, an all-time low, according to the Centers for Disease Control and Prevention (CDC). Cigarette smoking, however, results in more than 480,000 deaths each year, including 41,000 deaths from secondhand smoke, and researchers estimate smoking is responsible for nearly 30 percent of all cancer deaths each year. Most lung cancer deaths in the U.S. are due to smoking. 


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Notably, a recent Gallup poll found just 11 percent of American adults surveyed said they had smoked a cigarette in the past week, a decrease from the 16 percent who said the same a year prior. Meanwhile, polling also shows more Americans now smoke marijuana than tobacco at 16 percent. 

Despite the drop in popularity, smoking remains prevalent in many parts of the country, predominantly in the South and Midwest, according to the Global Smoking Report published by medication access company NiceRX. 

Here are the states with the highest smoking rates:

West Virginia — 23.8 percent

Kentucky — 23.6 percent

Louisiana — 21.9 percent 

Ohio — 20.8 percent

Mississippi — 20.4 percent 

Alabama — 20.2 percent

Arkansas — 20.2 percent

Tennessee — 19.9 percent

Missouri — 19.6 percent

Indiana — 19.2 percent

States with the lowest smoking rates

Rhode Island — 13.3 percent

New Jersey — 13.1 percent

Maryland — 12.7 percent

New York — 12.7 percent

Washington — 12.6 percent

Hawaii — 12.3 percent

Connecticut — 12.1 percent

Massachusetts — 12 percent

California — 10 percent

Utah — 7.9 percent


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