This Is the American County With the Highest Smoking Rate

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According to the Centers for Disease Control and Prevention (CDC), 14% of American adults smoke. That means 34 million adults in the United States smoke. The habit can have grim consequences. Cigarette smoking is the most preventable cause of death in America, and it kills 480,000 people a year.

Smoking also has economic consequences. The CDC reports that smoking-related health problems cost the economy $300 billion a year.

The news is not entirely bad. The number of adults who smoke declined by 20.9% between 2005 and 2019. It is part of a longer-term trend, and there is hope the figure will drop further.

Using data from County Health Rankings & Roadmaps (CHR), a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program, 24/7 Tempo identified the county with the most smоkers. Counties and county-equivalents were ranked on the adult smоking rate; that is, 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 50 counties with the highest numbers of smokers ranged from more than 30% to nearly 45%. The majority of these 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, the average life expectancy at birth is below the 79.2 year national average.

The county with the highest percentage of people who smoke is Kusilvak Census Area, Alaska. Here are the details:

  • Smoking rate: 44.6%
  • Adults reporting poor or fair health: 41.9% (the highest of 3,106 counties)
  • Premature deaths per 100,000: 678.7 (68th highest of 3,081 counties)
  • Life expectancy at birth: 67.19 years (sixth lowest of 3,073 counties)

Of the 3,220 counties or county-equivalents, 3,142 had boundaries that fell within one of the 50 states or the District of Columbia. Counties with a 2019 five-year population estimate from the U.S. Census Bureau of less than 1,000 were excluded.

The remaining 3,106 places were ranked based on the adult smoking 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 average life expectancy at birth are also from the 2021 CHR. Note that while the CHR report is from 2021, adult smoking rates are from 2018.

Click here to see all the American counties with the most smokers.

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