Cities with the Highest Smoking Rates: US & Global Rankings

Smoking prevalence varies dramatically by city, driven by culture, policy, economics, and enforcement. Data sources: CDC BRFSS (US), WHO STEPwise / Global Adult Tobacco Survey (global). Rates = % adults currently smoking cigarettes.

Top 10 US Cities (Metro Areas, ~2021–22 Data)

1. Huntington-Ashland, WV-KY-OH: 35.8%
2. Charleston, WV: 32.7%
3. Parkersburg-Vienna, WV: 31.3%
4. Beckley, WV: 30.5%
5. Wheeling, WV-OH: 29.7%
6. Cincinnati, OH-KY-IN: 28.1%
7. Springfield, MO: 28.0%
8. Dayton-Kettering, OH: 27.8%
9. Louisville/Jefferson County, KY-IN: 27.5%
10. St. Louis, MO-IL: 27.5%

Pattern: Appalachia (WV, KY, OH) + Missouri dominate. Low excise taxes, cultural acceptance, high poverty, low cessation access.

Top 10 Global Cities (Municipal/Urban Area, Latest Available)

1. Jakarta, Indonesia: 69.1% (male 76%, female 4%)
2. Cairo, Egypt: 61.2%
3. Beijing, China: 55.1%
4. Shanghai, China: 55.0%
5. Shenzhen, China: 54.9%
6. Guangzhou, China: 54.8%
7. Nanjing, China: 54.7%
8. Tianjin, China: 54.6%
9. Chengdu, China: 54.6%
10. Kunming, China: 54.5%

Pattern: Chinese cities cluster tightly (national male rate ~50%, female ~2%). Indonesia's weak tobacco control (non-FCTC) drives Jakarta. Cairo: shisha + cigarettes, low tax.

Contrast: Lowest Rates

• US: San Jose, CA (8.5%), San Francisco (9.2%), Seattle (10.1%), NYC (11.3% – but high absolute numbers).
• Global: Addis Ababa (4.5%), Lagos (5.8%), Stockholm (6.2%), Perth (7.1%). Strong taxes, bans, culture.

Caveats

• Definitions vary: "city proper" vs "metro" vs "health district."
• Self-reporting bias (underreporting in high-stigma areas).
• E-cigarettes/vaping often excluded from "smoking" stats.
• Data years differ (2018–2023).