TUESDAY, Jan. 10 (HealthDay News) -- The war against tobacco rages on, with some battles won -- a growing number of states have banned smoking in public places -- and some lost -- too little funding has gone toward tobacco prevention and cessation program

That's the assessment of the American Lung Association's fourth annual State of Tobacco Control Report Card, released Tuesday. Nine states have now banned smoking in all public spaces and workplaces, according to the association, which is challenging all states to become smoke-free by 2010. And more than 100 municipalities not in smoke-free states have adopted similar laws. And in 2005, for the first time, the report card had a valedictorian, with Maine receiving an A in all four categories measured, including cigarette taxes. "It's one that we would be proud to take home to our parents," said Edward Miller, chief executive officer of the American Lung Association of Maine. But the report card also criticized the federal government for not doing enough to combat smoking among Americans. "We're disappointed in the lack of action on the part of the federal government. Nothing's happening. I don't know how I can put it any other way," said John Kirkwood, president and CEO of the American Lung Association. "The federal government has been sitting there and watching the world go by." The stakes are high, according to the lung association. Each year, 438,000 people die of tobacco-related illness in the United States, costing $167 billion in health-care costs and lost productivity. The report card rated states on four criterion: cigarette taxes; smoke-free air laws; spending on prevention and control programs; and youth access. Maine emerged the clear winner. Thanks to various programs, youth smoking rates have plummeted 59 percent since 1997, and adult smoking rates have fallen 6 percent, from 27 percent in 1990 to 21 percent in 2005. The state has come a long way since 1996, when it had the highest rate of young adult smoking. But the report card called prevention programs across the country generally under-funded, with 40 states, the District of Columbia and Puerto Rico getting Fs for program funding. Cigarette excise taxes continued to increase, the report said, with 12 states raising their cigarette taxes in 2005. The average state cigarette tax is now 92 cents a pack, up from 84 cents in 2004. Twenty states have a tax of $1 or more and five (including Maine) have a tax of $2 or more. Kentucky increased its tax for the first time in 35 years in 2005. South Carolina, on the other hand, has the lowest tobacco tax in the country, at 7 cents. "It's way overdue for them to address this issue," said June Deen, spokeswoman for the American Lung Association's Southeast Region. South Carolina, along with Alabama, Kentucky, Louisiana and North Carolina, received all Fs. Dr. William Hacker, Kentucky's commissioner of public health, said, "The report documents that Kentucky has a significant public health problem as it relates to tobacco. We are a culture and a state that has had a long history of tobacco. We have not accomplished all of our public health goals, but the report does not capture some of the progress we have made." Hacker pointed to a 10 percent decrease in the adult smoking rate from 2003 to 2005, an 18 percent decrease in the youth smoking rate between 2002 and 2004, the recent tax increase, a new 800 telephone quit line, and four communities that have passed clean air ordnances. "That's progress. That's significant progress compared with 10 years ago," Hacker said. "If the Fs in the report card imply we're not trying, that's not accurate. We have a lot of energy involved in this process, and we're making progress." The report card said bipartisan legislation to give the U.S. Food and Drug Administration authority to regulate tobacco products has stalled and the federal government still hasn't moved to ratify the Framework Convention on Tobacco Control, the world's first public health treaty, even though more than 100 other nations have done so. On a positive note, the federal government has agreed to let Medicare cover smoking-cessation counseling for most of its beneficiaries, according to the report. So how can other states and the federal government match Maine's standards of success? According to Miller, there's no one easy answer. "For a long period of time, Maine has been consistently applying the multiple aspects of a tobacco-control program that we know works," he said. "It's not any one piece." One sign that might encourage other states to take a tougher anti-smoking stance -- tourism to Maine hasn't been hurt since the smoke-free laws took effect, as critics had predicted. "This has been marketed as a very positive thing for Maine," Miller said. "It's been turned around, and that takes some of the fear out of it for policymakers in other states." Smoke-free laws are no longer seen as anti-business and anti-employer. And Maine's governor, John Baldacci, whose family was in the restaurant business, is now a convert, Kirkwood said. But there's plenty of work to be done, Kirkwood said. "The tobacco industry is a very powerful adversary and they are in every corner of the country and every state capital," he said. Still, the lung association continues to note successes. Today, just under 21 percent of Americans smoke, compared with 46 percent in 1964, when the landmark U.S. Surgeon General's report came out. "Clearly these strategies work, and our objective is to get them implemented in every state in the country," Kirkwood said. "Our goal is to reduce smoking prevalence to 12 percent by 2010."

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