Feb. 3--Each year the American Lung Association, an archenemy of smoking, grades the states and federal government on their tobacco control efforts. There is no doubt South Dakota needs to improve its 2009 grades: Incomplete in smoke-free air, "F" in smoking cessation, "D" for prevention and control spending, and "C" for its cigarette tax.

The smoke-free-air issue might be resolved in the November election. The 2009 South Dakota Legislature passed a law that banned smoking in bars, video lottery establishments and casinos, about the only public places where smoking was -- and still is -- legal. Opponents succeeded in referring the law to the voters. As a result the state received an incomplete, compared to an "F" a year earlier. Neither grade is acceptable to the ALA, which is watching the election with a great deal of interest, according to Robert Moffitt, a spokesman for the ALA Midwest Region.

The state also needs to step up efforts in two other areas. It needs to allocate additional tobacco settlement funds for tobacco control and prevention programs, and it needs to expand smoking cessation coverage for Medicaid recipients and state employees.

When it comes to tobacco control and prevention, South Dakota spends 52.8 percent of the Centers for Disease Control and Prevention-recommended level of $11.3 million or slightly more than $5.96 million.

One small step toward improvement in this area comes from recently announced grants to 21 community coalitions totaling $313,617 to be used for reducing tobacco use and limiting exposure to secondhand smoke from the state's Tobacco Control Program to combat tobacco use.

By comparison, North Dakota is the only state that meets 100 percent of the CDC-recommended levels, which are based on state population. It spent slightly more than the recommended $9.3 million as a result of a referendum. The only other state that comes close is Alaska. They are the only two states to receive an "A" for tobacco control and prevention spending. Perhaps it's a coincidence, but both states had a budget surplus in 2009. Minnesota, which spent roughly 37 percent of the recommended amount, received an "F."

Currently the South Dakota Medicaid program covers only a few medications recommended to help people quit smoking and does not cover counseling. State employee health plans provide no coverage. As a result, South Dakota received an "F" for smoking cessation assistance.

North Dakota provides coverage for nearly all smoking cessation medications and counseling programs for Medicaid recipients. It requires state health plans to cover all medications as well as group and individual counseling. It also requires that policies from all standard private insurance companies include a one-time payment of $150 in smoking assistance cessation.

Minnesota's Medicaid program provides coverage for all seven recommended cessation medications and individual and group counseling. State health plans cover six of the seven medications and phone and online counseling.

Both of our neighbors received a "B."

South Dakota's "C" for its tobacco tax is based on the rate of $1.53 a pack. In 2006, the Legislature passed a bill increasing the tax on cigarettes by $1 a pack and increasing the tax on all other tobacco products on the wholesale level. That, too, went to a public vote, passed and took effect in 2007. The increase boosted the state's rating to the 10th highest in the nation. Since then other states have increased taxes, dropping South Dakota to 21st. Minnesota ranks 20th with a tax of $1.56 per pack, earning a "C"; North Dakota comes in at 45th with a tax of 44 cents per pack, earning it an "F." Per-pack tax ranges from $3.56 in Rhode Island to 7 cents in South Carolina.

It's time to take additional steps to clean up our act -- and our air.

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