Health Risk Behaviors
Current Cigarette Smoking by County — US Rankings
CDC PLACES 2023 · Age-adjusted prevalence · All 3,144 US counties
Current cigarette smoking is the share of adults who report smoking every day or some days. PLACES age-adjusts the estimate so younger counties are not flattered by demographic mix alone. National smoking prevalence has fallen for two decades, but the decline has been deeply uneven: the highest-smoking counties cluster in central Appalachia, the rural South, and tobacco-growing-region counties. Self-report introduces a small social-desirability bias, but it is roughly stable across geography, so rankings remain meaningful.
How this ranking is built
Source: CDC PLACES 2023 release. Methodology: BRFSS survey responses pooled across years, fitted with a small-area statistical model, age-adjusted to the 2000 US standard population. Confidence intervals (95%) are shown for each county — wider intervals indicate more uncertainty in the modeled estimate, typically driven by smaller populations.
Lowest Current Cigarette Smoking Rates — Top 100 Counties
Counties with the lowest reported current cigarette smoking prevalence — these counties show the most favorable position on this measure.
Best 100 counties for Current Cigarette Smoking.
Highest Current Cigarette Smoking Rates — Bottom 100 CountiesCounties with the highest reported current cigarette smoking prevalence.
Worst 100 counties for Current Cigarette Smoking.
What this ranking suggests
Smoking is the single behavioral measure most predictive of the chronic-disease rankings on this site. The COPD, CHD, lung-related cancer, and stroke patterns are largely smoking patterns from one to three decades ago. Today's CSMOKING ranking is a leading indicator of where those disease maps will sit in 2040.
Methodology notes & limitations
Estimates are statistical model outputs, not direct measurements. Small counties have wider confidence intervals; treat narrow rank differences in those rows as within-noise. Counties where the underlying population is too small to support modeling are suppressed entirely (about 1% of US counties). All measures are age-adjusted to the 2000 US standard population. The PLACES dataset uses BRFSS self-reported data — self-report introduces known direction-of-bias in some measures (BMI is under-reported; binge drinking is under-reported), but the bias is roughly uniform across counties so ranking comparability is preserved. See the methodology page for full data-pipeline documentation.
Data source: CDC PLACES 2023 release. Measure ID: CSMOKING.