12 States With The Highest Adult Smoking Rates in the U.S., New CDC Data Shows

The national adult cigarette smoking rate fell to 9.1% in 2025, another record low, according to preliminary data from the Centers for Disease Control and Prevention. Yolonda Richardson, president and CEO of the Campaign for Tobacco-Free Kids, called the decline “a monumental public health achievement.”

That progress, however, is not spread evenly across the map. The latest comparable state ranking from America’s Health Rankings uses 2024 data from the CDC Behavioral Risk Factor Surveillance System and reports a national adult smoking rate of 11.6%. The survey defines a current smoker as an adult who has smoked at least 100 cigarettes and now smokes every day or on some days.

The two national figures come from different CDC surveys, so they should not be directly compared. Still, both tell a similar story: cigarette smoking is declining nationwide while several states continue to report rates far above the national level.

These 12 recorded the highest adult cigarette smoking rates.

Mississippi

Mississippi begins the countdown with 13.8% of adults reporting that they currently smoke cigarettes. That is 2.2 percentage points above the 11.6% national figure used in the state ranking. The difference may look small on paper, but across an entire state population, even a few percentage points can represent a large number of residents facing increased risks of cancer, heart disease, stroke, and lung disease.

Indiana

Indiana posted an adult smoking rate of 13.9%, placing it just above Mississippi. It is one of several Midwestern states appearing near the top of the ranking, showing that the country’s remaining smoking burden is not limited to one corner of the South or Appalachia. Indiana’s rate is 2.3 percentage points higher than the national BRFSS figure.

Alabama

Alabama recorded a 14% adult smoking rate, narrowly surpassing Indiana and Mississippi. That works out to roughly one in seven adults, a reminder that national progress can hide serious state-level gaps. Smoking and secondhand smoke exposure are linked to more than 480,000 U.S. deaths each year, according to the CDC.

Oklahoma

Oklahoma tied with Ohio at 14.1%, putting both states 2.5 percentage points above the national BRFSS level. The ranking does not explain why a state’s rate is high, and no single factor can carry all the blame. National research has consistently found that smoking is more common among adults facing lower incomes, limited education, inadequate insurance coverage, and reduced access to cessation support.

Ohio

Ohio also recorded a 14.1% smoking rate. Because Ohio has a large population, the public health implications stretch far beyond its position on a ranking table. Smoking increases health care use, workplace absences, and the risk of long-term illnesses, including chronic obstructive pulmonary disease, diabetes, heart disease, and several cancers.

Maine

Maine stands out as the only New England state among the 12 highest-smoking states, with a rate of 14.4%. Nearby Massachusetts reported 8.8%, while Connecticut came in at 9%, showing how sharply smoking rates can differ even between states in the same part of the country. Maine’s figure was 2.8 percentage points above the national BRFSS rate.

Missouri

Missouri reported a 14.7% adult smoking rate, tying Alaska. That means nearly 15 out of every 100 adults surveyed said they still smoked daily or occasionally. Missouri’s result also places it more than five percentage points above Utah, which had the nation’s lowest rate at 5.7%.

Alaska

Alaska’s 14.7% rate matches Missouri’s despite the two states being separated by thousands of miles and having vastly different population sizes. The tie is a useful warning against treating smoking as a problem belonging to one region, culture, or demographic group. Tobacco-related disparities can appear wherever prevention services, health care access, and economic conditions leave some communities more exposed than others.

Louisiana

Louisiana is the first state in the countdown to reach 15%, meaning about three in every 20 adults reported currently smoking. The state sits 3.4 percentage points above the national BRFSS figure. Louisiana’s position also reinforces a broader regional pattern, with several Southern states appearing in the highest portion of the table.

Arkansas

Arkansas recorded a 16.5% adult smoking rate, creating a clear break from Louisiana at No. 4. The state’s rate is 4.9 percentage points above the national level and nearly three times Utah’s 5.7% figure. At this point in the ranking, smoking is no longer affecting roughly one in seven adults but is moving closer to one in six.

Kentucky

Kentucky’s smoking rate reached 17.2%, the second highest among states with available data. That is 5.6 percentage points above the national BRFSS figure and more than double California’s 7.6% rate. Kentucky has long been associated with tobacco production, but the current data measure adult behavior, not farming history, and should be viewed as a modern public health challenge requiring modern solutions.

West Virginia

West Virginia had the country’s highest adult cigarette smoking rate at 20.8%. That means more than one in five adults reported smoking every day or on some days, putting the state 9.2 percentage points above the national BRFSS figure. Its rate was also more than three and a half times Utah’s, creating the widest contrast in the entire ranking.

The National Decline is Real

The country’s overall decline in smoking is one of the clearest public health victories of the past several decades. In the mid-1960s, about 42% of American adults smoked, compared with roughly 9% in the preliminary 2025 national survey. Taxes, higher cigarette prices, smoke-free laws, public education, and changing social attitudes have all played a role in that decline.

Yet the state ranking shows how much work remains. America’s Health Rankings found that adults earning less than $25,000 had a smoking prevalence nearly five times higher than adults earning at least $150,000. Smoking was also more common among people living outside metropolitan areas, adults with less education, people with disabilities, and those experiencing serious psychological distress.

Those differences matter because cigarette smoking remains the leading preventable cause of disease, disability, and death in the United States. More than 16 million Americans live with a smoking-related illness, and the economic burden has been estimated at more than $600 billion when health care spending and lost productivity are included.

Quitting can improve health at any age, even after years of smoking. Free and confidential help is available nationwide through 1-800-QUIT-NOW, where trained coaches can help callers build a plan, manage cravings, and connect with medications or local support programs.