These Are the US Cities With the Biggest Smoking Population

Published: March 5, 2024 by John Harrington

Smoking is clearly on the decline in the United States, with about only one in eight adults indulging in the deadly habit. Even so, cigarette smoking continues to be the leading cause of preventable disease, disability, and death in the United States.

Smoking tobacco is blamed for more than 480,000 deaths per year in the U.S. In certain parts of the country, smoking is more prevalent than others.

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. Information on the share of adults reporting poor or fair health, the average life expectancy at birth, and premature death rate (the number of deaths among those under age 75 per 100,000) are also from the 2023 CHR.

Smoking harms nearly every body organ. It causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (which includes emphysema and chronic bronchitis). Smoking also raises the risk for tuberculosis, some eye diseases, and can disrupt the immune system.

The percentage of smokers in all cities on our list is 21% or above, nearly twice as high as the national average of 11.5% of all adults. Based on data from the Centers of Disease Control and Prevention, the ranks of daily smokers swell each day by 300 youthful smokers.

Five of 10 cities with the highest percentage of smokers are in West Virginia or in a metro area the Mountaineer State shares with another state such as Ohio.

West Virginia and an area it shares with Kentucky and Ohio also is home to three of the four metro areas on our list with the lowest life expectancy, all below 73.3 years. Only four cities on our list have a life expectancy that exceeds the national average of 76.4.

In six cities on our list, all from the South, people report having poor or fair health 20% of the time. (For information on states overall, click here to see the states with the biggest smoking population.)

50. Dayton-Kettering, Ohio

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Adults who smoke regularly: 21.0%
Adults in poor or fair health: 15.0% — #161 out of 384 metro areas
Premature death rate: 463 per 100,000 people — #81 out of 384 metro areas
Life expectancy at birth: 75.76 — #306 out of 384 metro areas

49. Texarkana, Texas-Arkansas

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Adults who smoke regularly: 21.1%
Adults in poor or fair health: 19.1% — #36 out of 384 metro areas
Premature death rate: 540 per 100,000 people — #16 out of 384 metro areas
Life expectancy at birth: 74.16 — #367 out of 384 metro areas

48. Albany, Georgia

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Adults who smoke regularly: 21.1%
Adults in poor or fair health: 20.0% — #20 out of 384 metro areas
Premature death rate: 557 per 100,000 people — #10 out of 384 metro areas
Life expectancy at birth: 73.6 — #375 out of 384 metro areas

47. Decatur, Alabama

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Adults who smoke regularly: 21.1%
Adults in poor or fair health: 19.1% — #38 out of 384 metro areas
Premature death rate: 536 per 100,000 people — #20 out of 384 metro areas
Life expectancy at birth: 73.91 — #372 out of 384 metro areas

46. Elizabethtown-Fort Knox, Kentucky

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Adults who smoke regularly: 21.1%
Adults in poor or fair health: 17.8% — #67 out of 384 metro areas
Premature death rate: 459 per 100,000 people — #86 out of 384 metro areas
Life expectancy at birth: 75.8 — #302 out of 384 metro areas

45. Dothan, Alabama

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Adults who smoke regularly: 21.2%
Adults in poor or fair health: 20.2% — #16 out of 384 metro areas
Premature death rate: 481 per 100,000 people — #59 out of 384 metro areas
Life expectancy at birth: 75.1 — #338 out of 384 metro areas

44. Monroe, Louisiana

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Adults who smoke regularly: 21.2%
Adults in poor or fair health: 20.8% — #14 out of 384 metro areas
Premature death rate: 562 per 100,000 people — #9 out of 384 metro areas
Life expectancy at birth: 73.31 — #377 out of 384 metro areas

43. Sebring-Avon Park, Florida

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Adults who smoke regularly: 21.2%
Adults in poor or fair health: 19.2% — #30 out of 384 metro areas
Premature death rate: 479 per 100,000 people — #61 out of 384 metro areas
Life expectancy at birth: 77.79 — #193 out of 384 metro areas

42. Clarksville, Tennessee-Kentucky

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Adults who smoke regularly: 21.2%
Adults in poor or fair health: 16.7% — #97 out of 384 metro areas
Premature death rate: 497 per 100,000 people — #44 out of 384 metro areas
Life expectancy at birth: 74.69 — #349 out of 384 metro areas

