Singapore markets closed
  • Straits Times Index

    -18.39 (-0.58%)
  • S&P 500

    +8.65 (+0.17%)
  • Dow

    -96.82 (-0.25%)
  • Nasdaq

    +59.05 (+0.37%)
  • Bitcoin USD

    +2,497.23 (+4.41%)
  • CMC Crypto 200

    0.00 (0.00%)
  • FTSE 100

    -56.90 (-0.74%)
  • Gold

    -7.00 (-0.34%)
  • Crude Oil

    -0.80 (-1.01%)
  • 10-Yr Bond

    0.0000 (0.00%)
  • Nikkei

    -31.49 (-0.08%)
  • Hang Seng

    -253.95 (-1.51%)
  • FTSE Bursa Malaysia

    -13.21 (-0.85%)
  • Jakarta Composite Index

    +43.32 (+0.59%)
  • PSE Index

    +15.85 (+0.23%)

20 States with the Highest Rates of Smoking in America

In this article, we will be taking a look at the 20 states with the highest rates of smoking in America. If you are not interested in reading the details, head straight to the 5 States with the Highest Rates of Smoking in America.

According to data from the World Health Organization (WHO), tobacco smoking, an unhealthy and lethal habit, kills more than 8 million people each year. It has been estimated that around 1 billion people smoke globally, with 80% of those individuals living in low- and middle-income nations.

Raising tobacco taxes, in the opinion of experts, is a very effective strategy to reduce smoking among youth and people from low-income backgrounds. Tobacco consumption declines by roughly 4% in high income countries and 5% in low- and middle-income countries for an increase in the price of tobacco by 10%, per the WHO data.

In addition, with tobacco use accounting for 22.3% of the global population in 2020, there was a noticeable difference in the smoking rates by gender. Less than 10% of women smoked worldwide, compared to about 40% of men. Similarly, some nations stand out due to their disturbingly high rates of smoking. Checkout our piece on the 20 Countries with the Highest Rates of Smoking for comprehensive details regarding these nations.

Prevalence of Smoking in America

The national public health agency of the United States, the Centers for Disease Control and Prevention (CDC), recently released preliminary data showing that the percentage of adults who smoke cigarettes in the country fell to an all-time low last year, with 11% reporting they do so currently. Nevertheless, the CDC findings, based on survey responses from 27,000 adults, also revealed that e-cigarette use rose to nearly 6% last year, up from 4.9% the year before.

Since the 1960s, the U.S. has seen a steady decline in smoking. Nonetheless, it continues to be the leading cause of preventable disease and death in the country, accounting for over 480,000 deaths annually. Furthermore, the nation spends more than $300 billion each year on smoking related illnesses.

On the other hand, many states in America continue to have smoking rates that surpass the national average because these states are yet to adopt more comprehensive laws to prevent and curtail tobacco use.

So, which state smokes the most cigarettes in the country? Per CDC’s 2019 Behavioral Risk Factor Surveillance System  (explained in the article below), West Virginia had the highest rate of smoking in the country,  at 23.8 %, followed by Kentucky, Louisiana, Ohio, Mississippi, Alabama, Arkansas, Tennessee, Missouri, Indiana, Oklahoma, and Michigan.

Furthermore, the region, which includes the aforementioned 12 contiguous states throughout the Midwest and South, has been dubbed “Tobacco Nation” by Truth Initiative, a nonprofit tobacco control organization. A recent report by Truth Initiative revealed that residents in this region are much more likely to smoke, and smoke more, than those living in the rest of the country.

Despite making up only 21% of the US population, the region is home to 28% of the nation’s smokers. Not only this, compared to the rest of the country, the prevalence of smoking is roughly 50% higher there, a difference that is mostly attributable to weaker local policy on tobacco prevention and cessation, according to the report.

Meanwhile, as per data from 2019, the state of Utah (7.9%) and California (10%) had the lowest percentage of smokers in America. For instance, over the past 30 years, the California Tobacco Control Program’s smoke free laws, public education campaigns, and smoking cessation services have not only helped Californians save $816 billion on medical expenses but have also contributed to a decline in the state’s smoking population, from 21.8% in 1989 to 10% in 2019.

Tobacco Industry: An Overview

According to a report, the global tobacco market was valued at $909.8 billion in 2022. The market is anticipated to expand at a compound annual growth rate (CAGR) of 2.6% from 2022 to 2030, reaching a value of $1.1 trillion at the conclusion of the predicted period. The cigarettes segment is expected to grow at a 2.4% CAGR and reach $943.7 billion by the end of this decade.

The key market players in the global tobacco market include Philip Morris International Inc. (NYSE:PM) and Altria Group, Inc. (NYSE:MO) among others.

Altria Group, Inc. (NYSE:MO), founded in 1985, manufactures and sells a variety of tobacco products, including machine made large cigars, moist smokeless tobacco, and cigarettes. The company generated a total of 25.1 billion in revenue last year.

Altria Group, Inc. (NYSE:MO) currently pays a quarterly dividend of $0.98 per share, having raised it by 4.3% in August this year. In addition, many hedge funds like the stock. According to Insider Monkey’s third quarter database, 40 hedge funds were bullish on Altria Group, Inc. (NYSE:MO) and disclosed positions worth 565.2 million in the company.

Philip Morris International Inc. (NYSE:PM), a manufacturer and distributor of cigarettes, tobacco related products, and other Nicotine containing products, has a market capitalization of 145.4 billion as of November 22.

