WASHINGTON - Two years after the surgeon general issued a report calling smoking a leading killer of women, state governments are failing to adequately address the problem, according to a study by an advocacy group.

State Medicaid programs spend $12 billion annually treating smoking-related diseases, according to the study released Tuesday by the National Women's Law Center. However, the report found that just seven state Medicaid programs cover comprehensive smoking cessation efforts. Those programs are offered in Florida, Indiana, Kansas, Maine Minnesota, Oregon and West Virginia. "We hope states will do more," said Judy Waxman, a co-author of the report, who said cessation programs cost states far less than treating sick smokers. Seventy percent of Medicaid participants over 15 years old are women, according to the report. Smoking is the primary cause of lung cancer, which kills more women than any other kind of cancer. Prior to 1987, breast cancer (news - web sites) was the leading cancer killer among women. "Every program that focuses on women's health should definitely make smoking cessation or smoking prevention among the highest priorities," said Virginia Ernster, an adviser to the law center and an editor of the 2001 surgeon general's report on women and smoking. The new report recommends that states shape cessation programs to meet women's needs. When it comes to quitting, women tend to use a greater number of cessation strategies and prefer a more gradual approach to quitting than men, according to the study. Nationally, about 20 percent of women smoke, compared to roughly 25 percent of men. But women smokers face unique risks: menstrual irregularities and earlier menopause, infertility; bone-thining osteoporosis; arthritis; cervical cancer; and dangerous blood clots if they use birth control pills. That's in addition to the dangers of smoking during pregnancy. The new report estimates at least 12 percent of pregnant women smoke. About half the states have telephone hot lines set up for pregnant smokers to receive counseling, according to the study. Only Utah has already met the federal government's goal of reducing smoking among women to 12 percent by 2010, according to the law center study. About 11 percent of women in Utah smoke. In comparison, roughly 28 percent of women in Nevada smoke more than in any other state.

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