Both Ohio and West Virginia scored poorly in terms of protecting people from tobacco smoke and other tobacco-related issues in a recent report issued by the American Lung Association.
A critical concern of the association is the amount of money - or the lack of money - being used to fund tobacco prevention and cessation efforts.
The agency says Ohio should spend $145 million each year to help curb tobacco use. The state has just more than $3 million budgeted for those efforts this year, about half of what was used in 2008, according to the Ohio Department of Health.
Stephanie Davis, director of the Washington County Tobacco Prevention Program, said funding for the local program has been in decline since 2008, when state officials sought to use money from Ohio's settlement with major tobacco companies for other purposes.
"Our funding has basically been cut in half," Davis said. "At one point we had five staff members and now we have two...It means we now offer fewer (cessation) classes and those classes are generally a lot bigger...And we have a harder time getting out and into our schools."
Since 2003, more than 2,000 people have completed the local cessation program and prevention programs have been held on a regular schedule at every school in the county.
On Thursday, Davis was visiting Belpre Elementary School where students in the school's Right Choice
Club were preparing stress kits for individuals participating in cessation programs. The kits contain candy and other tokens to help offer an alternative to a cigarette.
"We've all pledged not to smoke or use alcohol but we also wanted to help those who are trying to quit," said sixth grader Chase Baker, 12.
Baker said he has a grandfather and an uncle who use tobacco products.
"I've asked my grandpa to quit but he doesn't seem to want to," he said.
When the local tobacco program began it was primarily funded though a $110,000 grant from the U.S. Centers for Disease Control and Prevention, which was passed through the Ohio Department of Health. This year, the local cessation program is operating on a $52,000 budget.
For West Virginia, the lung association recommends $27.5 million be spent on tobacco prevention efforts. The state has $7.2 million appropriated this year for those efforts, according to the lung association. Specific figures for Wood County, W.Va., were not immediately available on Thursday. A message left for officials at the Mid-Ohio Valley Health Department in Parkersburg was not returned.
"West Virginia is doing a lot better with their funding than we are," Davis said. "They can still afford to do a lot of things with (nicotine replacement therapy), which we can't do much of anymore."
Davis said the local program, which is a free service to area residents, was able to help provide nicotine patches, gum or lozenges up until a few years ago. Now, the group must request help from a separate state cessation program, which will only assist pregnant women, the uninsured or those on Medicaid.
"Using those products in combination with a support group has a tremendous impact on success rates," Davis said, adding that the nicotine replacement products typically cost from $20 to $40 for a one-to-two-week supply.
"For a lot of people, there is a concern about a cost," she said. "Some people do OK budgeting $5 a day for a pack of cigarettes but they struggle to drop $30 or $40 at one stop for lozenges."
Davis said the efforts of her group are especially important in this region because the adult tobacco usage rate in Appalachian southeastern Ohio is 31.2 percent, compared to a state average of 25.9 percent.
"For our state, only Jackson County has a higher tobacco usage rate (than Washington County)," she said.
Tessie Pollock, Ohio Department of Health spokeswoman, said Ohio has never had general revenue funds to support tobacco prevention. So, as the tobacco settlement money has dried up and CDC grants have become smaller, so have tobacco prevention programs.
The Washington County cessation program is one of just nine currently funded by the ODH.
"We're continuing to pursue CDC grants and also looking to develop a more holistic approach to tobacco cessation," Pollock said. "We want cessation efforts to be coordinated with health care officials, so those individuals might help recognize the stresses in a person's life that lead to smoking."
Pollock said those multi-level cessation programs are still being developed.
Marcie Warne, 65, of Marietta, said she started smoking when she was 16 but quit about 10 years ago. She recently picked up the habit again and has sought help though the local cessation program.
"I hadn't wanted a cigarette in years and then I was listening to a family member go on and on about some serious problems he was having and the next thing I knew I asked for a cigarette," she said. "I know I shouldn't and a lot of times I feel really guilty about it."
Warne, who is retired, said she pays out of pocket for nicotine lozenges to help curb cravings.
"They help, but I think the only way I'll ever quit is to just really convince myself that's what I want," she said. "I don't know if I'm there yet."
In the American Lung Association report, Ohio received two "F" grades for tobacco-prevention and control spending and tobacco-cessation efforts.
The state received a "D" for the current tax it imposes on cigarettes (currently $1.25). Hawaii, which received an "A" in that category, has a $3.20 tax per pack.
Ohio received an "A" for a smoke-free environment, the results of a statewide ban on indoor smoking for businesses. That ban went into effect five years ago.
West Virginia and five other states received a straight failing report, although Wood County, W.Va., received an "A" for it's local smoking ordinance. The state did not fare well because there are no statewide policies on clean indoor air, Davis said.
There are no county grades in Ohio because of the statewide smoking ban.
Only four states - Delaware, Hawaii, Maine and Oklahoma - received all passing grades. No state received straight "A's" in the report.
Officials at the American Lung Association did not return a call seeking comment, but in a news release the agency said Ohio should commit to funding cessation and prevention efforts.
"Ohio collects more than $1 billion in tobacco revenues. Tough financial times don't justify a retreat in efforts to fight the leading cause of preventable death," Shelly Kiser, director of advocacy for the American Lung Association of Ohio, said in a statement.
