American Counties With the Most Smokers

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Claiming nearly half a million American lives annually, smоking is the leading cause of preventable death in the United States. Another 16 million Americans are living with a serious illness caused by smоking. Smоking also has an economic impact, including more than $225 billion each year spent on medical expenses to treat the smоking-related illness in the U.S. and over $156 billion in lost productivity.

Though the risks associated with smоking and tobacco use are well established and widely understood, 42.4 million American adults — or 16.6% of the adult population — regularly smоke сigarettes. In some parts of the country, smоking rates are far higher. 

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 50 counties with the most smоkers. 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 сigarettes in their lifetime.

Smоking rates in the counties on this list range from 30.5% to nearly 45%. The majority of counties on this list are located in Southern states, including 11 in Kentucky alone. 

Given the proven detrimental effects of smоking, it is perhaps not surprising that some important health outcome measures tend to be worse than average in metros with higher smоking rates. For example, in all 50 counties with the highest smоking rates, the share of adults who report being in fair or poor health is greater than the 16.5% share nationwide.

The correlation between smоking rates and life expectancy is also strong. In every metro area on this list with available data, average life expectancy at birth is below the 79.2 year national average.