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A new report has declared that Minnesota is a national leader in efforts to reduce tobacco use, but local officials warn that much work remains in the overall tobacco impacts.

Minnesota was one of two states to receive an A grade in "access to cessation services" by the American Lung Association’s "2018 State of Tobacco Control" study, the 16th annual report that was released Wednesday. South Carolina also received an A, while seven other states earned a B. Most of the remaining states received an F.

That rare ranking has been deemed an important step forward for Minnesota by Pat McKone, senior regional director of tobacco control and advocacy for Lung Association in Minnesota. She noted that tobacco remains the leading cause of preventable death in the state and across the country, annually claiming the lives of nearly 6,000 in Minnesota and more than 480,000 in the U.S.

"That A is a very powerful A," McKone said. "Not many states get that A and we are one of a handful. If they want to continue their journey to quitting, we want to help them — and the vast majority of those services are free."

The other four categories were a mixed bag for Minnesota. It received A and B grades, respectively, in smoke-free air and tobacco taxes, but F’s in tobacco prevention and control program funding and tobacco 21.

Those grades are critical, McKone said, because Minnesotans’ health care costs due to smoking totaled more than $2.5 billion in 2016.

The American Lung Association lists four goals for Minnesota to improve its grades: keep prices high on tobacco products; limit access to menthol and other flavored tobacco products; raise the age of tobacco sales to 21; and secure funding for proven tobacco prevention strategies.

Adult and youth cigarette smoking rates are near historic lows, sitting at 15.2 percent and 8.4 percent. However, the study found that tobacco use for the groups are higher at 18.4 percent and 19.3 percent.

Those numbers reflect the realty that more than one in five kids use tobacco products across Minnesota.

Additionally, the study found that significant disparities continue across different demographics. The groups with higher smoking rates include: public housing (33.6 percent), mental health (28.2 percent), uninsured (26.7 percent), making less than $20,000 (26.7 percent), multi-racial (24.7 percent) and rural residents (18 percent).

Native Americans and Alaskan Natives have traditionally had higher rates of commercial tobacco use, with the most recent estimates of 28.6 percent. State laws generally don’t apply to sovereign tribal lands, but McKone still lamented the lack of funding aimed at education and prevention.

Anna Hudson, community health specialist at Olmsted County Public Health, said tobacco rates in Olmsted County are lower than the state with 9 percent of adults reporting they currently smoke tobacco and 13.2 percent of adults reporting that they use tobacco products of any form.

McKone bemoaned the fact that more of the state’s landmark $6.5 billion settlement with tobacco companies in 1998 — paid out for the ensuing 25 years — hasn’t been used to tackle prevention.

"Funding for prevention is the key," McKone said. "We know the cure. It is prevention and we need to put more dollars toward that. Tobacco is the No. 1 killer in this country and in this state."

He says just 3-5 people out of 100 who attempt to quit on their own are successful. That number quadruples with the use of medications and extended counseling, Burke said.

Additionally, Minnesota’s QuitPlan hotline is unique in that its Medicaid plan covers counseling with physicians or tobacco treatment specialists.

"It’s the only product that kills 60 percent of people who use it as the producer intends," Burke said.

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