The American Lung Association has been giving out grades for 17 years.
Sarah Lawver, the association's advocacy director in Pennsylvania, said states are graded in five areas that are proven to reduce tobacco use.
"Funding for state tobacco programs, strength of smoke-free workplace laws, level of state tobacco taxes, coverage and access to services to quit tobacco and having the minimum age of sale for tobacco products to 21," she explained.
She said the report was similar to last year's, and while the number of people smoking cigarettes is down, the number of people using e-cigarettes is up.
"The lung association is very concerned that we're at risk of losing another generation to tobacco-caused diseases because of e-cigarettes. So, we're saying states, local government, the FDA must pass and enforce proven policies to protect the public and youth from e-cigarettes," Lawver added.
She says use of vaping products by high school students jumped 78 percent this past year.