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Introduction: Smoking significantly burdens human health, contributing to an increasing incidence of mortality and morbidity. This study aims to explore the prevalence of smoking, cessation, and the association between various risk factors and smoking intensity measured in pack-years among Chinese adults. Methods: During 2020-2021, the China Stroke High-risk Population Screening and Intervention Program (CSHPSIP) invited participants aged ≥ 40 from 31 provinces in mainland China. This cross-sectional study presented the standardized prevalence of smoking and cessation across various demographics, including age, sex, residence, income, education, BMI, and geographical region. Multivariable logistic regression was employed to examine the associations between smoking pack-years and related factors. Results: Among 524,741 participants (mean age: 61.9±10.9; 41.1% male; 58.9% female), standardized smoking prevalence was 19.3% (95% CI=19.2-19.4%), with men (37.2%; 95% CI=37.0-37.4%) displaying significantly higher rates than women (1.3%; 95% CI=1.2-1.3%). Smoking cessation rate stood at 11.2% (95% CI: 11.0-11.4%), with figures of 11.3% (95% CI: 11.1-11.5%) for men and 8.4% (95% CI: 7.5-9.2%) for women. Urban residents and those with advanced education had lower smoking rates and higher cessation rates. Additionally, the dose-response relationship indicated a more pronounced association between higher smoking pack-years and elevated health risks, including hypertension (aOR=1.30, 95% CI: 1.24-1.36), diabetes (aOR=1.26, 95% CI: 1.20-1.33), hyperlipidemia (aOR=1.22, 95% CI: 1.16-1.28), heart disease (aOR=1.40, 95% CI: 1.26-1.54), and stroke (aOR=1.23, 95% CI: 1.10-1.36). Conclusions: This comprehensive study emphasizes the profound impact of smoking on health in Chinese adults, indicating the critical need for tailored cessation programs, particularly for middle-aged individuals, men, rural residents, and those with lower educational backgrounds. [ABSTRACT FROM AUTHOR]