41. Sumter, South Carolina

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Adults who smoke regularly: 21.4%
Adults in poor or fair health: 18.8% — #44 out of 384 metro areas
Premature death rate: 543 per 100,000 people — #15 out of 384 metro areas
Life expectancy at birth: 74.31 — #363 out of 384 metro areas

40. Akron, Ohio

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Adults who smoke regularly: 21.5%
Adults in poor or fair health: 14.4% — #198 out of 384 metro areas
Premature death rate: 399 per 100,000 people — #167 out of 384 metro areas
Life expectancy at birth: 77.03 — #243 out of 384 metro areas

15. Jonesboro, Arkansas

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Adults who smoke regularly: 23.1%
Adults in poor or fair health: 22.8% — #6 out of 384 metro areas
Premature death rate: 597 per 100,000 people — #2 out of 384 metro areas
Life expectancy at birth: 72.87 — #379 out of 384 metro areas

38. Alexandria, Louisiana

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Adults who smoke regularly: 21.5%
Adults in poor or fair health: 18.6% — #46 out of 384 metro areas
Premature death rate: 574 per 100,000 people — #8 out of 384 metro areas
Life expectancy at birth: 73.47 — #376 out of 384 metro areas

37. Muskegon, Michigan

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Adults who smoke regularly: 21.6%
Adults in poor or fair health: 15.4% — #147 out of 384 metro areas
Premature death rate: 430 per 100,000 people — #119 out of 384 metro areas
Life expectancy at birth: 76.23 — #285 out of 384 metro areas

36. Saginaw, Michigan

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Adults who smoke regularly: 21.6%
Adults in poor or fair health: 15.9% — #130 out of 384 metro areas
Premature death rate: 435 per 100,000 people — #112 out of 384 metro areas
Life expectancy at birth: 76.11 — #290 out of 384 metro areas

35. Kokomo, Indiana

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Adults who smoke regularly: 21.8%
Adults in poor or fair health: 15.2% — #152 out of 384 metro areas
Premature death rate: 527 per 100,000 people — #25 out of 384 metro areas
Life expectancy at birth: 74.07 — #369 out of 384 metro areas

34. Hammond, Louisiana

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Adults who smoke regularly: 21.8%
Adults in poor or fair health: 19.5% — #26 out of 384 metro areas
Premature death rate: 506 per 100,000 people — #37 out of 384 metro areas
Life expectancy at birth: 74.64 — #352 out of 384 metro areas

33. Owensboro, Kentucky

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Adults who smoke regularly: 21.8%
Adults in poor or fair health: 18.2% — #55 out of 384 metro areas
Premature death rate: 442 per 100,000 people — #101 out of 384 metro areas
Life expectancy at birth: 76.36 — #280 out of 384 metro areas

32. Toledo, Ohio

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Adults who smoke regularly: 21.9%
Adults in poor or fair health: 15.2% — #151 out of 384 metro areas
Premature death rate: 451 per 100,000 people — #94 out of 384 metro areas
Life expectancy at birth: 75.73 — #307 out of 384 metro areas

31. Danville, Illinois

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Adults who smoke regularly: 22.1%
Adults in poor or fair health: 16.7% — #101 out of 384 metro areas
Premature death rate: 512 per 100,000 people — #31 out of 384 metro areas
Life expectancy at birth: 74.55 — #354 out of 384 metro areas

30. Bay City, Michigan

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Adults who smoke regularly: 22.1%
Adults in poor or fair health: 14.8% — #173 out of 384 metro areas
Premature death rate: 438 per 100,000 people — #103 out of 384 metro areas
Life expectancy at birth: 76.36 — #280 out of 384 metro areas

29. Bowling Green, Kentucky

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Adults who smoke regularly: 22.1%
Adults in poor or fair health: 18.9% — #40 out of 384 metro areas
Premature death rate: 452 per 100,000 people — #93 out of 384 metro areas
Life expectancy at birth: 76.2 — #288 out of 384 metro areas

28. Flint, Michigan

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Adults who smoke regularly: 22.2%
Adults in poor or fair health: 16.8% — #94 out of 384 metro areas
Premature death rate: 495 per 100,000 people — #48 out of 384 metro areas
Life expectancy at birth: 74.82 — #347 out of 384 metro areas

