Adult smoking

Adult Smoking is the percentage of the adult population that currently smokes every day or most days and has smoked at least 100 cigarettes in their lifetime. Please note that the methods for calculating this measure changed in the 2016 Rankings.

Measure Tabs

Reason for Ranking

Each year approximately 443,000 premature deaths can be attributed to smoking. Cigarette smoking is identified as a cause of various cancers, cardiovascular disease, and respiratory conditions, as well as low birthweight and other adverse health outcomes. Measuring the prevalence of tobacco use in the population can alert communities to potential adverse health outcomes and can be valuable for assessing the need for cessation programs or the effectiveness of existing programs.

Measurement Strengths and Limitations

Nelson et al. reviewed the reliability and validity of the BRFSS smoking measure by analyzing studies that used BRFSS data and studies that used data from other sources. They found high reliability and high validity for the “current smoker” responses.[1] This confirms that BRFSS survey data are a fairly accurate portrayal of the population’s smoking behavior. Because the BRFSS only surveys adults (age 18 and older), a weakness of the County Health Rankings measure is the lack of data on adolescent smoking. The Youth Behavioral Risk Factor Survey attempts to fill this gap, but it currently does not provide enough data to estimate county-level smoking prevalence among youth. Finally, new methods using biomarkers have shown that not all smokers are exposed to the same level of contaminants.[2] The simple “current smoker” status question does not capture the thousands of chemical compounds in cigarettes and cigarette smoke nor take into account the effects of secondhand smoke.

Please note that changes in the method CDC used to create this measure in 2016, 2017, and 2018 means that new estimates should not be compared with earlier years. To see more about these changes, look in the Data Source tab.