EYEWITNESS NEWS (WBRE/WYOU) — The leading cause of preventable death and disease in the US may surprise you, it’s tobacco use.

Smoking causes millions of deaths annually worldwide, including more than an estimated 22,000 a year in Pennsylvania.

The toll of tobacco-related deaths and medical costs is staggering and while progress has been made in recent decades to curb tobacco use, a report released Wednesday shows Pennsylvania is currently not making the grade.

In its 20th Annual State of Tobacco Control report, the American Lung Association gives harsh grades to Pennsylvania.

“We’re still among some of the worst states in terms of the state of tobacco control grades in the nation,” stated Molly Pisciottano, advocacy director of the American Lung Association.

The American Lung Association graded all 50 states and the District of Columbia in five identified areas that prevent and reduce tobacco use and save lives.

Pennsylvania received four F’s including funding for state tobacco prevention programs.

“You know, we’re woefully below the CDC recommended level of funding of $140 million. And with the necessary and the right amount of funding, we really do more to have resources for people to help them quit,” explained Pisciottano.

To help prevent young people from starting. While the adult smoking rate in Pennsylvania is 15.8%, the high school tobacco use rate is 26.7%.

Another failing grade category in the commonwealth? Ending the sale of all flavored tobacco products which still contain nicotine.

“Youths who never used combustible cigarettes will go on to start using e-cigarettes because of the attractiveness of the flavors and what not and many of them will go onto become combustible cigarette users,” stated Jamie Garfield, MD, Pulmonologist, Temple Lung Center.

Also, Dr. Garfield says e-cigarettes have no role as a means to kick traditional tobacco use.

“There are too many risks that we cannot account for. The products themselves are not well-regulated and so while there may be a harm reduction strategy from a well-regulated product, these products are not regulated,” explained Garfield.

The strength of smoke-free workplace laws earned Pennsylvania its only passing grade but barely: a D. Pennsylvania casinos were required to reopen this pandemic as smoke-free, but there’s still no such comprehensive smoke-free law.

“We really need to close the loopholes in the Clean Indoor Air Act that hasn’t been updated since 2008,” said Molly Pisciottano.

First-hand cigarette smoke is the number one cause of lung cancer. Second-hand cigarette smoke is the second most.

The American Lung Association urges you to contact your state lawmakers to help toughen tobacco control.

Check out the full State of Tobacco Control on the American Lung Association website.