COLUMBUS, Ohio (WCMH) — Ohio flunked three out of five categories from the American Lung Association’s most recent assessment of the state’s ability to mitigate tobacco use, according to a report released Wednesday.

In this year’s annual report, the ALA handed Ohio — a state that raked in more than $1.2 billion in tobacco-related revenue in 2020 — failing grades in three areas: tobacco prevention and cessation funding; tobacco taxes; and flavored tobacco products.

Although Ohio received an ‘A’ for its smoke-free air and a ‘B’ for its access to smoking cessation services, the ALA urged the state to implement a series of reforms to combat the “enormous toll” taken by tobacco use, which remains the No. 1 “cause of preventable death and disease” in Ohio, according to the report.

The ALA’s recommended actions include the following: ban flavored tobacco products and e-cigarettes; increase investment in tobacco prevention and cessation programs; and finally, implement a cigarette tax equal to the tax on non-cigarette items, like spit tobacco and cigars — a recommendation that the ALA said is not likely to happen in Ohio.

“Unfortunately, the current makeup of the Ohio legislature makes it unlikely that efforts to increase tobacco taxes will be successful,” the ALA said.

According to its report, the ALA applauded the state’s “vitally needed” move to increase funding toward ending tobacco use by $2.5 million a year for the next two years but said that more must be done to prevent the average 20,180 smoking-attributable deaths that occur in Ohio each year.

“Even with this increase, Ohio spends only 13% of what is recommended by the CDC for a state of our size,” the ALA said. “The revenue raised by increasing taxes on tobacco products could help fund further increases in tobacco control and prevention funding.”

Despite the state’s failing marks, the ALA said it will “continue to work with a broad coalition of stakeholders” in Ohio to encourage investment in tobacco prevention and cessation programs.