North Carolina ranks last in the nation for efforts to limit tobacco use, along with Alabama and Mississippi, according to the American Lung Association (ALA).
The ALA recommends that the state raise cigarette taxes, fund smoking-cessation programs and expand smoking bans to more locations to improve its failing grade.
North Carolina was named the least expensive state for smokers in a separate WalletHub study, the Charlotte Observer reported. The state remains the top producer of tobacco in the nation, even after the 2004 passage of the Tobacco Transition Payment Program (TTPP) or tobacco buyout.
Nearly 80 percent of flue-cured tobacco grown in the United States is grown in North Carolina. The total number of tobacco farms in the state has decreased since the tobacco buyout, but many current tobacco producers have increased their farm size to keep production amounts relatively stable.
The Centers for Disease Control and Prevention have long stressed that smoking has been linked to cancer, heart disease and other serious illnesses. The ALA has called on North Carolina to do more to prevent the use of tobacco products.
The Tar Heel State received the lowest scores for efforts to provide clean air, stiff tobacco taxes and a 21-year-old minimum age for tobacco purchases. It also fell short in access to programs that help people quit smoking.
Earning the highest scores were California, Washington, D.C., Maine, New York and Vermont, according to the American Lung Association.