Here are some comments from Philip Morris International Inc. (NYSE:PM)’s Q3 2023 Earnings Call:

“We delivered very strong and better than expected performance in Q3, driven by IQOS and ZYN. Adjusted Diluted EPS grew by an excellent plus 20% in currency neutral terms to reach a record quarterly high of $1.67, despite a significant adverse currency impact in the period. Once again, our total volumes were positive, with the Q3 progression of over plus 2% positioning us to deliver our third straight year of growth. While not yet in our organic metrics, ZYN continued its exceptional growth with US volumes up by plus 66% in Q3 and over plus 50% year-to-date with a substantial increase in category share. Importantly, our IQOS business delivered another strong quarter with HTU shipment growing plus 18%, in line with the year-to-day trend.”

That being said, today we will be taking a look at the states with the highest rates of smoking in America.

States with the Highest Rates of Smoking in America
States with the Highest Rates of Smoking in America

defotoberg /

Our Methodology

To compile our list of the states with the highest rates of smoking in America we referred to the Center for Disease Control (CDC)’s 2019 Behavioral Risk Factor Surveillance System. BRFSS, established in 1984, is a state-based telephone health survey system that examines behavioral risk factors in all 50 states and US territories. It is run by the CDC and conducted by individual state health departments.

The states are ranked in ascending order based on adult smoking rates.

20. North Dakota

Adult Smoking Rate: 17.0%

First up on our list of states with the highest rates of smoking in America is North Dakota. Smoking related illnesses claim the lives of 1,000 people in the state.

North Dakota also has the third-lowest state cigarette tax (0.44 per pack).

19. Pennsylvania

Adult Smoking Rate: 17.3%

Pennsylvania, located in the Mid-Atlantic region, is one of the most crowded states in the U.S., home to 13 million people. More than 22,000 Pennsylvanians die from cigarette smoking every year, and tobacco related illnesses currently cost the state more than $6 billion in annual health care.

18. Alaska

Adult Smoking Rate: 17.4%

Compared to the national rate of 6%, 8.4% of Alaskan high school students smoked cigarettes at least once in the past 30 days in 2019.

17. South Carolina

Adult Smoking Rate: 17.5%

Next up on our list of states with the highest rates of smoking in the US is South Carolina. This southeastern state has the tenth-lowest life expectancy in the country, at 74.8 years. Aside from that, South Carolina is among the 10 states in the country with the lowest tax rate on cigarettes, at $0.57 per a pack of 20 cigarettes.

16. Maine

Adult Smoking Rate: 17.6%

Maine, located in the northeastern corner of the country, has made some progress in reducing smoking rates among adults (22.8% in 2011 to 17.6% in 2019), and youth (15.5% in 2011 to 7.1% in 2019).

However, the state’s preventative efforts, especially among youth, are threatened by emerging tobacco products, as 45.1% of its high school students reported using e-cigarettes at some point in 2019.

15. South Dakota

Adult Smoking Rate: 18.3%

South Dakota has seen a decline in smoking rate from 2003 to 2019. However, it still has a higher adult smoking rate than the national average.

14. Wyoming

Adult Smoking Rate: 18.4%

Wyoming, located in the western region, is among the states with the highest rates of smoking in America. Roughly 30% of cancer related deaths in the state are caused by smoking.

13. North Carolina

Adult Smoking Rate: 18.5%

Compared to the national average of 14%, North Carolina had a higher adult smoking rate in 2019 at 18.5%.

Besides, North Carolina has the fourth-lowest cigarette tax rate among the 50 states, at 45 cents per pack. As such, increasing the state’s cigarette tax rate will help in lowering the smoking prevalence.

12. Michigan

Adult Smoking Rate: 18.7%

Michigan, a state in the Great Lakes region of the upper Midwestern United States, is home to nearly 10 million as of the 2020 census.

The state spends nearly $5 billion annually on smoking related medical expenses. Moreover, over 16,000 deaths in Michigan are attributed to tobacco use each year, making it a serious public health concern. This highlights the need for effective prevention and cessation programs.

11. Oklahoma

Adult Smoking Rate: 18.9%

Compared to the national rate of 6%, 9.1% of high school students in the state smoked cigarettes at least once in the past 30 days in 2019.

10. Indiana

Adult Smoking Rate: 19.2%

Indiana, a Midwestern US state, has a smoking rate of 19.2%. Additionally, in 2019, the state had the thirteenth-highest smoking related deaths in the nation (163 per 100,000).

9. Missouri

Adult Smoking Rate: 19.6%

Missouri, located in the Midwestern region, is one of the top 10 states with the highest rate of smoking related deaths (178 per 100,000).

Also, Missouri has the lowest cigarette tax rate out of all 50 states, at $0.17 per pack.

8. Tennessee

Adult Smoking Rate: 19.9%

Tennessee, a state with nearly 7 million people, has one of the highest smoking rates in the nation. Moreover, 11,400 people die in this landlocked state each year from illnesses related to smoking.

7. Arkansas

Adult Smoking Rate: 20.2%

Arkansas, a southern state bordering the Mississippi River, has the seventh-lowest life expectancy in the nation, at 73.8 years.

It is also one of the states with the highest rates of adult smoking in the US. Furthermore, it ranks third among all 50 states in terms of smoking related deaths (192 deaths per 100,000), which highlights the necessity for effective prevention and cessation programs.

6. Alabama

Adult Smoking Rate: 20.2%

Alabama’s adult smoking rate (20.2%) was higher than the national average of 14 % in 2019.

However, to safeguard the health of its children, the Alabama Legislature has taken a noteworthy step. A newly enacted Alabama law, effective from August 1 2023, prohibits smoking or vaping inside a vehicle with children who are 14 years of age or younger.


Click to continue reading and see 5 States with the Highest Rates of Smoking in America.


Suggested articles:

Disclosure. None: 20 States with the Highest Rates of Smoking in America is originally published on Insider Monkey.