Fifty years ago, U.S. Surgeon General Dr. Luther Terry released the first detailed report that linked smoking to bad health, a report that launched the decades-long "war against tobacco" in America, a war that Ohio, when measured up against its fellow states, is losing.
According to National Health Interview Surveys reported by Gannett newspapers, one in four Ohioans still smoke, 23.3 percent of adults in 2012, which puts Ohio at the end of the ranks for tobacco cessation efforts.
That rate is only 5.4 percent lower than it was in 1984, according to the report.
Local health experts blame generational factors, even Appalachian culture, and lack of funding for anti-smoking programs on Ohio's high smoking rates.
Ohio ranks among seven states who fall into the highest quartile amount of smokers, defined by the CDC as anyone who smokes at least 100 cigarettes in their lifetime.
"I think a lot of it is generational," said Stephanie Davis, program director for the Tobacco Prevention Program run out of Selby General Hospital. "When family members smoke, we as children try to emulate adults. We always want to grow up faster."
At a glance
Ohio Department of Health's Tips to Quit:
1. Take deep breaths
2. Drink lots of water and avoid caffeine.
3. Do something to avoid focusing on tobacco cravings.
4. Avoid drinking alcohol
5. Avoid weight gain as much as possible
6. Avoid situations where tobacco use is likely to occur.
Not only is Ohio one of the worst "offenders" when it comes to adult smoking, but Washington County stacks up as an even worse statistic.
The most recent 2012 data reports that Washington County's newly found lung cancer incidence rate is at 76.9 percent, while Ohio's sits at 75.4 percent.
Though the percentages are not too far off, Washington County Health Department Administrator Court Witschey said there are cultural factors in the region that can be obstacles.
"It's more of an culture thing, of behaviors being passed down to children, with eating, physical habits and tobacco habits," Witschey said.
He also said cigarette taxes per state and tobacco-free policies are two factors that make the difference.
Ohio's tax on cigarettes is $1.25 a pack, which is better than almost half the country. However, Witschey points out that West Virginia's tax is only 55 cents.
"It's very convenient for people in Ohio to cross the bridge and get cheaper cigarettes in West Virginia," he said.
Though addiction can mean smokers are more willing to pay the price, higher taxes still help, as it can especially deter younger people from starting smoking because they simply cannot afford it.
Davis runs tobacco cessation classes at Selby that are free of charge. She said that program, in addition to the Mid-Ohio Valley Health Department's Quitline, can help people ditch tobacco locally.
The easy access and addictive nature of cigarettes, Davis said, drives the numbers up.
"You know it's hurting your body, but you just can't quit," she said. "If you go to Wal-mart, there's a whole wall of tobacco products there for you to purchase. The stacks are against you because it's everywhere."
Witschey said Ohio is simply not doing enough, citing the fact that Ohio ranks last of all states for funding for tobacco cessation.
"We need to make it where we're not desensitized, so there's still a negative connotation behind it," Witschey said. "We're not setting a good example as responsible adults. Our state needs to put more dollars toward it."
Tobacco-free policies are important, too, Witschey said. Though Ohio has banned smoking inside public places, more work needs to be done in schools where impressionable children are.
"When they see teachers out behind school or in their car, I don't think we're sending a consistent message," Witschey said. "We could do a much better job at making 100 percent tobacco free campuses where we bar use of any kind."
Nationally, pharmacy chain CVS recently announced that by Oct. 1, it would discontinue all sales of tobacco products in its 7,600 nationwide stores, a move hailed by many, including President Obama.
"We came to the decision that cigarettes and providing health care just don't go together in the same setting," said CVS chief-executive Larry J. Merlo in a press release.
Witschey said that as a health professional committed to health and wellness for residents, there just needs to be more available that Ohio just is not doing.
"It's hard to get those services. I don't think there's a magic bullet, there's a combination of pieces that share the same goal," he said. (Ohio) is not leading the way on any of those things. We have work to do."