27. Joplin,

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Adults who smoke regularly: 22.2%
Adults in poor or fair health: 17.0% — #88 out of 384 metro areas
Premature death rate: 470 per 100,000 people — #72 out of 384 metro areas
Life expectancy at birth: 75.66 — #310 out of 384 metro areas

26. St. Joseph, Missouri-Kansas

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Adults who smoke regularly: 22.2%
Adults in poor or fair health: 16.2% — #120 out of 384 metro areas
Premature death rate: 437 per 100,000 people — #107 out of 384 metro areas
Life expectancy at birth: 76.41 — #278 out of 384 metro areas

25. Houma-Thibodaux, Louisiana

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Adults who smoke regularly: 22.3%
Adults in poor or fair health: 19.6% — #25 out of 384 metro areas
Premature death rate: 457 per 100,000 people — #90 out of 384 metro areas
Life expectancy at birth: 75.89 — #297 out of 384 metro areas

13. Cleveland, Tennessee

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Adults who smoke regularly: 23.2%
Adults in poor or fair health: 18.0% — #59 out of 384 metro areas
Premature death rate: 537 per 100,000 people — #19 out of 384 metro areas
Life expectancy at birth: 74.27 — #364 out of 384 metro areas

23. Muncie, Indiana

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Adults who smoke regularly: 22.5%
Adults in poor or fair health: 17.3% — #82 out of 384 metro areas
Premature death rate: 528 per 100,000 people — #24 out of 384 metro areas
Life expectancy at birth: 74.18 — #366 out of 384 metro areas

22. Battle Creek, Michigan

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Adults who smoke regularly: 22.5%
Adults in poor or fair health: 15.5% — #141 out of 384 metro areas
Premature death rate: 481 per 100,000 people — #60 out of 384 metro areas
Life expectancy at birth: 75.24 — #331 out of 384 metro areas

21. Canton-Massillon, Ohio

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Adults who smoke regularly: 22.6%
Adults in poor or fair health: 14.8% — #175 out of 384 metro areas
Premature death rate: 417 per 100,000 people — #134 out of 384 metro areas
Life expectancy at birth: 76.54 — #268 out of 384 metro areas

20. Farmington, New Mexico

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Adults who smoke regularly: 22.6%
Adults in poor or fair health: 17.7% — #69 out of 384 metro areas
Premature death rate: 547 per 100,000 people — #12 out of 384 metro areas
Life expectancy at birth: 74.04 — #370 out of 384 metro areas

19. Kingsport-Bristol, Tennessee-Virginia

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Adults who smoke regularly: 22.9%
Adults in poor or fair health: 16.3% — #117 out of 384 metro areas
Premature death rate: 510 per 100,000 people — #33 out of 384 metro areas
Life expectancy at birth: 74.86 — #344 out of 384 metro areas

18. Lima, Ohio

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Adults who smoke regularly: 22.9%
Adults in poor or fair health: 16.0% — #128 out of 384 metro areas
Premature death rate: 433 per 100,000 people — #114 out of 384 metro areas
Life expectancy at birth: 76.25 — #283 out of 384 metro areas

17. Wheeling, West Virginia-Ohio

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Adults who smoke regularly: 23.0%
Adults in poor or fair health: 16.6% — #106 out of 384 metro areas
Premature death rate: 466 per 100,000 people — #77 out of 384 metro areas
Life expectancy at birth: 75.51 — #317 out of 384 metro areas

16. Johnson City, Tennessee

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Adults who smoke regularly: 23.0%
Adults in poor or fair health: 16.4% — #111 out of 384 metro areas
Premature death rate: 509 per 100,000 people — #34 out of 384 metro areas
Life expectancy at birth: 74.66 — #351 out of 384 metro areas

15. Jonesboro, Arkansas

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Adults who smoke regularly: 23.1%
Adults in poor or fair health: 22.8% — #6 out of 384 metro areas
Premature death rate: 597 per 100,000 people — #2 out of 384 metro areas
Life expectancy at birth: 72.87 — #379 out of 384 metro areas

14. Fort Smith, Arkansas-Oklahoma

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Adults who smoke regularly: 23.1%
Adults in poor or fair health: 20.1% — #18 out of 384 metro areas
Premature death rate: 494 per 100,000 people — #49 out of 384 metro areas
Life expectancy at birth: 75.36 — #326 out of 384 metro areas

