Hawaii was one of only four states to receive passing grades in all four areas covered by a new American Lung Association report on states’ anti-tobacco efforts.

The group said Anti-tobacco efforts by U.S. states were “abysmal” last year as their collective spending on anti- smoking programs declined 11 percent and only two raised cigarette taxes.

While more than half the states already ban the use of cigarettes in restaurants, bars and workplaces, no additional states passed comprehensive anti-smoking laws last year, the Washington-based health advocacy group said today in a report.

Forty-three states and the District of Columbia earned grades of “F” for funding smoking-prevention programs at less than half the levels the Centers for Disease Control and Prevention urged in a 2007 report, the lung group said. Smoking costs the U.S. economy almost $193 billion a year in medical expenses and lost productivity, said Charles Connor, the association’s president and chief executive officer.

“At a time when our country is trying to get a handle on health-care spending, this is an enormous expense that could be avoided by investing in effective tobacco-prevention and cessation programs and policies,” Connor said yesterday on a conference call.

More than 20 percent of adults in the U.S., or 46 million people, smoke cigarettes, according to the Atlanta-based CDC. Smoking is the biggest cause of preventable death in the U.S., killing about 443,000 people a year.

Nationwide, state investments in tobacco control dropped 11 percent to $477 million in 2011 from $534 million in 2010, according to the report. Washington, Iowa and Wisconsin were among states that reduced spending.

No states earned “A” grades in all four policy areas covered in the report: Hawaii, Delaware, Maine and Okalahoma were the only states that received passing grades in all four areas covered by the report.

Alaska Spending

Alaska was the only state that funded tobacco programs at levels suggested by the CDC, allocating $10.8 million for tobacco control in fiscal 2012, according to the lung association’s report. In 2007, the CDC recommended anti-tobacco funding levels for each state.

Vermont and Connecticut were the only states that raised tobacco taxes last year, while eight states rejected proposed increases. New Hampshire reduced its cigarette tax 10 cents per pack, the survey found.

While 26 states and the District of Columbia enacted laws in the past decade that ban smoking in public places such as restaurants, 2011 was the first year since 2001 when no state passed a comprehensive anti-smoking law, the report said.

Failing Grades

Six states — Alabama, Mississippi, Missouri, South Carolina, Virginia and West Virginia — scored grades of “F” in all four areas, according to the report.

Most states’ anti-smoking scores lagged behind those of the federal government, which didn’t receive any failing grades in four categories and earned an “A” for the Food and Drug Administration’s implementation of a 2009 law that restricts tobacco marketing.

The U.S. earned a “C” in smoking-cessation programs, for partially covering the programs for beneficiaries of Medicaid, the health program for the poor, and other federal benefits programs.

“The federal government has made real progress in helping many Americans end their deadly addiction to tobacco, but state policy makers must step up and close the gap,” Thomas Carr, the lung association’s director of national policy and the report’s lead author, said on the conference call.

The 2009 tobacco law bars companies led by Altria Group Inc. (MO), Reynolds American Inc. (RAI) and Lorillard Inc. (LO) from marketing tobacco to young people. It also bans the use of the words “mild,” “light” and “low-tar” on cigarette packs.

While the law also calls for all cigarette packs to carry graphic warning labels, a U.S. judge blocked those rules in November, saying the required images may violate tobacco companies’ free-speech rights. The FDA is appealing the ruling.