The number of smokers in Perth and Kinross rose by 4.6% last year, the highest percentage increase in Scotland.
Health bosses have raised serious concerns as the amount of smokers increased across Tayside and Fife, with only Angus seeing a small drop in people turning to cigarettes.
The population of Dundee smokers rose by 1% to 21.8% while an extra 0.3% people started smoking in Fife, according to new figures released by the Office of National Statistics.
In Angus the smoking population fell by o.4% between 2017 and 2018.
The figures are based on cigarette smokers and do not include vaping.
NHS Tayside said the increase could be down to a variety of reasons, including the population rise in Perth and Kinross.
Andrew Radley, NHS Tayside consultant in public health pharmacy, said: “We know that the number of people smoking tobacco has fallen across Scotland so any increase in smokers is a concern.
“Giving up smoking is the single most important lifestyle decision that anyone can make to improve their health immediately.
“We know that quitting smoking can be difficult and that sometimes it can take a few attempts to stop so we would encourage people to find out about the support on offer.”
Mr Radley added that preventing young people from taking up smoking is a very effective way of decreasing the numbers of people who smoke in communities.
“NHS Tayside has been working closely with education colleagues for a number of years to help young people make healthy decisions about the way that they live,” he said.
Sheila Duffy, chief executive of the anti-smoking charity ASH Scotland, said more must be done to help people quit.
Ms Duffy said: “Any increase in the number of people smoking is of serious concern.
“Along with the Scottish Government and other partner organisations in Scotland, we are working hard to highlight the health risks associated with smoking and the benefits of quitting.
“Stopping smoking is a significant step to better heath and can save a lot of money.
“We will be watching to see if this change in smoking prevalence continues or not. Regardless, we cannot be complacent in the face of the danger still posed by tobacco and a habit that will kill one in two of those who buy the products.
“More must be done to get the message out.”
Information on how to stop smoking can be found at www.nhsinform.scot/campaigns/quit-your-way-scotland