This article was originally published on Crafting Your Home. A human contributor also wrote and edited the post.
America is smoking fewer cigarettes, but the national victory looks far less complete when we examine the map state by state.
Preliminary data from the 2025 National Health Interview Survey place the national adult cigarette smoking rate at 9.1%, a historic low. However, a separate state comparison based on the CDC’s 2024 Behavioral Risk Factor Surveillance System found that several states still reported rates well above the 11.6% figure produced by that survey.
The two national percentages should not be directly compared because they come from different surveys, samples, and methods. Still, they point toward the same conclusion: cigarette use continues to decline across the United States, but progress remains deeply uneven.
For the state ranking, a current smoker means an adult who has smoked at least 100 cigarettes during their lifetime and now smokes every day or on some days. Tennessee did not receive a ranking because its data were unavailable in the source files.
Here are the 10 states with the highest available adult smoking rates.
West Virginia: 20.8%
West Virginia had the highest available adult cigarette smoking rate in the United States at 20.8%.
More than one in five adults reported smoking every day or on some days. The state stood 9.2 percentage points above the national BRFSS figure and more than three and a half times higher than Utah.
West Virginia’s rate is not simply the worst number in a ranking. It signals a concentrated burden of nicotine addiction and smoking-related disease that may fall heavily on families, hospitals, employers, and public health programs.
The result also illustrates the close connection between tobacco use and broader inequality. Nationally, smoking is more common among adults in nonmetropolitan areas, people with lower incomes and those with less formal education, all factors that can influence the availability and affordability of quitting support.
Kentucky: 17.2%
Kentucky reported the second-highest adult cigarette smoking rate at 17.2%. That was 5.6 percentage points above the national BRFSS figure and more than double California’s 7.6%.
The state has a deep historical connection to tobacco farming, but its modern smoking rate should not be dismissed as a leftover cultural habit. The current figure represents a continuing health problem shaped by nicotine addiction, economics, and unequal access to help.
Nicotine dependence is a chronic, relapsing condition, and quitting often takes several attempts. CDC data show that 67.7% of adults who smoked wanted to quit in 2022, but only 8.8% achieved recent successful cessation.
That gap between wanting to quit and succeeding shows why public health systems must offer more than encouragement.
Arkansas: 16.5%
Arkansas recorded a smoking rate of 16.5%, creating a noticeable jump from Louisiana’s 15%.
At this level, cigarette use affects almost one in six adults. Arkansas also stood 4.9 percentage points above the national BRFSS estimate and nearly three times higher than Utah’s rate.
The gap matters because smoking prevalence often overlaps with other social and health disadvantages. Adults with less education, lower incomes, disabilities, or serious psychological distress report higher smoking rates nationally.
Arkansas, therefore, faces a challenge that reaches beyond tobacco education. Reducing smoking may also require stronger health coverage, mental health support, and accessible cessation services.
Louisiana: 15%
Louisiana was the first state in the ranking to reach 15%. That means approximately three out of every 20 adults surveyed said they smoked daily or occasionally.
The rate stood 3.4 percentage points above the national BRFSS figure. It also reinforced the strong Southern presence near the top of the list.
Louisiana communities already face health and economic pressures that can make tobacco prevention more difficult. Effective responses may require more than warning labels, including affordable medication, counseling, smoke-free policies, and dependable access to primary care.
Alaska: 14.7%
Alaska matched Missouri despite the enormous geographic and demographic differences between the two states.
The comparison demonstrates that cigarette use cannot be explained through a simple regional stereotype. High smoking rates can develop under very different circumstances, especially when communities face barriers involving income, transportation, health care access, or culturally appropriate support.
Alaska’s remote geography may create additional challenges for people seeking regular medical care or in-person cessation services. However, the statewide percentage alone cannot identify the reasons individual residents smoke.
Missouri: 14.7%
Missouri tied Alaska with 14.7% of adults reporting current cigarette use. That works out to nearly 15 smokers for every 100 adults surveyed.
Missouri’s rate was nine percentage points higher than Utah’s 5.7%, the lowest state figure in the ranking. The contrast reveals how dramatically the remaining smoking burden differs across the country.
It also raises questions about access to effective quitting assistance. CDC research found that most adults who smoke want to quit, yet fewer than four in 10 people attempting to stop used counseling or medication.
Maine: 14.4%
Maine reported an adult smoking rate of 14.4%, making it the only New England state among the 12 highest-smoking states.
The regional contrast is striking. Massachusetts recorded 8.8%, while Connecticut stood at 9%. Maine’s rate was therefore more than five percentage points higher than rates in some neighboring states.
Those differences show how state policies, economic conditions, health care access, and population patterns can influence tobacco use even within the same region. A shared border does not guarantee a shared public health outcome.
Oklahoma: 14.1%
Oklahoma tied Ohio with an adult smoking rate of 14.1%. Both states stood 2.5 percentage points above the national figure used in the state comparison.
No single policy or economic condition explains Oklahoma’s position. However, national data consistently show that cigarette smoking is more common among adults with lower incomes, less education, and limited access to health services.
Adults earning less than $25,000 have a smoking prevalence nearly five times higher than people earning at least $150,000, according to America’s Health Rankings. Smoking is also more common outside metropolitan areas, which may place some Oklahoma communities at greater risk.
Alabama: 14%
Alabama reached 14%, meaning roughly one in seven adults surveyed identified as a current smoker. Its rate was 2.4 percentage points above the national BRFSS estimate.
Cigarettes damage nearly every organ and remain linked to conditions ranging from chronic obstructive pulmonary disease to diabetes, heart disease, and cancer. The CDC attributes more than 480,000 U.S. deaths each year to cigarette smoking, including deaths connected to secondhand smoke exposure.
Alabama’s rate shows why falling national averages can create a misleading sense that the problem is nearly solved. In many communities, cigarette-related illness remains a daily public health reality.
Mississippi: 13.8%
Mississippi begins the list with 13.8% of adults reporting that they currently smoke cigarettes. That places the state 2.2 percentage points above the 11.6% national figure used in the Behavioral Risk Factor Surveillance System comparison.
A difference of only a few percentage points may appear modest, but statewide health consequences rarely remain small. Higher smoking prevalence can translate into more cases of lung disease, heart disease, stroke, and multiple forms of cancer.
Mississippi’s position also reflects a broader challenge across parts of the South, where poverty, limited health care access and rural isolation can make quitting support harder to reach. Those conditions do not fully explain any state’s rate, but they help show why tobacco use cannot be treated only as an individual choice.
Conclusion
More than 16 million Americans live with at least one illness caused by smoking. These conditions include cancer, heart disease, stroke, emphysema and chronic bronchitis.
The financial cost extends through the health care system and the economy. Smoking-related medical spending, premature deaths and lost productivity create a burden measured in hundreds of billions of dollars.
However, quitting produces benefits at every age. Counseling and approved medications can increase the likelihood of success, especially when people use them together.
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