Sisters Kim and Terri Lawrence shared many things during their recent pregnancies.

They laughed and ached together. They cried and ate together. They religiously went to doctor's appointments together. And they smoked together. ``They said, `Try cutting back,' '' Terri said, cradling her baby, Summer, the 26-year-old's first child. Emily was 24-year-old Kim's second child. ``But it's so hard to do,'' Terri explained, her sleeping daughter burrowed into her arm. When the Lawrences' father recently contracted smoking-related lung cancer, it scared them straight. Almost. They're down to a few cigarettes a week. ``I cheat sometimes,'' Terri said, ``but I'm trying.'' Kim summed up the pair's struggle. ``I knew better,'' she said of her habit. ``I just did it.'' They look like any other new mothers -- tired but never happier. A glow emanates from each of their faces as they hold and rock their children, born a week apart in July. They love their children. They want nothing better for them than a good life. But despite all the medical research and advice, they couldn't quit smoking. They're not bad women. They're Ohio women, who happen to be among the nation's least healthy. Ohio ranks in the bottom 10 states -- many times, the worst five -- in many women's health statistics. The state's women are far more likely to die of lung, breast and colon cancer, heart disease and diabetes than the average woman in America. They smoke more, eat worse, work out less, earn less and are not as educated as the average American woman. Form a line of pregnant women in Ohio and have each raise a hand. About every fifth hand would be holding a cigarette. It's not as bad as it once was: Ten years ago, the pall of smoke would have risen from one hand in four. In Columbus, where lawmakers recently shifted $100 million from tobacco settlement funds to balance the state budget, pregnant women smoke at twice the rate of mothers-to-be in the largest 50 cities in the United States. Of every five girls in high school, two smoke. Only five other states have a higher percentage than Ohio. Is anything being done? The Ohio Department of Health is aware of the problems facing all Ohioans, especially women, and does not dispute the numbers or rankings. ``This is not just an Ohio phenomenon,'' said Nick Baird, the Health Department director for Gov. Bob Taft. Baird is unable to pinpoint why Ohio, in category after category, rates so poorly. ``It's a good question,'' he said. ``We don't have all the answers.'' The department has a number of programs designed to fight obesity, smoking, lack of exercise and poor diet, Baird said. He said many problems are rooted in personal choices, and it is difficult for any government to regulate behavior. The Centers for Disease Control and Prevention lists 25 states that have created ``exemplary'' programs to address such problems as cancer, heart disease, physical inactivity and tobacco use. Ohio is not among them. Baird said Ohio is innovative, and pointed to a program working with employers to reach out to people in the workplace through the Healthy Ohioans Business Council. Regarding women's health issues, Baird said the department focuses on problems within subgroups of a population. ``We have limited resources,'' he said. In the fiscal year that ended June 30, those resources were limited even more by the department's own inaction. Health officials failed to use $3.3 million in federal funding available to hire people -- at no cost to the state -- to work on a wide array of health issues, including many affecting women and children. Rose Morgan, the department's fiscal officer, said the state lost four jobs as a result and 67 positions were not filled, including two in the Women, Infants and Children nutrition program. The state did not lose all the money. It can carry over federal dollars into this fiscal year. Morgan said many of the jobs that went unfilled are posted and some people have been hired. Baird said the problems facing Ohio and the country did not occur overnight. It will take a decade or two to see results. Colorectal cancer deaths Three months to Victoria Haupt was the difference between curable and terminal cancer, between a 95 percent and a 5 percent chance of survival. The Hartville woman, the mother of three grown children, had just come out of surgery to remove cancer from her colon. ``My oncologist told me, `You had one ugly cancer.' I almost hit the floor. He said, `Vicki, I said you had it.' '' A colonoscopy had found the cancerous cells. Her doctor told her if they had waited three months it would have been too late: The cancer would have spread and survival odds would have been about one in 20. ``It's the same with any kind of cancer. You're terrified of it. It took me a couple of months to say the word `cancer,' '' Haupt said. She has become active in seeking that insurance companies pay for colorectal cancer screenings. State lawmakers have postponed any vote on legislation mandating coverage. State Sen. Lynn Wachtman, R-Napoleon, the chairman of the Health, Human Services and Aging Committee, did not return phone calls to the Beacon Journal to talk about the legislation. Colorectal cancer is the second-leading cause of cancer deaths in the country and in Ohio. Only Maine and Rhode Island have worse colorectal cancer death rates for women than Ohio. Haupt said she doesn't know why Ohio has such high rates, but said people who catch the cancer early with a screening almost never die of the disease. Michelle Jones, an American Cancer Society spokeswoman, said 15 states already mandate insurance coverage for colorectal cancer screening. She said early detection and education are key to fighting cancer, but those elements have to work in tandem. Ohio women make an effort to detect breast cancer early. The state is the 17th best for the percentage of women who have mammograms. However, only two states have worse breast cancer death rates than Ohio. Jones said she believes the education effort for mammograms is not reaching the populations most at risk for breast cancer, including minority women. Of every 100,000 white women in Ohio, 29 die of breast cancer. The rate is 38 deaths per 100,000 black women. Data on women's health in ohio Smoking • One woman in four smokes. Only two states have higher rates. • Two in five high school girls smoke. Only four states have higher rates. Cancer • Eighth worst in the nation to die of cancer. • Third worst in the nation to die of colon cancer. • Third worst in the nation to die of breast cancer, but Ohio ranks better in mammogram testing at 17th best. • 10th worst in the nation to die of lung cancer. Heart disease • 12th worst in the country to die of heart disease. Diabetes • Sixth highest rate nationally for deaths from diabetes. Fitness • Almost half of Ohio's women are overweight. Ohio is 17th worst nationally. • Almost one in three women in Ohio report no leisure-time activity, making the state 13th worst. • Three in four women eat fewer than five vegetable and fruit servings a day, making the state 12th worst. • Even fewer high school girls -- 1 in 7 -- eat five servings of fruit and vegetables a day. Only three states are worse.

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