The American Lung Association gave 43 states and Washington DC a failing class as it comes to funding prevention programs.
The dramatic increase in children using e-cigarettes is another cause for concern.
"The e-cigarette epidemic threatens to erase all the progress the US has made to reduce tobacco speeds in general," said Lung Society Erika Sward.
According to the Centers for Disease Control, over 20 percent of high school students reported last year with e-cigarettes.
The Lung Association says there are steps the FDA can take to reverse the trend.
"First, all tasteful tobacco products prohibit and remove them from the market," says Sward.
Although no state became perfect "A" in the report, the best states in general were Alaska, California, Hawaii, Maine, Massachusetts Aad Washington DC
The worst was Mississippi, Missouri, Texas and Virginia.
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