CHARLESTON, W.Va. -- Charleston and Huntington are at the top of a list of cities with the highest proportion of smokers, according to a new national ranking.

Charleston ranked No. 1 in the nation, followed by Huntington at No. 3 on a list of the top 10 cities nationwide with the most smokers, according to Healthways, a well-being company based in Tennessee.

The list, released this week, is based on data from the Gallup-Healthways Well-Being Index, according to a news release.

"The question is why" the smoking rate is so high, said Dr. Rahul Gupta, department chief of the Kanawha-Charleston Health Department.

"One point is, this state does not fund tobacco-cessation programs at the level recommended by [U.S. Centers for Disease Control and Prevention], and that has been a continuation over the years."

"It is very obvious to us, and people on the ground, that whatever policies the state has in place are not working," Gupta said.

The CDC recommends that West Virginia spend about $27 million a year on tobacco-cessation programs, but the state allocates about $6 million, said Chuck Hamsher, director of public advocacy for the American Heart Association in West Virginia.

No money from the 55-cent per pack state tax on cigarettes goes toward smoking-cessation programs, Hamsher said.

The state Division of Tobacco Prevention offers a Quitline for people to call in, but cannot afford to hold classes or offer products and medications to help people quit smoking, he said.

"The Quitline is great, but it is not all," Gupta said. "We need a comprehensive tobacco-control program with accountability. I want to see the rates go down, not up."

West Virginia has the highest smoking rate in the nation, at about 27 percent, compared to 20 percent nationwide, according to 2008 data from the CDC.

The Healthways rankings don't provide a specific smoking rate for each city. In 2008, about 25 percent of Charleston residents smoked, according to CDC data. Roughly 28 percent of residents in the Huntington tri-state area did.

Smoking costs West Virginia about $690 million a year in medical expenses, according to the CDC.

"A solution is to dedicate more funding and the resolve to what is a very serious health problem in West Virginia," Hamsher said. "It's cost us a lot of lives, and a lot of money."

Earlier this month, the Coalition for a Tobacco-Free West Virginia and the Campaign for Tobacco-Free Kids released a study saying that 63 percent of state residents support a $1 hike on the cigarette tax.

That tax would generate about $117 million in new revenue, of which $21 million could be spent on smoking cessation to put the state at the CDC-recommended level, Hamsher said.

The hike would ease state fiscal woes, and stop about 19,000 youth from smoking, he said.

Gupta had similar thoughts.

"Two things would happen: It will discourage new smokers; and folks in the lower income category won't be able to afford it anymore," Gupta said. "If they can't smoke any longer because they can't afford it, then they're probably the people that don't have insurance coverage for smoking-cessation programs."

It's this group of people that are being left "out in the cold" when it comes to providing support in their effort to quit smoking, Gupta said.

"At the state and local level, this is a concern for us," Gupta said. "We are the second-fattest city, according to Men's Health, and now we're the city with the highest smoking rate," he said.

"Smoking obesity, diabetes -- we can't ignore it any longer, and we can't afford to ignore it any longer," he said.

Cities with the most smoking as reported by Healthways are: Charleston; Fort Smith, Ark.; Huntington; Hagerstown, Md.; Evansville, Ind.; Topeka, Kan.; Louisville, Ky.; Fort Wayne, Ind.; Flint, Mich.; and Youngstown, Pa.

Cities with the lowest rates of smoking as reported by Healthways are: Provo, Utah; Boulder, Colo.; Santa Rosa, Calif.; Santa Barbara, Calif.; Salinas, Calif.; Ventura, Calif.; San Jose, Calif.; Naples, Fla.; San Francisco; and San Luis Obispo, Calif.

Reach Veronica Nett at veroni...@wvgazette.com or 304-348-5113.