American Cities Where the Most People Smoke

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Statistics from the Centers for Disease Control and Prevention (CDC) show that the percentage of adults who smoke in America declined from nearly 21% in 2005 to 14% in 2019. Although any decrease is welcome news, however, plenty of people still light up — and for smokers the risk of serious health issues like lung cancer and chronic obstructive pulmonary disease (COPD) remains high.

The National Institute of Health’s National Cancer Institute estimates that there will be about 235,760 new lung and bronchus (bronchial) cancer cases in 2021, resulting in about 131,880 deaths. That will represent 21.7% of all cancer deaths, meaning that more people will succumb to these cancers than to any other form of the disease.

Though it doesn’t claim as many victims as lung cancer, COPD, a term for respiratory disorders including emphysema and chronic bronchitis, was the fourth leading cause of death in the U.S. in 2018. According to the CDC, between 80% and 90% of lung and bronchus cancer deaths and about 80% of those related to COPD can be linked to cigarette smoking.

As of March of this year, smoking in bars, restaurants, and both private and public workplaces has been banned in 29 states and territories as well as the District of Columbia. Several other states prohibit smoking in bars and restaurants but not workplaces, or on government worksites but not in private offices. In addition, hundreds of cities and counties around the country have prohibitions of their own. Some states also levy heavy taxes on cigarettes — as much as $4.35 per pack in Connecticut and New York. These are the states with the highest and lowest cigarette taxes.

24/7 Tempo has reviewed data from several sources to determine which metropolitan statistical areas — either individual cities or agglomerations of cities, sometimes across state lines — report the highest rates of adult smoking, self-reported fair or poor health, and incidence of lung and bronchus cancer. These are the 40 U.S. cities with the shortest life expectancy.

Methodology

To identify the cities with the highest percentage of smokers, 24/7 Tempo reviewed data from the 2021 County Health Rankings & Roadmaps, a joint study by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, based on data from the 2018 Behavioral Risk Factor Surveillance System report from the Centers for Disease Control and Prevention (CDC). The list includes only metropolitan statistical areas with a population of at least 500,000 people based on annual estimates from the U.S. Census Bureau’s American Community Survey for 2019. Lung and bronchus cancer diagnosis rates per 100,000 are based on CDC cancer incidence statistics for 2017.