COLUMBUS, Ohio (WCMH) — Smokers in Ohio have earned top-10 status in smoking-related deaths, according to a Global Smoking Report by RX Health.

Ohioans rank fourth in the U.S. with a 20.8% smoking rate with over 2.4 million smokers with a population of nearly 11.8 million people. It ranks eighth overall in annual smoking related deaths – 171 per 100,000 people.

West Virginia has the highest smoking rate (23.8%) and adult annual smoking related deaths at 241 per 100,000 people. Kentucky (197), Arkansas (192) and Oklahoma (188) and Mississippi (183) round out the top five. Utah boasts the lowest smoking rate at 7.9% and fewest deaths (39) per 100,000 people.