WASHINGTON - Wisconsin is failing to do enough to address the problem of women smoking, according to a new advocacy group study that graded states on their efforts to curb tobacco use.

The study found that 23 percent of women in Wisconsin smoke. But the cheesehead state isn't the only one having trouble kicking the habit. All but 11 states failed the "report card" released this week by the National Women's Law Center and Oregon Health and Science University. Hawaii and Utah received a "satisfactory minus" grade, and nine others were rated as "unsatisfactory" for overall effort in reducing smoking toward the federal government's goal of 12 percent by 2010. The rest failed along with Wisconsin, which ranked 22nd. "It's a very credible report, said David Gundersen, tobacco prevention control coordinator for the Wisconsin Department of Health and Family Services. "We're among the 39 states that get a failing grade because, quite honestly, we haven't done enough." Even though the overall percentage of women smokers in Wisconsin is only slightly above the national average of 20 percent, the state has a higher percentage of female smokers than the national average in every age category. Gundersen cited a 2001 state youth risk behavior survey showing that, for the first time, high school girls had higher smoking rates than boys. "We trace a lot of the problems of women smoking to the '40s, '50s and '60s when they became a target of tobacco marketing campaigns," Gundersen said. While tobacco companies spend more than $200 million a year in Wisconsin, he said the state only has $10 million for cessation programs, down from $20 million last year. Smoking is the primary cause of lung cancer, which kills more women than any other kind of cancer, according to the Centers for Disease Control and the American Cancer Society. The nationwide annual total for smoking-related female deaths was more than 178,300, with about 3,000 in Wisconsin. Wisconsin death rates from smoking related chronic obstructive pulmonary disease in women have quadrupled since 1979, Gundersen added. There were 152 deaths then, compared with 888 in 1998. The number of cases for men is still higher, but did not even double over that period of time. State Medicaid programs spend $12 billion annually on treating smoking-related diseases, but the report determined that only seven states had programs covering comprehensive smoking cessation efforts. Wisconsin scored high on only one of the report's 10 policy indicators, which range from counseling programs to excise tobacco taxes. The good marks were for the state's Tobacco Quitline, a free telephone support and counseling service. But local health officials were wary of the low rankings, pointing to positive cessation programs for pregnant smokers, state initiatives to combat teen smoking and free educative material from places such as the Tobacco Free Dane County Coalition. The real problem, officials said, lies more in making sure people know about the available resources. "It's frustrating because we know the treatment works and the counseling works, still people in Wisconsin are not aware of this," said Lezli Redmond, director of statewide programs at the UW Center for Tobacco Research and Intervention. Redmond said health care providers could also do more to promote medical treatments that help smokers quit and follow up with their patients. Some of the programs have been paying off - Redmond said 30 percent of hotline callers have quit successfully since the service started in 2001. "Amid all of this terrible information, we have had some successes," Gundersen agreed. But, he said, "The little successes are trumped by the huge problems that we see. We know what's killing people. It's just a question if we have a commitment to what works. It's education, but it's more about changing the social environment for kids."

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