CDC PLACES County-Level Data
Smoking Rates by State
The national average county-level adult smoking prevalence is 15.5%. Smoking remains the leading cause of preventable death in the United States, and rates are significantly higher in rural communities where tobacco cessation programs and primary care access are limited. States with the highest smoking rates also tend to have elevated COPD, heart disease, and cancer mortality.
Smoking Prevalence Map
Average county-level adult smoking prevalence by state. Darker colors indicate higher rates. Click a state to explore its full health profile.
% of counties with no hospital
All 50 States Ranked by Smoking Prevalence
Sorted by highest average county-level smoking rate. Click any column header to re-sort. Click a state name to see its full profile.
| # | State | Avg Smoking % ▼ |
|---|---|---|
| 1 | West VirginiaWV | 21.5% |
| 2 | TennesseeTN | 20.7% |
| 3 | LouisianaLA | 20.4% |
| 4 | AlaskaAK | 20.1% |
| 5 | MississippiMS | 19.3% |
| 6 | MissouriMO | 19.1% |
| 7 | OklahomaOK | 19.0% |
| 8 | ArkansasAR | 18.6% |
| 9 | AlabamaAL | 18.1% |
| 10 | South DakotaSD | 18.0% |
| 11 | IndianaIN | 17.8% |
| 12 | OhioOH | 17.8% |
| 13 | GeorgiaGA | 17.3% |
| 14 | NevadaNV | 17.0% |
| 15 | MichiganMI | 16.4% |
| 16 | South CarolinaSC | 16.2% |
| 17 | North CarolinaNC | 16.1% |
| 18 | IowaIA | 16.0% |
| 19 | KansasKS | 16.0% |
| 20 | MaineME | 15.9% |
| 21 | MontanaMT | 15.8% |
| 22 | FloridaFL | 15.6% |
| 23 | IllinoisIL | 15.6% |
| 24 | MinnesotaMN | 15.4% |
| 25 | North DakotaND | 15.4% |
| 26 | WisconsinWI | 15.4% |
| 27 | TexasTX | 15.2% |
| 28 | VirginiaVA | 15.1% |
| 29 | New MexicoNM | 15.0% |
| 30 | ArizonaAZ | 14.7% |
| 31 | WyomingWY | 14.7% |
| 32 | NebraskaNE | 14.5% |
| 33 | OregonOR | 13.8% |
| 34 | HawaiiHI | 13.7% |
| 35 | IdahoID | 13.7% |
| 36 | New YorkNY | 13.7% |
| 37 | DelawareDE | 13.2% |
| 38 | ColoradoCO | 13.0% |
| 39 | MarylandMD | 12.9% |
| 40 | CaliforniaCA | 12.7% |
| 41 | VermontVT | 12.5% |
| 42 | WashingtonWA | 12.4% |
| 43 | MassachusettsMA | 12.0% |
| 44 | New HampshireNH | 11.9% |
| 45 | New JerseyNJ | 11.9% |
| 46 | ConnecticutCT | 11.0% |
| 47 | Rhode IslandRI | 11.0% |
| 48 | UtahUT | 10.1% |
| 49 | KentuckyKY | — |
| 50 | PennsylvaniaPA | — |
Source: CDC PLACES (county-level model-based estimates), AHRF (workforce), CMS Provider of Services (hospital data).
Why Smoking Rates Matter for Rural Health
Tobacco use remains the single largest cause of preventable death and disease in the United States, killing more than 480,000 Americans annually. Smoking rates are consistently higher in rural areas, where adult prevalence can exceed urban rates by 5-10 percentage points. This disparity is driven by lower educational attainment, higher poverty, weaker tobacco control policies, and limited access to cessation programs.
For state health agencies and rural hospital leaders, county-level smoking data is a critical upstream indicator. High smoking prevalence predicts future surges in COPD, lung cancer, heart disease, and stroke — conditions that drive emergency department utilization and inpatient admissions at already-strained rural facilities.
The RHT Compass platform integrates CDC PLACES smoking prevalence data with COPD rates, hospital financial metrics, and workforce supply — helping decision-makers identify where tobacco-related disease burden is highest and where intervention capacity is most limited.
Frequently Asked Questions
Where does the smoking prevalence data come from?
Smoking prevalence estimates come from the CDC PLACES dataset, which provides model-based county-level estimates for health risk behaviors. The data reflects current smoking among adults aged 18 and older. RHT Compass averages county-level rates to produce each state's score.
Why are smoking rates higher in rural areas?
Rural communities have historically higher smoking rates due to cultural factors, lower access to cessation programs, weaker tobacco control policies, lower health literacy, and higher poverty rates. The “tobacco belt” in the Southeast and Appalachia reflects these compounding socioeconomic factors.
How does smoking relate to COPD and hospital utilization?
Smoking is the primary cause of COPD, which is among the most common reasons for hospital admissions and readmissions in rural areas. States with high smoking prevalence consistently show higher COPD rates, more frequent ER visits, and greater financial strain on rural hospitals managing chronic respiratory disease.
Can I see county-level smoking data for my state?
Yes. Every state profile page includes county-level CDC PLACES data, including smoking, COPD, diabetes, and other health indicators. Click any state in the table above to see its full breakdown.
Explore Smoking & Health Access in Your State
Every state page includes county-level chronic disease data, hospital financials, and workforce metrics. Start with your state, or request a demo of the full analytics platform.
Smoking and COPD prevalence from CDC PLACES (model-based county-level estimates). Workforce data from HRSA Area Health Resources File (AHRF). Hospital data from CMS Provider of Services. Last updated: 2026-02-15.