Adult Smoking Rates by U.S. State
Cigarette smoking among American adults continues to fall, but where you live still shapes the odds dramatically. According to the CDC's U.S. Chronic Disease Indicators, drawn from the Behavioral Risk Factor Surveillance System (BRFSS), adult cigarette smoking prevalence ranged from 6.9% in Utah to 22.3% in West Virginia in the most recent complete state-level release (2022 data). The national age-adjusted rate stood at 13.2%.
A persistent regional divide
The geography of smoking is strikingly consistent year over year. The heaviest burden sits in Appalachia and the South: West Virginia (22.3%), Arkansas (19.9%), Tennessee (19.2%), Mississippi (18.1%), Missouri (17.8%), Ohio (17.7%), and Kentucky (17.6%) anchor the top of the list. These states share lower median incomes, historically tobacco-friendly policy environments, weaker indoor-smoking restrictions, and — in several cases — a legacy tobacco-growing economy.
At the other end, the lowest-prevalence states cluster on the coasts and in the Mountain West's Utah: Utah (6.9%), Maryland (9.8%), California (9.9%), Washington (10.1%), and Connecticut (10.3%). Utah's outlier status is widely attributed to the large share of residents who abstain from tobacco for religious reasons, while California has decades of aggressive tobacco control, high cigarette taxes, and broad smoke-free laws.
The middle of the pack
Most states fall in a band between roughly 12% and 16%. The Upper Midwest and Plains (Wisconsin 15.0%, Kansas 15.1%, Iowa 15.5%, North Dakota 15.8%) sit modestly above the national average, while large, diverse states such as Texas (12.0%), Florida (12.0%), Illinois (12.8%), and New York (11.5%) land at or below it. The District of Columbia (11.0%) tracks with the lower-prevalence states.
Important caveats
These figures are self-reported survey estimates from BRFSS, a telephone-based system, and can be affected by social-desirability bias and response patterns that differ across states. Values are age-adjusted to allow fair comparison between states with different age structures. Crucially, the measure captures cigarette smoking only — it excludes e-cigarettes/vaping, cigars, hookah, and smokeless tobacco, so total tobacco use in every state is higher than shown.
National single-digit smoking figures sometimes cited in the news (about 10.8% in 2023 and 9.9% in 2024) come from the separate National Health Interview Survey and are not directly comparable to these BRFSS state estimates, which use different methods and a different reference period. For year-over-year state tracking, BRFSS remains the standard source. This page presents population statistics only and is not medical advice.