13. Cleveland, Tennessee

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Adults who smoke regularly: 23.2%
Adults in poor or fair health: 18.0% — #59 out of 384 metro areas
Premature death rate: 537 per 100,000 people — #19 out of 384 metro areas
Life expectancy at birth: 74.27 — #364 out of 384 metro areas

12. Michigan City-La Porte, Indiana

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Adults who smoke regularly: 23.2%
Adults in poor or fair health: 16.7% — #98 out of 384 metro areas
Premature death rate: 475 per 100,000 people — #67 out of 384 metro areas
Life expectancy at birth: 75.36 — #326 out of 384 metro areas

11. Homosassa Springs, Florida

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Adults who smoke regularly: 23.4%
Adults in poor or fair health: 16.3% — #114 out of 384 metro areas
Premature death rate: 543 per 100,000 people — #13 out of 384 metro areas
Life expectancy at birth: 74.52 — #356 out of 384 metro areas

10. Parkersburg-Vienna, West Virginia

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Adults who smoke regularly: 23.5%
Adults in poor or fair health: 19.2% — #33 out of 384 metro areas
Premature death rate: 497 per 100,000 people — #46 out of 384 metro areas
Life expectancy at birth: 74.84 — #346 out of 384 metro areas

9. Terre Haute, Indiana

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Adults who smoke regularly: 23.7%
Adults in poor or fair health: 16.9% — #92 out of 384 metro areas
Premature death rate: 463 per 100,000 people — #80 out of 384 metro areas
Life expectancy at birth: 75.83 — #300 out of 384 metro areas

8. Youngstown-Warren-Boardman, Ohio-Pennsylvania

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Adults who smoke regularly: 23.7%
Adults in poor or fair health: 16.3% — #112 out of 384 metro areas
Premature death rate: 469 per 100,000 people — #73 out of 384 metro areas
Life expectancy at birth: 75.44 — #322 out of 384 metro areas

7. Springfield, Ohio

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Adults who smoke regularly: 23.9%
Adults in poor or fair health: 16.3% — #113 out of 384 metro areas
Premature death rate: 543 per 100,000 people — #14 out of 384 metro areas
Life expectancy at birth: 73.9 — #373 out of 384 metro areas

6. Huntington-Ashland, West Virginia-Kentucky-Ohio

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Adults who smoke regularly: 24.0%
Adults in poor or fair health: 19.4% — #27 out of 384 metro areas
Premature death rate: 576 per 100,000 people — #7 out of 384 metro areas
Life expectancy at birth: 73.28 — #378 out of 384 metro areas

5. Charleston, West Virginia

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Adults who smoke regularly: 24.2%
Adults in poor or fair health: 19.7% — #23 out of 384 metro areas
Premature death rate: 596 per 100,000 people — #5 out of 384 metro areas
Life expectancy at birth: 72.63 — #381 out of 384 metro areas

4. Morristown, Tennessee

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Adults who smoke regularly: 24.5%
Adults in poor or fair health: 17.6% — #73 out of 384 metro areas
Premature death rate: 522 per 100,000 people — #27 out of 384 metro areas
Life expectancy at birth: 74.43 — #359 out of 384 metro areas

3. Weirton-Steubenville, West Virginia-Ohio

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Adults who smoke regularly: 24.7%
Adults in poor or fair health: 17.5% — #74 out of 384 metro areas
Premature death rate: 499 per 100,000 people — #43 out of 384 metro areas
Life expectancy at birth: 74.72 — #348 out of 384 metro areas

2. Beckley, West Virginia

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Adults who smoke regularly: 25.8%
Adults in poor or fair health: 21.7% — #8 out of 384 metro areas
Premature death rate: 645 per 100,000 people — #1 out of 384 metro areas
Life expectancy at birth: 71.93 — #384 out of 384 metro areas

1. Mansfield, Ohio

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Adults who smoke regularly: 26.0%
Adults in poor or fair health: 16.4% — #109 out of 384 metro areas
Premature death rate: 473 per 100,000 people — #69 out of 384 metro areas
Life expectancy at birth: 75.62 — #314 out of 384 metro areas