Did you know smoking costs the U.S. economy more than $193 billion each year? This includes $96 billion in health-care costs and $97 billion in lost productivity, according to the Centers for Disease Control and Prevention (CDC).

Then there's the pain and suffering that smokers--and the people around them--endure, which is a lot: Cigarette smoking increases the risk for heart disease; stroke; emphysema; and cancers of the lip, mouth, pharynx, esophagus, pancreas and kidney, to name a few. Tobacco use is also the leading cause of preventable death in the U.S.--443,000 annually--of which more than 393,000 are from smoking-related diseases.

To alleviate this burden, the American Lung Association (ALA) is calling states out on their tobacco control laws and regulations--or lack thereof. The State of Tobacco Control report grades the federal government, the 50 state governments and the District of Columbia on their tobacco control laws and whether they're adequately protecting citizens.

Each state is given an A through F grade in four categories: smoke-free air, tobacco tax, program spending and cessation coverage. And each state's grades, according to the report, "reflect how well the state's tobacco-control laws measure up to the best in the nation or to goals set by federal agencies such as the CDC."

The truth is, the majority of states received F grades in at least one category--Arkansas and Maine were the only exceptions. But let's look more closely, starting with the smoke-free air category. In January 2006, the ALA issued the Smokefree Air Challenge, in which states and localities were asked to pass comprehensive legislation prohibiting smoking in all public and work places. As of early January, 22 states and Washington, D.C., received A grades. However, 13 states failed, meaning millions of nonsmokers in those regions are still exposed to secondhand smoke, increasing their chances of heart disease and lung cancer.

When taxes on tobacco products increase, many smokers groan about it: On average, smokers pay $1.34 in taxes on every pack of cigarettes they buy. A lot of that average comes from states, 14 to be exact, adding tobacco taxes in 2009 to help balance their budgets, according to the report. On the whole, only four states received an A for cigarette tax grades, one being Rhode Island for its tax of $3.46 per pack. The majority of states (41) received C's, D's and F's, including South Carolina, which only taxes 7 cents per pack.

Not surprisingly, increased tobacco taxes are actually linked to prevention and cessation--but in a rather surprising way. Tobacco prevention and cessation programming was cut in the same states that raised their taxes in 2009: Wisconsin, for example, increased its cigarette tax by 75 cents, and simultaneously cut funding for its tobacco prevention and cessation programs by more than 50 percent. And aside from their funding link, tobacco taxes and cessation programs are intertwined in another way: After a tobacco tax increase, some smokers can no longer afford to smoke--but with cessation programs being cut, they aren't getting the help they need to quit.

And for prevention and control programs, the numbers are similar: 40 states and the District of Columbia cited budget deficits as the reason they received failing grades, while only two states received A grades for their prevention and control programs. Those deep cuts to state tobacco control programs are having two detrimental effects: Kids aren't being deterred from smoking, and current smokers aren't being encouraged to quit.

"We'd like everybody to stop smoking or never start in the first place," says U.S. Health and Human Services Secretary Kathleen Sebelius on July 15, 2009. "It would save an enormous amount on health-care costs."

But by cutting prevention and cessation programs, states aren't realizing savings that can come from more productive workers and lower health-care expense for smokers, and are instead spending funds on costs that needn't exist. Will this Catch-22 ever be remedied?